Tetrazepam
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Reactions 785 - 22 Jan 2000 S Venlafaxine Clotting disorders: case report A 47-year-old woman with early onset type I diabetes mellitus, hypertension and hypothyroidism, developed clotting abnormalities during treatment with venlafaxine for depression. Her hypertension was stable at 130–140mm Hg systolic. The woman’s hypertension had been stable at 130–140mm Hg systolic; however, 1 month after the patient started venlafaxine 37.5mg twice daily, her hypertension worsened (up to 180–200mm Hg systolic). In addition, she noted an increased tendency to bruise after mild trauma. Approximately 2 weeks later, she had an episode of atraumatic epistaxis and required transfusion of 2 units of packed RBCs. Her clotting parameters were normal at this time. However, after 2.5 months of venlafaxine therapy, she was hospitalised with ecchymoses and hypertension. Laboratory analysis showed an increased partial thromboplastin time of 89sec (normal 22–36) and a high antihaemophilic factor VIII, C antibody, titre of 190 BU/ml. Her systolic BP was 200mm Hg. The woman was treated empirically with desmopressin, IV immunoglobulin and cyclophosphamide; venlafaxine was stopped. Her concentration of factor VIII antibody decreased over the next 4 days to 40 BU/ml. The woman remained in hospital for 1 month and her antibody titres to factor VIII continued to decrease. At discharge, her partial thromboplastin time was 40 sec, her hypertension had returned to baseline and her ecchymoses were resolving. Author comment: ‘Previously proposed theories suggest that lowered vascular tone or increased time for platelet aggregation with serotonin reuptake inhibitors leads to increased bleeding tendencies; this case demonstrates an alternative autoimmmune mechanism. We wondered whether caution should be taken when prescribing venlafaxine to patients with suspected autoimmune pathology (non-insulin- dependent diabetes mellitus and thyroid disease in this case).’ Tham CJ, et al. Abnormal clotting and production of factor VIII inhibitor in a patient treated with venlafaxine. Canadian Journal of Psychiatry 44: 923-924, Nov 1999 - Canada 800808198 1 Reactions 22 Jan 2000 No. 785 0114-9954/10/0785-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Transcript of Tetrazepam
Reactions 785 - 22 Jan 2000
SVenlafaxine
Clotting disorders: case reportA 47-year-old woman with early onset type I diabetes
mellitus, hypertension and hypothyroidism, developedclotting abnormalities during treatment with venlafaxine fordepression. Her hypertension was stable at 130–140mm Hgsystolic.
The woman’s hypertension had been stable at 130–140mmHg systolic; however, 1 month after the patient startedvenlafaxine 37.5mg twice daily, her hypertension worsened(up to 180–200mm Hg systolic). In addition, she noted anincreased tendency to bruise after mild trauma. Approximately2 weeks later, she had an episode of atraumatic epistaxis andrequired transfusion of 2 units of packed RBCs. Her clottingparameters were normal at this time. However, after 2.5months of venlafaxine therapy, she was hospitalised withecchymoses and hypertension. Laboratory analysis showed anincreased partial thromboplastin time of 89sec (normal 22–36)and a high antihaemophilic factor VIII, C antibody, titre of 190BU/ml. Her systolic BP was 200mm Hg.
The woman was treated empirically with desmopressin, IVimmunoglobulin and cyclophosphamide; venlafaxine wasstopped. Her concentration of factor VIII antibody decreasedover the next 4 days to 40 BU/ml. The woman remained inhospital for 1 month and her antibody titres to factor VIIIcontinued to decrease. At discharge, her partialthromboplastin time was 40 sec, her hypertension hadreturned to baseline and her ecchymoses were resolving.
Author comment: ‘Previously proposed theories suggestthat lowered vascular tone or increased time for plateletaggregation with serotonin reuptake inhibitors leads toincreased bleeding tendencies; this case demonstrates analternative autoimmmune mechanism. We wondered whethercaution should be taken when prescribing venlafaxine topatients with suspected autoimmune pathology (non-insulin-dependent diabetes mellitus and thyroid disease in this case).’Tham CJ, et al. Abnormal clotting and production of factor VIII inhibitor in apatient treated with venlafaxine. Canadian Journal of Psychiatry 44: 923-924, Nov1999 - Canada 800808198
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Reactions 22 Jan 2000 No. 7850114-9954/10/0785-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
