Adrenal hemorrhage and non-ST elevation myocardial infarction: an antiphospholipid syndrome dilemma
Published: September 18 2023
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
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Antiphospholipid syndrome (APS) can affect different organ systems, including the heart and adrenal glands. Despite being known for its prothrombotic characteristics, APS can have serious bleeding complications. Occasionally, thrombotic and bleeding episodes can present simultaneously in an APS patient. Whenever these events co-occur, resuming anticoagulation becomes a topic of debate. As such, we present the case of a 43-year-old male with triple positive antiphospholipid antibodies, indicating APS, who presented with chest pain. Anticoagulants were switched one month before presentation from warfarin to a direct oral anticoagulant, rivaroxaban. Non-ST elevation myocardial infarction, as well as new-onset left-sided adrenal hemorrhage, were diagnosed. The patient developed adrenal insufficiency; therefore, corticosteroids were administered, and warfarin was resumed to prevent further thrombotic episodes.
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Musiał J. Antiphospholipid antibodies and thrombosis. Thromb Res 2012; 129: 345-7. DOI: https://doi.org/10.1016/j.thromres.2011.10.029
Miyakis S, Lockshin MD, Atsumi T, Branch DW, Brey RL, Cervera R, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost 2006; 4: 295-306. DOI: https://doi.org/10.1111/j.1538-7836.2006.01753.x
El Hasbani G, Taher AT, Sciascia S, Uthman I. Antiphospholipid syndrome: the need for new international classification criteria. Expert Rev Clin Immunol 2021; 17: 385-94. DOI: https://doi.org/10.1080/1744666X.2021.1900733
El Hasbani G, Saliba AN, Uthman I, Taher AT. Hematological manifestations of antiphospholipid syndrome: going beyond thrombosis. Blood Rev 2023; 58: 101015. DOI: https://doi.org/10.1016/j.blre.2022.101015
Cervera R, Serrano R, Pons-Estel GJ, Ceberio-Hualde L, Shoenfeld Y, de Ramon E, et al. Morbidity and mortality in the antiphospholipid syndrome during a 10-year period: a multicentre prospective study of 1000 patients. Ann Rheum Dis 2015; 74: 1011-8. DOI: https://doi.org/10.1136/annrheumdis-2013-204838
Ramon I, Mathian A, Bachelot A, Hervier B, Haroche J, Boutin-Le Thi Huong D, et al. Primary adrenal insufficiency due to bilateral adrenal hemorrhage-adrenal infarction in the antiphospholipid syndrome: long-term outcome of 16 patients. J Clin Endocrinol Metab 2013; 98: 3179-89. DOI: https://doi.org/10.1210/jc.2012-4300
Kaaroud H, Beji S, Guermazi S, Moussa FB, Hamida FB, Ezzine S, et al. Bleeding and thrombosis in a patient with secondary antiphospholipid syndrome. Saudi J Kidney Dis Transpl 2008; 19: 227-31.
Bolla E, Tentolouris N, Sfikakis PP, Tektonidou MG. Cardiovascular risk management in antiphospholipid syndrome: trends over time and comparison with rheumatoid arthritis and diabetes mellitus. Lupus Sci Med 2021; 8: e000579. DOI: https://doi.org/10.1136/lupus-2021-000579
Wang WH, Chen YC, Hsieh MH. Acute myocardial infarction involving left main artery in a patient with antiphospholipid syndrome. Acta Cardiol Sin 2019; 35: 655-8.
Padjas A, Płazak W, Celińska-Lowenhoff M, Mazurek A, Perricone C, Podolec P, et al. Myocardial ischaemia, coronary atherosclerosis and pulmonary pressure elevation in antiphospholipid syndrome patients. Adv Clin Exp Med 2016; 25: 1199-205. DOI: https://doi.org/10.17219/acem/63753
Cuadrado MJ, López-Pedrera C, Khamashta MA, Camps MT, Tinahones F, Torres A, et al. Thrombosis in primary antiphospholipid syndrome: a pivotal role for monocyte tissue factor expression. Arthritis Rheum 1997; 40: 834-41. DOI: https://doi.org/10.1002/art.1780400509
Gan Y, Zhao Y, Li G, Ye H, Zhou Y, Hou C, et al. Risk factors and outcomes of acute myocardial infarction in a cohort of antiphospholipid syndrome. Front Cardiovasc Med 2022; 9: 871011. DOI: https://doi.org/10.3389/fcvm.2022.871011
Hamsten A, Norberg R, Björkholm M, De Faire U, Holm G. Antibodies to cardiolipin in young survivors of myocardial infarction: an association with recurrent cardiovascular events. Lancet 1986; 1: 113-6. DOI: https://doi.org/10.1016/S0140-6736(86)92258-0
Uthman I, Salti I, Khamashta M. Endocrinologic manifestations of the antiphospholipid syndrome. Lupus 2006; 15: 485-9. DOI: https://doi.org/10.1191/0961203306lu2318rr
Berneis K, Buitrago-Tellez C, Müller B, Keller U, Tsakiris DA. Antiphospholipid syndrome and endocrine damage: why bilateral adrenal thrombosis? Eur J Haematol 2003; 71: 299-302. DOI: https://doi.org/10.1034/j.1600-0609.2003.00145.x
Jacobs AR, Ben-Yosef N, Tiram Y, Juravel E, Nachshon A, Scheiman Elazary A, et al. Bilateral adrenal hemorrhage in a patient with antiphospholipid syndrome following reversal of warfarin-induced over-anticoagulation. Isr Med Assoc J 2021; 23: 387-9.
Pengo V, Hoxha A, Andreoli L, Tincani A, Silvestri E, Prisco D, et al. Trial of rivaroxaban in antiphospholipid syndrome (TRAPS): two-year outcomes after the study closure. J Thromb Haemost 2021; 19: 531-5. DOI: https://doi.org/10.1111/jth.15158
Arosemena MA, Rodriguez A, Ediriweera H. Bilateral adrenal haemorrhage secondary to rivaroxaban in a patient with antiphospholipid syndrome. BMJ Case Rep 2020; 13: e234947. DOI: https://doi.org/10.1136/bcr-2020-234947
Alidoost M, Soomro R, Gubeladze A, Morabia A, Holland S, Asif A, et al. Rivaroxaban related bilateral adrenal hemorrhage: a rare complications of direct oral anticoagulants - a case reports. Am J Case Rep 2019; 20: 1607-11. DOI: https://doi.org/10.12659/AJCR.917780
Cherico AS, White RJ, Shah D, Bhagavatula R. Bilateral adrenal haemorrhage in antiphospholipid syndrome and a short review of the literature. BMJ Case Rep 2022; 15: e251199. DOI: https://doi.org/10.1136/bcr-2022-251199
Cohen H, Efthymiou M, Devreese KMJ. Monitoring of anticoagulation in thrombotic antiphospholipid syndrome. J Thromb Haemost 2021; 19: 892-908. DOI: https://doi.org/10.1111/jth.15217
Zuily S, Cohen H, Isenberg D, Woller SC, Crowther M, Dufrost V, et al. Use of direct oral anticoagulants in patients with thrombotic antiphospholipid syndrome: Guidance from the scientific and standardization committee of the international society on thrombosis and haemostasis. J Thromb Haemost 2020; 18: 2126-37. DOI: https://doi.org/10.1111/jth.14935
Martinelli I, Abbattista M, Bucciarelli P, Tripodi A, Artoni A, Gianniello F, et al. Recurrent thrombosis in patients with antiphospholipid antibodies treated with vitamin K antagonists or rivaroxaban. Haematologica 2018; 103: e315-e7. DOI: https://doi.org/10.3324/haematol.2017.185132
Williams B, Saseen JJ, Trujillo T, Palkimas S. Direct oral anticoagulants versus warfarin in patients with single or double antibody-positive antiphospholipid syndrome. J Thromb Thrombolysis 2022; 54: 67-73. DOI: https://doi.org/10.1007/s11239-021-02587-0
Pastori D, Menichelli D, Cammisotto V, Pignatelli P. Use of direct oral anticoagulants in patients with antiphospholipid syndrome: a systematic review and comparison of the international guidelines. Front Cardiovasc Med 2021; 8: 715878. DOI: https://doi.org/10.3389/fcvm.2021.715878
Tektonidou MG, Andreoli L, Limper M, Amoura Z, Cervera R, Costedoat-Chalumeau N, et al. EULAR recommendations for the management of antiphospholipid syndrome in adults. Ann Rheum Dis 2019; 78: 1296-304. DOI: https://doi.org/10.1136/annrheumdis-2019-215213
Espinosa G, Santos E, Cervera R, Piette JC, de la Red G, Gil V, et al. Adrenal involvement in the antiphospholipid syndrome: clinical and immunologic characteristics of 86 patients. Medicine 2003; 82: 106-18. DOI: https://doi.org/10.1097/00005792-200303000-00005
Cervera R, Piette JC, Font J, Khamashta MA, Shoenfeld Y, Camps MT, et al. Antiphospholipid syndrome: clinical and immunologic manifestations and patterns of disease expression in a cohort of 1,000 patients. Arthritis Rheum 2002; 46: 1019-27. DOI: https://doi.org/10.1002/art.10187
Warriach SA, Mustafa M, O'Keeffe D, Watts M. Unusual case of antiphospholipid syndrome presenting as adrenal insufficiency. BMJ Case Rep 2020; 13: e233631. DOI: https://doi.org/10.1136/bcr-2019-233631
Kolinioti A, Tsimaras M, Stravodimos G, Komporozos V. Acute adrenal insufficiency due to adrenal hemorrhage complicating colorectal surgery: report of two cases and correlation with the antiphospholipid antibody syndrome. Int J Surg Case Rep 2018; 51: 90-4. DOI: https://doi.org/10.1016/j.ijscr.2018.07.034
Rangel ML, Alghamdi I, Contreras G, Harrington T, Thomas DB, Barisoni L, et al. Catastrophic antiphospholipid syndrome with concurrent thrombotic and hemorrhagic manifestations. Lupus 2013; 22: 855-64. DOI: https://doi.org/10.1177/0961203313491024
Rodriguez V, Reed AM, Kuntz NL, Anderson PM, Smithson WA, Nichols WL. Antiphospholipid syndrome with catastrophic bleeding and recurrent ischemic strokes as initial presentation of systemic lupus erythematosus. J Pediatr Hematol Oncol 2005; 27: 403-7. DOI: https://doi.org/10.1097/01.mph.0000174565.91343.43
Vieregge GB, Harrington TJ, Andrews DM, Carpintero MF, Green DF, Nayer A. Catastrophic antiphospholipid syndrome with severe acute thrombotic microangiopathy and hemorrhagic complications. Case Rep Med 2013; 2013: 915309. DOI: https://doi.org/10.1155/2013/915309
Al Abdulhai SA, El-Ali MW, El-Dahshan MES. Bleeding and thrombosis in a patient with primary antiphospholipid syndrome using norethisterone: a case report. J Med Case Rep 2015; 9: 87. DOI: https://doi.org/10.1186/s13256-015-0554-3
Ruiz-Irastorza G, Cuadrado MJ, Ruiz-Arruza I, Brey R, Crowther M, Derksen R, et al. Evidence-based recommendations for the prevention and long-term management of thrombosis in antiphospholipid antibody-positive patients: report of a task force at the 13th international congress on antiphospholipid antibodies. Lupus 2011; 20: 206-18. DOI: https://doi.org/10.1177/0961203310395803
Coloma Bazán E, Donate López C, Moreno Lozano P, Cervera R, Espinosa G. Discontinuation of anticoagulation or antiaggregation treatment may be safe in patients with primary antiphospholipid syndrome when antiphospholipid antibodies became persistently negative. Immunol Res 2013; 56: 358-61. DOI: https://doi.org/10.1007/s12026-013-8407-x
How to Cite
Adrenal hemorrhage and non-ST elevation myocardial infarction: an antiphospholipid syndrome dilemma. (2023). Reumatismo, 75(3). https://doi.org/10.4081/reumatismo.2023.1584
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