Acquired von Willebrand syndrome in patients with overt hypothyroidism: a prospective cohort study

被引:26
作者
Stuijver, D. J. F. [1 ,2 ]
Piantanida, E. [3 ]
van Zaane, B. [1 ,2 ]
Galli, L. [4 ]
Romualdi, E. [4 ]
Tanda, M. L. [3 ]
Meijers, J. C. M. [2 ,5 ]
Buller, H. R. [2 ]
Gerdes, V. E. A. [1 ,2 ]
Squizzato, A. [4 ]
机构
[1] Slotervaart Hosp, Dept Internal Med, Amsterdam, Netherlands
[2] Univ Amsterdam, Acad Med Ctr, Dept Vasc Med, NL-1105 AZ Amsterdam, Netherlands
[3] Univ Insubria, Dept Clin & Expt Med, Endocrinol Unit, Varese, Italy
[4] Univ Insubria, Dept Clin & Expt Med, Res Ctr Thromboembol Disorders & Antithrombot The, Varese, Italy
[5] Univ Amsterdam, Acad Med Ctr, Dept Expt Vasc Med, NL-1105 AZ Amsterdam, Netherlands
关键词
hypothyroidism; coagulation; acquired; von Willebrand syndrome; bleeding; VONWILLEBRANDS DISEASE; COAGULATION DISORDERS; DIAGNOSIS; TYPE-1; PATHOPHYSIOLOGY; FIBRINOLYSIS; DESMOPRESSIN; THROMBOGRAM; HEMOSTASIS; GUIDELINES;
D O I
10.1111/hae.12275
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Numerous case reports have been published on acquired von Willebrand syndrome (aVWS) in patients with hypothyroidism, but no prospective studies have been published. The aim of this study was to investigate laboratory and clinical characteristics of aVWS in patients with newly diagnosed overt hypothyroidism. An observational cohort study was performed between May 2007 and February 2012. Consecutive hypothyroid patients before or within the first 48h of replacement therapy were enrolled. At inclusion, blood was sampled for coagulation tests and bleeding history was documented by means of a standardized bleeding questionnaire. Repeat samples were obtained after restoration of euthyroidism. The prevalence of aVWS, defined as von Willebrand factor antigen (VWF:Ag) <= 50% and/or VWF ristocetin activity (VWF:RCo) <= 50%, was calculated. Patients with aVWS were subsequently divided into severe (VWF:Ag and/or VWF:RCo <= 10%), moderate (VWF:Ag and/or VWF:RCo between 10 and 30%) or mild (VWF:Ag and/or VWF:RCo between 30 and 50%). A total of 90 patients were included among whom a prevalence of aVWS of 33% was found. There were no patients with severe aVWS. Eight patients (9%) had moderate aVWS and 21 (23%) had mild aVWS. Bleeding score was negatively correlated with both VWF:Ag (beta -0.32, P=0.03) and VWF:RCo (beta -0.32, P=0.02). After restoration of euthyroidism, VWF:Ag had significantly increased by 44%, VWF:RCo by 36%, factor VIII by 39%, and endogenous thrombin potential by 10%. aVWS has a high prevalence in hypothyroid patients. Highest bleeding scores in patients with lower VWF levels suggest clinical relevance.
引用
收藏
页码:326 / 332
页数:7
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