Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Banacha 1a, 02-097, Warsaw, Poland.
J Endocrinol Invest. 2019 Feb;42(2):217-225. doi: 10.1007/s40618-018-0907-z. Epub 2018 Jun 9.
Venous thromboembolic events (VTE), with their life-threatening manifestation as pulmonary embolism, are potential adverse effects of intravenous methylprednisolone (IVMP) pulse therapy, partially due to a hypercoagulable state. The aim of the study was to analyze the influence of IVMP on selected hemostatic parameters in patients with moderate-to-severe Graves' orbitopathy (GO).
26 euthyroid patients with GO were treated with 12 pulses of IVMP (6 × 0.5, 6 × 0.25 g every week). Hemostatic variables [factor (F) II, FV, FVII, FVIII, fibrinogen, antithrombin, activated partial thromboplastin time (aPTT), prothrombin time, international normalized ratio of prothrombin time, platelets and D-dimer] were analysed before, 24 and 48 h after 1st, 6th and 12th pulse.
A constant, transient trend in changes of some hemostatic variables was observed after all assessed pulses. We discovered an increase in median activity of FVIII 24 and 48 h after pulses, with a shortening of aPTT 24 h after each IVMP pulse (p < 0.00005). FVII decreased 24 h after each pulse (p < 0.0005 after 1st and 12th, p < 0.00005 after 6th). Fibrinogen level decreased 48 h after each pulse (P < 0.00005). We did not observe any statistically significant changes in hemostatic parameters in the long-term evaluation. Therapy was concluded in one patient after the 9th pulse due to pulmonary embolism.
The increase of FVIII activity is a consequence of treatment with IVMP and occurs after each pulse. In patients with additional risk factors of VTE, anticoagulation prophylaxis should be considered.
静脉血栓栓塞事件（VTE），其致命表现为肺栓塞，是静脉注射甲基强的松龙（IVMP）脉冲治疗的潜在不良反应，部分原因是血液处于高凝状态。本研究旨在分析 IVMP 对中重度格雷夫斯眼病（GO）患者选定止血参数的影响。
26 例甲状腺功能正常的 GO 患者接受 12 个 IVMP 脉冲治疗（6×0.5、6×0.25 g，每周一次）。在第 1、6 和 12 个脉冲后的第 1、24 和 48 小时，分析止血变量[因子（F）II、FV、FVII、FVIII、纤维蛋白原、抗凝血酶、活化部分凝血活酶时间（aPTT）、凝血酶原时间、凝血酶原时间国际标准化比值、血小板和 D-二聚体]。
在所有评估的脉冲后，观察到一些止血变量的恒定、短暂变化趋势。我们发现脉冲后 24 和 48 小时 FVIII 活性中位数增加，每个 IVMP 脉冲后 aPTT 缩短 24 小时（p<0.0005）。FVII 在每个脉冲后 24 小时下降（第 1 和第 12 次下降 p<0.0005，第 6 次下降 p<0.0005）。纤维蛋白原水平在每个脉冲后 48 小时下降（p<0.0005）。在长期评估中，我们没有观察到止血参数有任何统计学意义的变化。由于肺栓塞，在第 9 个脉冲后，一名患者停止了治疗。
FVIII 活性的增加是 IVMP 治疗的结果，并且在每个脉冲后发生。在有 VTE 额外危险因素的患者中，应考虑抗凝预防。
