PMID- 32685891
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20240329
IS  - 2475-0379 (Electronic)
IS  - 2475-0379 (Linking)
VI  - 4
IP  - 5
DP  - 2020 Jul
TI  - N-Methyl-3,4-methylendioxymethamphetamine (MDMA)-related coagulopathy and 
      rhabdomyolysis: A case series and literature review.
PG  - 829-834
LID - 10.1002/rth2.12360 [doi]
AB  - Coagulation changes, thrombosis, and hemorrhage have been described in patients 
      following N-methyl-3,4-methylenedioxymethylamphetamine (MDMA) intoxication who 
      subsequently developed serotonin syndrome and rhabdomyolysis. The clinical 
      features and mechanism of this remain poorly described. We describe 5 sequential 
      cases admitted to critical care due to severe recreational MDMA toxicity where 
      coagulopathy occurred, and discuss key clinical issues. All patients presented 
      with hyperpyrexia then developed subsequent rhabdomyolysis accompanied by a 
      coagulopathy within 24 hours of presentation. This included a severe 
      thrombocytopenia, prolonged coagulation times, grossly elevated D-dimer levels, 
      and hypofibrogenemia. Multiorgan dysfunction was seen in all patients, including 
      stroke in one patient and major hemorrhage in another. In 2 cases, low-dose 
      low-molecular-weight heparin was used early after presentation, with no 
      significant bleeding complications. Blood products usage was high but variable 
      between the patients with lower use in those who received low-molecular-weight 
      heparin early. Other treatments included intravascular therapeutic cooling, renal 
      replacement therapy with large filter pores and cyprohepatidine. Current evidence 
      suggests that in this group, rhabdomyolysis with subsequent myosin release may be 
      a profound activator of coagulation leading to disseminated intravascular 
      coagulation. Myosin-activated coagulation seems a potential cause of MDMA-related 
      coagulopathy in the setting of rhabdomyolysis and serotonin syndrome. Further 
      studies are needed to validate this and explore the use of low-molecular-weight 
      heparin to reduce the clinical effects of this coagulopathy.
CI  - (c) 2020 The Authors. Research and Practice in Thrombosis and Haemostasis by Wiley 
      Periodicals LLC on behalf of International Society on Thrombosis and Haemostasis 
      (ISTH).
FAU - Doyle, Andrew J
AU  - Doyle AJ
AUID- ORCID: 0000-0002-1001-0486
AD  - Centre for Thrombosis & Haemophilia St Thomas' Hospital London UK.
FAU - Meyer, Joel
AU  - Meyer J
AD  - Department of Intensive Care Medicine St Thomas' Hospital London UK.
FAU - Breen, Karen
AU  - Breen K
AD  - Centre for Thrombosis & Haemophilia St Thomas' Hospital London UK.
FAU - Hunt, Beverley J
AU  - Hunt BJ
AUID- ORCID: 0000-0002-4709-0774
AD  - Centre for Thrombosis & Haemophilia St Thomas' Hospital London UK.
LA  - eng
PT  - Case Reports
DEP - 20200614
PL  - United States
TA  - Res Pract Thromb Haemost
JT  - Research and practice in thrombosis and haemostasis
JID - 101703775
PMC - PMC7354411
OTO - NOTNLM
OT  - 3,4-methylenedioxymethylamphetamine
OT  - coagulopathy
OT  - critical care
OT  - rhabdomyolysis
OT  - serotonin syndrome
EDAT- 2020/07/21 06:00
MHDA- 2020/07/21 06:01
PMCR- 2020/06/14
CRDT- 2020/07/21 06:00
PHST- 2019/12/30 00:00 [received]
PHST- 2020/04/03 00:00 [revised]
PHST- 2020/04/10 00:00 [accepted]
PHST- 2020/07/21 06:00 [entrez]
PHST- 2020/07/21 06:00 [pubmed]
PHST- 2020/07/21 06:01 [medline]
PHST- 2020/06/14 00:00 [pmc-release]
AID - S2475-0379(22)02034-9 [pii]
AID - RTH212360 [pii]
AID - 10.1002/rth2.12360 [doi]
PST - epublish
SO  - Res Pract Thromb Haemost. 2020 Jun 14;4(5):829-834. doi: 10.1002/rth2.12360. 
      eCollection 2020 Jul.