Thalidomide treatment leading thrombotic events: two cases

Introduction. - First used as a sedative, thalidomide was taken out the market because of its teratogenicity. Despite other side effects, especially neuropathies, this drug is now again prescribed in various autoimmune and neoplasic diseases. Recently, venous or arterial thrombotic events have been described after the introduction of thalidomide. Exegesis. - In this report, we describe two new venous thrombosis cases occurring during a treatment with thalidomide. The first case is a 37-year-old man treated for a discoid lupus, who developed three deep-vein thrombosis and a massive pulmonary embolism, with recurrent thrombosis even with an efficient anticoagulation therapy until the final stop of thalidomide. The second one is a 66-year-old woman treated with thalidomide for a multiple myeloma and a melanoma in therapeutic escape, who developed a deep-vein thrombosis two months after the beginning of her treatment. Published reports suggest that most thrombotic events appeared under three months after the introduction of the treatment and that thalidomide could have acted as a precipiting or as a starting factor in a patient population already at risk of thrombosis. Those complications should be particularly severe, but the mechanism underlying thrombosis with thalidomide is unknown. Conclusion. - A complete coagulation check-up is advised before beginning a, treatment with thalidomide. (C) 2002 Editions scientifiques et medicales Elsevier SAS. All rights reserved.