LETTER
Thrombocytosis Associated with Low-Molecular-Weight Heparin
Eliot Williams, MD, PhD
1 May 1997 | Volume 126 Issue 9 | Page 742
TO THE EDITOR:
Rizzieri and coworkers [1] report a case of thrombocytosis that they attribute to treatment with enoxaparin. The patient had metastatic carcinoma and was asplenic; enoxaparin was given for pulmonary embolism. The platelet count was normal (285 cells/mm3) before enoxaparin treatment, increased to 1114 cells/mm3 within 4 weeks of treatment, and became normal after chemotherapy for carcinoma and discontinuation of enoxaparin therapy. I propose an alternate explanation for these findings. I suspect that the patient had the Trousseau syndrome with disseminated intravascular coagulation and rapid platelet consumption. A platelet count of more than 1 million cells/mm3 could result from the combination of metastatic carcinoma and asplenia [2]; the increase in platelet count after enoxaparin treatment may therefore have represented a return to "baseline" as a result of suppression of disseminated intravascular coagulation by enoxaparin rather than an increase in platelet production induced by that drug.
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Author and Article Information
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University of Wisconsin, Madison, WI 53792
1. Rizzieri DA, Wong WM, Gockerman JP. Thrombocytosis associated with low-molecular-weight heparin [Letter]. Ann Intern Med. 1996; 125:157.
2. Buss DH, Cashell AW, O'Connor ML, Richards F, Case LD. Occurrence, etiology, and clinical significance of extreme thrombocytosis: a study of 280 cases. Am J Med. 1994; 96:247-53.
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