Bohlius et al identified risk factors for thrombo-embolic events in patients treated with recombinant human erythropoietin. A patient with one or more risk factors may benefit from closer monitoring or discontinuation of erythropoietin therapy. The authors are from the University of Cologne, University of Birmingham (UK), University of Frieburg, H. Lee Moffitt Cancer Center, Northwestern University, Veterans Administration Chicago and Chicago Blue Cross and Blue Shield.


Recombinant human erythropoietin:

(1) epoetin alfa and beta

(2) darbepoetin alfa


Types of thrombo-embolic events reported in patients treated with erythropoietin:

(1) transient ischemic attack or stroke

(2) pulmonary embolism

(3) deep vein thrombosis

(4) myocardial infarction


Risk factors for thrombosis:

(1) therapy with a thrombogenic chemotherapeutic agent (see below)

(2) underlying conditions associated with hypercoagulable state

(3) continuing erythropoietin therapy with hemoglobin > 12 g/dL


Thrombogenic chemotherapeutic agents include (Doll, 2001):

(1) cyclophosphamide

(2) cisplatin

(3) methotrexate

(4) 5-fluoruracil (5-FU)

(5) doxorubicin

(6) vinblastine or vincristine

(7) prednisone

(8) bleomycin

(9) etoposide

(10) tamoxifen (possibly)

(11) estramustine


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