THROMBOTIC STORM - WHEN THROMBOSIS BEGETS THROMBOSIS

Patients with hypercoagulability may present with a single thrombosis and subsequently develop progressive thromboses at other sites. With i nadequate therapy, the thrombotic process may self-perpetuate, leading to multiple thromboses and even death. Six cases are presented demons trating key features of what ma) be termed thrombotic storm: (1) an un derlying hypercoagulable disorder; (2) a provocation to initiate throm bosis; (3) rapid development of new thromboses; (4) response to prompt use of thrombolytic agent or anticoagulant therapy; and (5) remarkabl e good long-term prognosis if the cycle of thrombosis is interrupted. Continued activation of coagulation by fresh thrombosis is hypothesize d as the cause of the syndrome, which may explain its control by antic oagulants. Whereas these unusual patients' courses most likely represe nt only an extreme of hypercoagulability and not a new disorder, their characteristic behavior warrants attention. (C) 1998 by Excerpta Medi ca, Inc.