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Is heparin administration necessary during induction chemotherapy for
patients with acute promyelocytic leukemia?
MA Goldberg, D Ginsburg, RJ Mayer, RM Stone, M Maguire, DS Rosenthal and JH Antin
The role of heparin in the treatment of the disseminated intravascular
coagulation (DIC) associated with acute promyelocytic leukemia (APL)
remains unclear. Between 1974 and 1985, we treated 27 patients with APL
using four different chemotherapeutic regimens; 23/27 (85%) had evidence of
DIC either at presentation or following the initiation of induction
chemotherapy. The coagulopathy was treated primarily with fresh frozen
plasma and platelet transfusions; only 2/27 (7%) patients received heparin.
Twenty of 27 patients (74%) entered complete remission. Major bleeding or
thrombotic complications occurred in 5/27 patients (19%), but 2 of these 5
patients presented after hemorrhage had already occurred. None of the 5
patients with bleeding or thrombosis entered complete remission. All of the
hemorrhagic complications due to DIC in our study occurred before 1979,
which may reflect changes in the management of leukemic patients. This
observation emphasizes the risks inherent in the use of historical controls
in this population. In conclusion the DIC associated with APL can be
successfully treated with intensive blood product support without the use
of heparin.
Volume 69,
Issue 1,
pp. 187-191,
01/01/1987
Copyright © 1987 by The American Society of Hematology
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