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High-dose intravenous methylprednisolone therapy in patients with Graves’ orbitopathy is associated with the increased activity of factor VIII

PURPOSE: 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 s...

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Autores principales: Miśkiewicz, P., Milczarek-Banach, J., Rutkowska-Hinc, B., Kondracka, A., Bednarczuk, T.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6394431/
https://www.ncbi.nlm.nih.gov/pubmed/29949121
http://dx.doi.org/10.1007/s40618-018-0907-z
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author Miśkiewicz, P.
Milczarek-Banach, J.
Rutkowska-Hinc, B.
Kondracka, A.
Bednarczuk, T.
author_facet Miśkiewicz, P.
Milczarek-Banach, J.
Rutkowska-Hinc, B.
Kondracka, A.
Bednarczuk, T.
author_sort Miśkiewicz, P.
collection PubMed
description PURPOSE: 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). METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s40618-018-0907-z) contains supplementary material, which is available to authorized users.
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spelling pubmed-63944312019-03-15 High-dose intravenous methylprednisolone therapy in patients with Graves’ orbitopathy is associated with the increased activity of factor VIII Miśkiewicz, P. Milczarek-Banach, J. Rutkowska-Hinc, B. Kondracka, A. Bednarczuk, T. J Endocrinol Invest Original Article PURPOSE: 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). METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s40618-018-0907-z) contains supplementary material, which is available to authorized users. Springer International Publishing 2018-06-09 2019 /pmc/articles/PMC6394431/ /pubmed/29949121 http://dx.doi.org/10.1007/s40618-018-0907-z Text en © The Author(s) 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Original Article
Miśkiewicz, P.
Milczarek-Banach, J.
Rutkowska-Hinc, B.
Kondracka, A.
Bednarczuk, T.
High-dose intravenous methylprednisolone therapy in patients with Graves’ orbitopathy is associated with the increased activity of factor VIII
title High-dose intravenous methylprednisolone therapy in patients with Graves’ orbitopathy is associated with the increased activity of factor VIII
title_full High-dose intravenous methylprednisolone therapy in patients with Graves’ orbitopathy is associated with the increased activity of factor VIII
title_fullStr High-dose intravenous methylprednisolone therapy in patients with Graves’ orbitopathy is associated with the increased activity of factor VIII
title_full_unstemmed High-dose intravenous methylprednisolone therapy in patients with Graves’ orbitopathy is associated with the increased activity of factor VIII
title_short High-dose intravenous methylprednisolone therapy in patients with Graves’ orbitopathy is associated with the increased activity of factor VIII
title_sort high-dose intravenous methylprednisolone therapy in patients with graves’ orbitopathy is associated with the increased activity of factor viii
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6394431/
https://www.ncbi.nlm.nih.gov/pubmed/29949121
http://dx.doi.org/10.1007/s40618-018-0907-z
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