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2025, Number 1

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Rev Hematol Mex 2025; 26 (1)

Thromboprophylaxis in erythrocytosis patients at high altitude

Amaru R, Mamani R, Velarde J, Mancilla E, Mancilla S, Patón D, Carrasco M

Language: Spanish
References: 33
Page: 1-8
PDF size: 306.08 Kb.


ABSTRACT

Objective: To propose thrombotic risk strata and thromboprophylactic procedures through the evaluation of clinical and hematimetric variables in patients with erythrocytosis residing at high altitudes.
Materials and Methods: Retrospective cohort study that included records of patients diagnosed with erythrocytosis, from 2019 to 2023, all dwellers of La Paz and El Alto (Bolivia) at 3650 and 4150 meters above sea level, respectively. Occurrence of thrombotic events, erythropoietin, body mass index, hemoglobin and age were analyzed. A thrombotic risk stratification was proposed (low, intermediate, high) incorporating scores concatenated with the occurrence of thrombosis.
Results:There were included 636 patients with an average age of 53 years. Erythropoietin concentrations higher than 30 mU/mL and age older than 60 years correlated with the occurrence of thrombotic events. Obesity and hemoglobin did not correlate with thrombosis. According to the proposed risk stratification, thrombosis rates reflected 1.6%, 12.5% and 30% in low, intermediate and high risk groups, respectively. No thrombotic events were observed during the thromboprophylactic treatment.
Conclusions: Increased erythropoietin and age older than 60 years are thrombotic risk factors in patients with erythrocytosis at high altitude. Thrombotic risk stratification implies clinical utility regarding thromboprophylactic procedures.


REFERENCES

  1. Amaru R, Quispe T, Torres G, Mamani J, et al. Caracterizaciónclínica de la eritrocitosis patológica de altura. RevHematol 2016; 17 (1): 8-20.

  2. Morales OAS, Vela EV, Acosta FG, González PB, et al.Estudio PETRO: evaluación de tromboprofilaxis y riesgoembólico en pacientes hospitalizados en una instituciónde tercer nivel en Bogotá, Colombia. Rev Colomb Neumol2017; 29 (1): 7-18.

  3. Noroña Calvachi CD. Trombofilias hereditarias. Rev CientíficaCiencia Médica 2015; 18 (1): 43-9.

  4. Esmon CT. Molecular circuits in thrombosis and inflammation.Thromb Haemost 2013; 109 (03): 416-20. https://doi.org.10.1160/TH12-08-0634

  5. Stark K, Massberg S. Interplay between inflammation andthrombosis in cardiovascular pathology. Nat Rev Cardiol2021; 18 (9): 666-82. https://doi.org.10.1038/s41569-021-00552-1

  6. Nair V, Singh S, Ashraf MZ, Yanamandra U, et al. Epidemiologyand pathophysiology of vascular thrombosis inacclimatized lowlanders at high altitude: A prospectivelongitudinal study. Lancet Regional Health-Southeast Asia2022; 3. https://doi.org.10.1016/j.lansea.2022.05.005

  7. Gupta N, Zhao Y-Y, Evans CE. The stimulation of thrombosisby hypoxia. Thromb Res 2019; 181: 77-83. https://doi.org.10.1016/j.thromres.2019.07.013

  8. Amaru R, Mamani LF, Mancilla E, Paton D, et al. Transferrinand erythropoietin increased levels correlate with thrombosisat high altitude. Blood 2023; 142: 5548. https://doi.org/10.1182/blood-2023-188302

  9. Olivas-Martinez A, Corona-Rodarte E, Nuñez-Zuno A, Barrales-Benítez O, et al. Causes of erythrocytosis and its impact asa risk factor for thrombosis according to etiology: experiencein a referral center in Mexico City. Blood Res 2021; 56 (3):166-74. https://doi.org.10.5045/br.2021.2021111

  10. Salas Morales GA. Incidencia y caracterización de la TrombosisVenosa Profunda en los pacientes adultos con cáncer,en los hospitales: Honorio Delgado Espinoza, Goyenechee IREN Sur 2017-2018. 2019.

  11. Semenza GL. Regulation of erythropoiesis by the hypoxiainduciblefactor pathway: Effects of genetic and pharmacologicalperturbations. Ann Rev Med 2023; 74: 307-19.https://doi.org.10.1146/annurev-med-042921-102602

  12. Mallet RT, Burtscher J, Richalet J-P, Millet GP, Burtscher M.Impact of high altitude on cardiovascular health: currentperspectives. Vasc Health Risk Manag 2021; 17: 317-35.https://doi.org.10.2147/VHRM.S294121

  13. Jelkmann W. Regulation of erythropoietin production. JPhysiol 2011; 589 (6): 1251-8. https://doi.org.10.1113/jphysiol.2010.195057

  14. Rolfs A, Kvietikova I, Gassmann M, Wenger RH. Oxygenregulatedtransferrin expression is mediated by hypoxiainduciblefactor-1. J Biol Chem 1997; 272 (32): 20055-62.https://doi.org.10.1074/jbc.272.32.20055

  15. Smith KJ, Bleyer AJ, Little WC, Sane DC. The cardiovasculareffects of erythropoietin. Cardiovasc Res 2003; 59 (3):538-48. https://doi.org.10.1016/s0008-6363(03)00468-1

  16. Stohlawetz PJ, Dzirlo L, Hergovich N, Lackner E, et al.Effects of erythropoietin on platelet reactivity and thrombopoiesisin humans. Blood 2000; 95 (9): 2983-9. https://doi.org/10.1182/blood.V95.9.2983.009k27_2983_2989

  17. Amaru R, Mancilla E, Patón D, Luna J, et al. Eritrocitosispatológicas con niveles de eritropoyetina baja e incrementada:características clínicas y laboratoriales. RevistaMédica La Paz 2022; 28 (1): 27-32.

  18. Rolfs A, Kvietikova I, Gassmann M, Wenger RH. Oxygenregulatedtransferrin expression is mediated by hypoxiainduciblefactor-1. J Biol Chem 1997; 272 (32): 20055-62.https://doi.org.10.1074/jbc.272.32.20055

  19. Semenza GL. Regulation of oxygen homeostasis by hypoxiainduciblefactor 1. Physiology (Bethesda) 2009; 24 (2): 97-106. https://doi.org.10.1152/physiol.00045.2008

  20. Shah BN, Zhang X, Sergueeva AI, Miasnikova GY, et al.Increased transferrin protects from thrombosis in Chuvasherythrocytosis. Am J Hematol 2023; 98 (10): 1532-9.https://doi.org.10.1002/ajh.27021

  21. Méndez Osorio AP. Factores de riesgo de trombosis: Universidadde Talca (Chile). Escuela de Tecnología Médica; 2022.

  22. Wilkerson WR, Sane DC, editors. Aging and thrombosis.Seminars in thrombosis and hemostasis. Thieme MedicalPublishers, 2002.

  23. Campoverde Vintimilla VA. Tromboembolia pulmonar enpacientes adultos mayores diagnóstico y tratamiento. 2021.

  24. Raso AG. Dislipemia y obesidad en la enfermedad tromboembólicavenosa: factores de riesgo y complicacionestrombóticas: Universidad Autónoma de Madrid; 2013.

  25. Blokhin IO, Lentz SR. Mechanisms of thrombosis in obesity.Curr Opin Hematol 2013; 20 (5): 437-44. https://doi.org.10.1097/MOH.0b013e3283634443

  26. Bryce-Moncloa A, Alegría-Valdivia E, Martin-San MartinS, Mauricio G, editors. Obesidad y riesgo de enfermedadcardiovascular. Anales de la Facultad de Medicina; 2017:UNMSM. Facultad de Medicina.

  27. Amaru R, Velarde J, Mamani R, Carrasco M, et al. Tratamientode la eritrocitosis secundaria en la altura. RevistaMédica La Paz 2020; 26 (2): 16-23.

  28. Amaru Lucana R, Vera Carrasco O. Guía para el diagnósticoy tratamiento de las eritrocitosis patológicas en la altura.Revista Médica La Paz 2016; 22 (2): 70-7.

  29. Torres DZ, Rodríguez MR, Quismondo NC, Martínez-LópezJ. Tratamiento anticoagulante profiláctico. Medicine-Programa de Formación Médica Continuada Acreditado2020; 13 (22): 1280-3.

  30. Tobu M, Iqbal O, Fareed D, Chatha M, et al. Erythropoietininducedthrombosis as a result of increased inflammationand thrombin activatable fibrinolytic inhibitor. ClinApplied Thromb Hemost 2004; 10 (3): 225-32. https://doi.org.10.1177/107602960401000304

  31. Salvati F, Liani M. Erythropoietin and thrombotic events.Lancet 1998; 352 (9138): 1471.

  32. Esmon CT. Basic mechanisms and pathogenesis of venousthrombosis. Blood Rev 2009; 23 (5): 225-9. https://doi.org.10.1016/j.blre.2009.07.002

  33. McDonald AP, Meier TR, Hawley AE, Thibert JN, et al. Agingis associated with impaired thrombus resolution in a mousemodel of stasis induced thrombosis. Thromb Res 2010; 125(1): 72-8. https://doi.org.10.1016/j.thromres.2009.06.005




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