Coagulation and fibrinolysis in hyperparathyroidism secondary to vitamin D deficiency

Laura P B Elbers; Marije Wijnberge; Joost C M Meijers; Dennis C W Poland; Dees P M Brandjes; Eric Fliers; Victor E A Gerdes

doi:10.1530/EC-17-0249

Coagulation and fibrinolysis in hyperparathyroidism secondary to vitamin D deficiency

Endocr Connect. 2018 Feb;7(2):325-333. doi: 10.1530/EC-17-0249. Epub 2018 Jan 9.

Authors

Laura P B Elbers^{1

2}, Marije Wijnberge^{1

2

3}, Joost C M Meijers^{4

5}, Dennis C W Poland⁶, Dees P M Brandjes^{1

2}, Eric Fliers⁷, Victor E A Gerdes^{1

2}

Affiliations

¹ Department of Internal MedicineMedical Center Slotervaart, Amsterdam, the Netherlands.
² Department of Vascular MedicineAcademic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
³ Laboratory of Experimental Intensive Care and AnesthesiologyAcademic Medical Center, University of Amsterdam, the Netherlands.
⁴ Department of Experimental Vascular MedicineAcademic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
⁵ Department of Plasma ProteinsSanquin Research, Amsterdam, the Netherlands.
⁶ Clinical Chemistry LaboratoryMedical Center Slotervaart, Amsterdam, the Netherlands.
⁷ Department of Endocrinology and MetabolismAcademic Medical Center, University of Amsterdam, Amsterdam, the Netherlands e.fliers@amc.uva.nl.

Abstract

Introduction: Abnormal coagulation tests have been observed in patients with primary hyperparathyroidism (HPT) suggesting a prothrombotic effect of parathyroid hormone (PTH). Vitamin D deficiency (VIDD) is the most frequent cause of secondary HPT. Aim of our study was to investigate the influence of HPT secondary to moderate-to-severe VIDD and vitamin D replacement on the coagulation and fibrinolysis system.

Subjects and methods: Prospective cohort study of patients with vitamin D <25 nmol/L with and without HPT, and a control group of patients on vitamin D suppletion. At baseline and after 2 months of vitamin D suppletion (900,000 IU in 2 months), endocrine and coagulation markers were measured.

Results: 59 patients with VIDD of which 34 had secondary HPT and 36 controls were included. After 2 months of suppletion, vitamin D increased by 399% (VIDD with HPT), 442% (all patients with VIDD) and 6% (controls). PTH decreased by 34% (VIDD with HPT, P < 0.01 for decrease), 32% (all VIDD, P < 0.01) and increased by 8% in the controls (P-values: <0.01 for relative changes between VIDD with HPT or all VIDD patients vs controls). Relative changes in PT, aPTT, fibrinogen, Von Willebrand factor, factors VII, VIII and X, thrombin generation, TAFI, clot-lysis time and d-dimer were not different between patients with VIDD with HPT or all VIDD vs controls.

Discussion: Secondary HPT due to VIDD does not have a prothrombotic effect. In contrast with previous reports, PTH does not seem to influence coagulation or fibrinolysis, which is relevant because of the high prevalence of VIDD.

Keywords: coagulation; fibrinolysis; parathyroid hormone; secondary hyperparathyroidism; vitamin D deficiency.