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Annales de Dermatologie et de Vénéréologie
Vol 127, N° 2  - mars 2000
p. 171
Doi : AD-03-2000-127-2-0151-9638-101019-ART62
Mémoires originaux

Thalidomide et thromboses
 

B. Flageul [1], D. Wallach [2], B. Cavelier-Balloy [1], H. Bachelez [1], F. Carsuzaa [3], L. Dubertret [1]
[1]  Clinique des Maladies Cutanées, Hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75475 Paris Cedex 10.
[2]  Service de Dermatologie, Hôpital Tarnier, Paris.
[3]  Service de Dermatologie, Hôpital d'Instruction des Armées, Toulon.

Abstract
Introduction

La tératogénicité et la neurotoxicité du thalidomide sont les deux effets secondaires majeurs reconnus actuellement. Nous rapportons 5 cas d'accidents thrombotiques survenus après l'introduction du thalidomide. Le contexte nous fait penser que le thalidomide pourrait avoir agi comme un facteur précipitant ou déclenchant dans l'apparition de ces accidents.

Observations

Quatre malades suivis pour un lupus (1 lupus discoïde, 1 lupus subaigu et 2 lupus systémiques) et un malade ayant une dermatite atopique grave, tous sans antécédent d'accidents vasculaires, ont développé un accident thrombotique artériel (2 cas) ou veineux (3 cas), grave dans 4 cas, dans un délai de quelques jours à 3 mois après l'introduction d'un traitement par thalidomide (50 à 100 mg/jour).

Discussion

Les malades avaient tous un facteur de risque thrombotique : présence d'anticorps anti-cardiolipines et/ou antiphospholipides chez les 4 malades lupiques et notion de traumatisme chez le malade atopique. Cependant, l'absence de passé thrombotique, l'intensité de la thrombose et la rapidité de survenue après l'introduction du thalidomide sont surprenantes. Des travaux récents ont montré que, parmi ses nombreux effets, le thalidomide agirait sur l'angiogenèse. Tous ces éléments paraissent suffisants pour envisager un effet secondaire thrombotique du thalidomide chez des malades à risque. Cette hypothèse, jamais rapportée à notre connaissance, méritera d'être confirmée.

Abstract
Thalidomide and thrombosis.
Background

Teratogenicity and neuropathy are the well known serious side effects induced by thalidomide. We describe 5 cases of thrombotic events occurring within a brief delay after the onset of thalidomide in a manner that suggests that thalidomide could have acted as a precipiting or as a starting factor in these events.

Observations

Five patients including 4 patients with lupus erythematosus (1 discoid lupus, 1 subacute lupus and 2 systemic lupus erythematosus) and one patient with a severe atopic dermatitis, all without previous history of vascular events, developed an arterial thrombosis (2 cases) or a venous thrombosis (3 cases), severe in 4 cases, few days or weeks after the onset of thalidomide treatment (50 to 100 mg daily).

Discussion

All the patients had risk factors of thrombosis: the presence of antiphospholipids and/or anticardiolipin antibodies in lupus erythematosus patients and a trauma in the atopic case. However the absence of a previous story of thrombosis, its rapid occurrence after the onset of thalidomide and its severity are intriguing. In addition, recent studies demonstrate that thalidomide has various effects that would act, among other things, on angiogenesis. Thus, we think that a doubt exists on a negative effect of thalidomide in thrombosis risk factors patients and that this hypothesis has to be confirmed.






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