Thrombosis in Acute Promyelocytic Leukemia: The Current Understanding

Abstract

Despite enormous improvement in the management of patients with acute promyelocytic leukemia (APL), the distinctive coagulopathy observed at presentation in affected patients is often life-threatening. While hemorrhagic manifestations are well known and described in this setting, APL-related thromboses are underappreciated. Data regarding this complication are scarce showing variable incidence. Furthermore, risk factors for thrombosis are inconsistent and unreliable; so, differentiation of increased risk of hemorrhage from an increased thrombotic risk is quite difficult in the absence of adequate predictive scores. Besides, prophylactic use of anticoagulants and recombinant thrombomodulin are a matter of ongoing debate. Also, due to the common feature of thrombocytopenia and other hemorrhagic risks, patients with APL are excluded from trials analyzing anticoagulant prophylaxis in cancers; so, data from prospective trials are lacking. A detailed analysis of thrombotic risks in APL with the development of a reliable risk stratification model is needed to further improve the care of APL patients.

Keywords

acute promyelocytic leukemia - thrombosis - hypercoagulability

Authors' Contribution

N.S. researched the literature, critically analyzed data, and drafted the manuscript. M.M. and J.T. brought the idea, analyzed literature, and revised and critically appraised the manuscript. N.P. designed table and figure and revised the manuscript.

Publication History

Received: 22 October 2023

Accepted: 03 January 2024

Article published online:
11 March 2024

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