Calciphylaxis: A Disease of Pannicular Thrombosis

Rokea A. el-Azhary, Michelle T. Patzelt, Robert D. McBane, Amy L. Weaver, Robert C. Albright, Alina D. Bridges, Paul L. Claus, Mark D P Davis, John J. Dillon, Ziad M El-Zoghby, LaTonya Hickson, Rajiv Kumar, Kathleen A M McCarthy-Fruin, Marian T. McEvoy, Mark R. Pittelkow, David A. Wetter, Amy W. Williams, James T. McCarthy

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21 Scopus citations

Abstract

Objective To identify coagulation risk factors in patients with calciphylaxis and the relationship between anticoagulation use and overall survival. Patients and Methods Study subjects were 101 patients with calciphylaxis seen at Mayo Clinic from 1999 to September 2014. Data including thrombophilia profiles were extracted from the medical records of each patient. Survival status was determined using patient registration data and the Social Security Death Index. Survival was estimated using the Kaplan-Meier method, and associations were evaluated using Cox proportional hazards models. Results Sixty-four of the 101 patients underwent thrombophilia testing. Of these, a complete test panel was performed in 55 and a partial panel in 9. Severe thrombophilias observed in 60% (33 of 55) of the patients included antiphospholipid antibody syndrome protein C, protein S, or antithrombin deficiencies or combined thrombophilias. Of the 55 patients, severe thrombophilia (85%, 23 of 27) was noted in patients who were not on warfarin at the time of testing (27). Nonsevere thrombophilias included heterozygous factor V Leiden (n=2) and plasminogen deficiency (n=1). For the comparison of survival, patients were divided into 3 treatment categories: Warfarin (n=63), other anticoagulants (n=20), and no anticoagulants (n=18). There was no statistically significant survival difference between treatment groups. Conclusion Laboratory testing reveals a strikingly high prevalence of severe thrombophilias in patients with calciphylaxis, underscoring the importance of congenital and acquired thrombotic propensity potentially contributing to the pathogenesis of this disease. These findings may have therapeutic implications; however, to date, survival differences did not vary by therapeutic choice.

Original languageEnglish (US)
Pages (from-to)1395-1402
Number of pages8
JournalMayo Clinic Proceedings
Volume91
Issue number10
DOIs
StatePublished - Oct 1 2016

ASJC Scopus subject areas

  • Medicine(all)

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    el-Azhary, R. A., Patzelt, M. T., McBane, R. D., Weaver, A. L., Albright, R. C., Bridges, A. D., Claus, P. L., Davis, M. D. P., Dillon, J. J., El-Zoghby, Z. M., Hickson, L., Kumar, R., McCarthy-Fruin, K. A. M., McEvoy, M. T., Pittelkow, M. R., Wetter, D. A., Williams, A. W., & McCarthy, J. T. (2016). Calciphylaxis: A Disease of Pannicular Thrombosis. Mayo Clinic Proceedings, 91(10), 1395-1402. https://doi.org/10.1016/j.mayocp.2016.06.026