Grima Maria Angela, Camilleri David James
Department of Health, Mater Dei Hospital, Triq Dun Karm, L-Imsida, Malta.
Eur J Case Rep Intern Med. 2016 May 4;3(4):000410. doi: 10.12890/2016_000410. eCollection 2016.
Thalidomide is an effective chemotherapeutic agent used to achieve remission in multiple myeloma. However, its administration is associated with several adverse effects including venous thromboembolism, while arterial thrombosis has also, although rarely, been described in the literature. We report a case of internal carotid artery occlusion within 1 week of starting thalidomide with prophylactic low molecular weight heparin in a patient who had no other prothrombotic risk factors. It is not known why this complication occurs despite the administration of anticoagulant prophylaxis. The role of factor VIII, von Willebrand factor antigen levels and fibrinogen in multiple myeloma patients should be studied in order to determine if these factors should be targeted in future prophylactic treatment.
Thalidomide increases risk of arterial thrombosis in multiple myeloma (MM), even if no other procoagulant risk factors are present.All patients starting thalidomide must be assessed before commencing venous thromboprophylaxis, although its efficacy in preventing arterial thrombosis has not yet been proven.Further research is required to target anti-thrombotic factors in order to prevent arterial thrombosis in patients with MM being treated with thalidomide and its derivatives.
沙利度胺是一种用于使多发性骨髓瘤达到缓解的有效化疗药物。然而，其使用会带来多种不良反应，包括静脉血栓栓塞，而动脉血栓形成在文献中也有报道，尽管很少见。我们报告了1例在开始使用沙利度胺并预防性使用低分子量肝素1周内发生颈内动脉闭塞的病例，该患者无其他血栓形成危险因素。尽管进行了抗凝预防，仍不清楚为何会出现这种并发症。应研究多发性骨髓瘤患者中凝血因子VIII、血管性血友病因子抗原水平和纤维蛋白原的作用，以确定这些因素在未来预防性治疗中是否应作为靶点。
沙利度胺会增加多发性骨髓瘤（MM）患者动脉血栓形成的风险，即使不存在其他促凝血危险因素。所有开始使用沙利度胺的患者在开始静脉血栓预防前都必须进行评估，尽管其预防动脉血栓形成的疗效尚未得到证实。需要进一步研究以确定抗血栓形成因子是否为靶点，从而预防接受沙利度胺及其衍生物治疗的MM患者发生动脉血栓形成。
