The thrombophilic state in acute promyelocytic leukemia

Acute promyelocytic leukemia is characterized by the association with a sev ere coagulopathy resulting in hemorrhagic manifestations. The pathogenesis underlying the hemorrhagic syndrome is complex and involves the activation of the coagulation cascade and the fibrinolytic system. All-trans-retinoic acid (ATRA) appears to correct both procoagulant and fibrinolytic activitie s in vitro and in vivo. Early results of treatment with arsenic trioxide, w hich acts by inducing apoptosis of the leukemic promyelocytes, also show re gression in the coagulopathy with a decrease in fibrin degradation products and D-Dimer, A clear understanding of the relationship between laboratory changes and the effects of ATRA and arsenic trioxide requires further studi es.