Aim: To study hemostasis in ATRA treatment of acute promyelocytic leukemia (APL).
Material and methods: Hemostasis was studied in 8 newly admitted APL patients treated with ATRA. All of them had hemorrhages, thrombocytopenia 5-15 x 10(9)/l at diagnosis, laboratory signs of the DIC syndrome at induction therapy.
Results: Hemorrhage arresting was seen on the ATRA therapy day 14 to 30. Duration of thrombocytopenia under 20 x 10(9)/l was 5.8 +/- 1.8 days. After 7 days of ATRA therapy coagulation tests improved with some hypercoagulation tendency. Subsequent condition of hemostasis was considered as normo/hypercoagulation accompanied by constant thrombin persistence (in the presence of FDP) and depression of hageman-dependent fibrinolysis even in remission. A case of ileofemoral thrombosis followed by fatal thromboembolism of the pulmonary artery is reported.
Conclusion: It is suggested to use heparin, especially low molecular weight heparin when there are signs of hypercoagulation in APL patients.