51
|
Frelinger AL. Platelet Function Testing in Clinical Research Trials. Platelets 2019. [DOI: 10.1016/b978-0-12-813456-6.00037-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
52
|
van Geffen JP, Brouns SLN, Batista J, McKinney H, Kempster C, Nagy M, Sivapalaratnam S, Baaten CCFMJ, Bourry N, Frontini M, Jurk K, Krause M, Pillitteri D, Swieringa F, Verdoold R, Cavill R, Kuijpers MJE, Ouwehand WH, Downes K, Heemskerk JWM. High-throughput elucidation of thrombus formation reveals sources of platelet function variability. Haematologica 2018; 104:1256-1267. [PMID: 30545925 PMCID: PMC6545858 DOI: 10.3324/haematol.2018.198853] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 12/05/2018] [Indexed: 01/25/2023] Open
Abstract
In combination with microspotting, whole-blood microfluidics can provide high-throughput information on multiple platelet functions in thrombus formation. Based on assessment of the inter- and intra-subject variability in parameters of microspot-based thrombus formation, we aimed to determine the platelet factors contributing to this variation. Blood samples from 94 genotyped healthy subjects were analyzed for conventional platelet phenotyping: i.e. hematologic parameters, platelet glycoprotein (GP) expression levels and activation markers (24 parameters). Furthermore, platelets were activated by ADP, CRP-XL or TRAP. Parallel samples were investigated for whole-blood thrombus formation (6 microspots, providing 48 parameters of adhesion, aggregation and activation). Microspots triggered platelet activation through GP Ib-V-IX, GPVI, CLEC-2 and integrins. For most thrombus parameters, inter-subject variation was 2-4 times higher than the intra-subject variation. Principal component analyses indicated coherence between the majority of parameters for the GPVI-dependent microspots, partly linked to hematologic parameters, and glycoprotein expression levels. Prediction models identified parameters per microspot that were linked to variation in agonist-induced αIIbβ3 activation and secretion. Common sequence variation of GP6 and FCER1G, associated with GPVI-induced αIIbβ3 activation and secretion, affected parameters of GPVI-and CLEC-2-dependent thrombus formation. Subsequent analysis of blood samples from patients with Glanzmann thrombasthenia or storage pool disease revealed thrombus signatures of aggregation-dependent parameters that were subject-dependent, but not linked to GPVI activity. Taken together, this high-throughput elucidation of thrombus formation revealed patterns of inter-subject differences in platelet function, which were partly related to GPVI-induced activation and common genetic variance linked to GPVI, but also included a distinct platelet aggregation component.
Collapse
Affiliation(s)
- Johanna P van Geffen
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, the Netherlands
| | - Sanne L N Brouns
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, the Netherlands
| | - Joana Batista
- Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, UK.,National Health Service Blood and Transplant (NHSBT), Cambridge Biomedical Campus, UK
| | - Harriet McKinney
- Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, UK.,National Health Service Blood and Transplant (NHSBT), Cambridge Biomedical Campus, UK
| | - Carly Kempster
- Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, UK.,National Health Service Blood and Transplant (NHSBT), Cambridge Biomedical Campus, UK
| | - Magdolna Nagy
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, the Netherlands
| | - Suthesh Sivapalaratnam
- Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, UK.,The Royal London Haemophilia Centre, London, UK
| | - Constance C F M J Baaten
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, the Netherlands
| | - Nikki Bourry
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, the Netherlands
| | - Mattia Frontini
- Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, UK.,National Health Service Blood and Transplant (NHSBT), Cambridge Biomedical Campus, UK.,BHF Centre of Excellence, Division of Cardiovascular Medicine, Cambridge University Hospitals, Cambridge Biomedical Campus, UK
| | - Kerstin Jurk
- Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | | | | | - Frauke Swieringa
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, the Netherlands
| | - Remco Verdoold
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, the Netherlands
| | - Rachel Cavill
- Department of Data Science & Knowledge Engineering, Faculty of Humanities and Sciences, Maastricht University, the Netherlands
| | - Marijke J E Kuijpers
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, the Netherlands
| | - Willem H Ouwehand
- Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, UK.,National Health Service Blood and Transplant (NHSBT), Cambridge Biomedical Campus, UK.,BHF Centre of Excellence, Division of Cardiovascular Medicine, Cambridge University Hospitals, Cambridge Biomedical Campus, UK.,NIHR BioResource, University of Cambridge, Cambridge Biomedical Campus, UK.,Department of Human Genetics, The Wellcome Sanger Institute, Hinxton, Cambridge, UK
| | - Kate Downes
- Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, UK .,National Health Service Blood and Transplant (NHSBT), Cambridge Biomedical Campus, UK.,NIHR BioResource, University of Cambridge, Cambridge Biomedical Campus, UK
| | - Johan W M Heemskerk
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, the Netherlands
| |
Collapse
|
53
|
Hanrahan JP, Wakefield JD, Wilson PJ, Mihova M, Chickering JG, Ruff D, Hall M, Milne GT, Currie MG, Profy AT. A Randomized, Placebo-Controlled, Multiple-Ascending-Dose Study to Assess the Safety, Tolerability, Pharmacokinetics, and Pharmacodynamics of the Soluble Guanylate Cyclase Stimulator Praliciguat in Healthy Subjects. Clin Pharmacol Drug Dev 2018; 8:564-575. [PMID: 30422390 DOI: 10.1002/cpdd.627] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 10/08/2018] [Indexed: 12/14/2022]
Abstract
Nitric oxide (NO)-soluble guanylate cyclase (sGC)-cyclic guanosine monophosphate (cGMP) signaling is central to the regulation of several physiological processes, including blood flow and inflammation. Deficient NO signaling is implicated in multiple diseases. sGC stimulators are small molecules that enhance sGC activity, particularly in combination with NO. In a randomized, placebo-controlled phase 1 study, the safety, tolerability, pharmacokinetics, and pharmacodynamics of multiple ascending doses of the sGC stimulator praliciguat were assessed in 44 healthy adults. Four cohorts of 11 subjects (8 praliciguat, 3 placebo) received once-daily praliciguat for 14 days before up-titrating for 7 days (treatment sequences: 15/30 mg, 20/40 mg, 30/40 mg, and weight-based). All doses were tolerated. No serious or severe adverse events (AEs) were reported. The most common AEs in praliciguat recipients were headache and symptoms consistent with blood pressure (BP) lowering/vasodilation. There were no laboratory, vital sign, electrocardiographic, or platelet function findings indicative of a safety concern. Pharmacokinetics were dose proportional, with an effective half-life of 24-37 hours, supporting once-daily dosing. Praliciguat produced dose-related increases in plasma cGMP consistent with stimulation of sGC. Repeated once-daily dosing showed sustained decreases in BP. Results support evaluation of praliciguat for the treatment of conditions associated with deficient NO signaling.
Collapse
Affiliation(s)
| | | | | | | | | | - Dennis Ruff
- ICON Early Phase Services LLC, San Antonio, TX, USA
| | - Michael Hall
- Ironwood Pharmaceuticals Inc., Cambridge, MA, USA
| | - G Todd Milne
- Ironwood Pharmaceuticals Inc., Cambridge, MA, USA
| | | | | |
Collapse
|
54
|
Hayward CPM. How I investigate for bleeding disorders. Int J Lab Hematol 2018; 40 Suppl 1:6-14. [PMID: 29741250 DOI: 10.1111/ijlh.12822] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 02/07/2018] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Laboratory investigations for bleeding disorders are warranted when an individual has a personal and/or family history of bleeding, and/or laboratory findings that suggest the possibility of an inherited or acquired bleeding disorder. METHODS This review summarizes author's experience with ordering and reporting on diagnostic investigations for common and rare bleeding disorders, with consideration of recent articles on diagnosing bleeding disorders. An updated strategy is presented for investigating common and rare, congenital and acquired bleeding disorders. RESULTS An investigation of a suspected bleeding disorder requires a practical strategy that considers the clinical problem to be investigated, the pretest probability of true-positive and false-positive findings, the investigations can be performed locally or in a reference laboratory and limit the number of blood samples required to establish a diagnosis. It is often advantageous to simultaneously test for von Willebrand disease and platelet function disorders, and for coagulation defects, including fibrinogen disorders. An investigation for rarer bleeding disorders, including those affecting factor XIII, α2 antiplasmin, and plasminogen activator inhibitor-1, is appropriate when faced with a severe congenital or acquired bleeding problem that cannot be explained by the initial diagnostic investigations. CONCLUSION An organized strategy for investigating bleeding disorders that consider important issues, confirms abnormal findings, encourages proper interpretation of the results, and provides a helpful framework for assessing both common and rare causes of bleeding.
Collapse
Affiliation(s)
- C P M Hayward
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada.,Department of Medicine, McMaster University, Hamilton, ON, Canada.,Hamilton Regional Laboratory Medicine Program, Hamilton, ON, Canada
| |
Collapse
|
55
|
|
56
|
Von Willebrand factor and the aortic valve: Concepts that are important in the transcatheter aortic valve replacement era. Thromb Res 2018; 170:20-27. [PMID: 30092557 DOI: 10.1016/j.thromres.2018.07.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 07/17/2018] [Accepted: 07/27/2018] [Indexed: 12/14/2022]
Abstract
Since the approval of the first transcatheter aortic valve replacement (TAVR) device in 2011, this technology has undergone substantial enhancements and exponential growth. However, valve thrombosis and residual paravalvular leaks (PVL) are among the challenges that require further investigation. Recently, monitoring von Willebrand factor (vWF) multimers has emerged as a tool to help evaluate the severity of PVL after TAVR. Following TAVR, vWF large multimers recovery have been documented. The role of large vWF multimers recovery and their interactions with platelets, and the endothelium have not been entirely elucidated. In this review, we discuss vWF synthesis and its role in aortic stenosis. We further provide an overview of the studies that investigated changes affecting vWF multimers following TAVR and the role of HMW vWF multimers monitoring in the determination of PVL severity. We also offer potential future directions for what will be fertile ground for research in this field.
Collapse
|
57
|
Rand ML, Reddy EC, Israels SJ. Laboratory diagnosis of inherited platelet function disorders. Transfus Apher Sci 2018; 57:485-493. [DOI: 10.1016/j.transci.2018.07.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
58
|
Affiliation(s)
- Jose Rivera
- a Centro Regional de Hemodonación , Universidad de Murcia , Murcia , Spain
| | - Maria Luisa Lozano
- a Centro Regional de Hemodonación , Universidad de Murcia , Murcia , Spain
| |
Collapse
|
59
|
Dovlatova N, Heptinstall S. Platelet aggregation measured by single-platelet counting and using PFA-100 devices. Platelets 2018; 29:656-661. [PMID: 29985716 DOI: 10.1080/09537104.2018.1492109] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Platelets play a crucial role in haemostasis and thrombosis and evaluation of platelet function in vitro, in particular platelet aggregation responses, has been one of the most common and useful ways of evaluating the risk of bleeding and thrombotic events and assessing the effects of various compounds and conditions on platelets. Traditional approaches to assessing platelet aggregation require specialised equipment and trained laboratory personnel and have other limitations. Studying platelet aggregation in whole blood offers a more physiologically relevant measurement. Additionally, certain approaches could be more widely available than in specialised laboratories. Here we summarise the application of the platelet function analyser (PFA-100), an accessible first point-of-care test for platelet function in whole blood, and the less established, but promising approach of assessing platelet aggregation by single-platelet counting that can also be performed in whole blood. The possibilities of a wider and more accessible application of the latter methodology are also discussed.
Collapse
Affiliation(s)
- Natalia Dovlatova
- a Thrombosis and Haemostasis Research Group, Division of Clinical Neuroscience , University of Nottingham , Nottingham, United Kingdom.,b Platelet Solutions Ltd ., Nottingham , United Kingdom
| | - Stan Heptinstall
- a Thrombosis and Haemostasis Research Group, Division of Clinical Neuroscience , University of Nottingham , Nottingham, United Kingdom.,b Platelet Solutions Ltd ., Nottingham , United Kingdom
| |
Collapse
|
60
|
Harrison P, Bethel MA, Kennedy I, Dinsdale R, Coleman R, Holman RR. Comparison of nine platelet function tests used to determine responses to different aspirin dosages in people with type 2 diabetes. Platelets 2018; 30:521-529. [DOI: 10.1080/09537104.2018.1478402] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Paul Harrison
- Institute of Inflammation and Ageing, University of Birmingham Medical School, Birmingham, UK
| | | | - Irene Kennedy
- Diabetes Trials Unit, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Churchill Hospital, Oxford, UK
| | - Robert Dinsdale
- Institute of Inflammation and Ageing, University of Birmingham Medical School, Birmingham, UK
| | - Ruth Coleman
- Diabetes Trials Unit, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Churchill Hospital, Oxford, UK
| | - Rury R. Holman
- Diabetes Trials Unit, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Churchill Hospital, Oxford, UK
| |
Collapse
|
61
|
Tabrizi R, Khaheshi I, Hoseinzadeh A, Rezvanpour B, Shafie S. Do Antiplatelet Drugs Increase the Risk of Bleeding After Dental Implant Surgery? A Case-and-Crossover Study. J Oral Maxillofac Surg 2018; 76:2092-2096. [PMID: 29928849 DOI: 10.1016/j.joms.2018.04.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 04/14/2018] [Accepted: 04/30/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE Cessation versus continuation of antiplatelet drugs in patients undergoing dental implant surgery is a controversial issue. The present study evaluated postoperative bleeding during and after dental implant surgery in patients taking aspirin (ASA) or clopidogrel. MATERIAL AND METHODS The present study is a case-and-crossover study. Patients who were using antiplatelet drugs and receiving 2 bilateral dental implants in the posterior region of the mandible were studied. During session 1, dental implants were placed without stopping the intake of antiplatelet drugs. During session 2, antiplatelet drugs were stopped for 5 days. In group 1, platelet activity was measured by an assay based on flow cytometry and represented the platelet reactivity index. In group 2, platelet function analysis was used to monitor the antiplatelet effect of ASA. Bleeding severity was assessed using a visual analog scale for 72 hours after dental implant placement during sessions 1 and 2. Use of antiplatelet drugs was the predictive factor of the study and bleeding severity and platelet function were the outcomes of the study. RESULTS Twenty-two patients composed group 1 (clopidogrel 75 mg) and 20 composed group 2 (ASA 80 mg). In group 1, bleeding severity was 4.86 ± 0.77 during session 1 and 4.59 ± 0.66 during session 2. Data analysis showed no difference in bleeding severity between sessions 1 and 2 in group 1 (P = .72). In group 2, bleeding severity was 4.05 ± 0.94 during session 1 and 3.9 ± 0.85 during session 2. There was no difference in bleeding severity between sessions 1 and 2 in patients taking ASA (P = .19). CONCLUSION The results suggest that continuing the intake of antiplatelet drugs did not increase bleeding after placement of dental implants.
Collapse
Affiliation(s)
- Reza Tabrizi
- Associate Professor of Oral and Maxillofacial Surgery, Shahid Beheshti Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Isa Khaheshi
- Assistant Professor of Cardiology, Cardiovascular Research Centre, Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Afshin Hoseinzadeh
- Student of Dentistry, Shahid Beheshti Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Babak Rezvanpour
- Student of Dentistry, Shahid Beheshti Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shervin Shafie
- Student of Dentistry, Shahid Beheshti Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
62
|
Mullins ES, Miller RJ, Mullins TLK. Abnormal Uterine Bleeding in Adolescent Women. CURRENT PEDIATRICS REPORTS 2018. [DOI: 10.1007/s40124-018-0164-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
63
|
Morgan LM, Miller ER, Raj AB, Coventry SC, Elster JD. Angiomatoid Fibrous Histiocytoma With Paraneoplastic Platelet Storage Pool Deficiency. Pediatrics 2018; 141:peds.2016-2065. [PMID: 29472492 DOI: 10.1542/peds.2016-2065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/24/2017] [Indexed: 11/24/2022] Open
Abstract
Angiomatoid fibrous histiocytoma is a rare soft tissue tumor usually discovered in young individuals. This tumor is often mistaken for a hematoma and typically misdiagnosed. It is commonly found in the extremities and may be associated with a site of recent or previous trauma. Characteristic histology includes nodules of histiocytoid spindle cells with pseudoangiomatoid spaces, fibrous pseudocapsules, and lymphoid cuffing. We describe the case of an 8-year-old girl who presented after incision and drainage of a superficial thigh lesion and experienced subsequent chronic bleeding of her wound. Her initial presentation was concerning for an underlying bleeding disorder, and laboratory analysis uncovered a paraneoplastic platelet function disorder that resolved with therapy of the primary tumor.
Collapse
Affiliation(s)
- Lerraughn M Morgan
- Department of Pediatrics, University of Louisville, Louisville, Kentucky
| | - Emily R Miller
- Department of Pediatrics, University of Louisville, Louisville, Kentucky
| | - Ashok B Raj
- Department of Pediatrics, University of Louisville, Louisville, Kentucky.,Divisions of Pediatric Hematology and Oncology and
| | - Susan C Coventry
- Department of Pediatrics, University of Louisville, Louisville, Kentucky.,Pediatric Pathology
| | - Jennifer D Elster
- Department of Pediatrics, University of Louisville, Louisville, Kentucky.,Divisions of Pediatric Hematology and Oncology and
| |
Collapse
|
64
|
Gebhart J, Hofer S, Panzer S, Quehenberger P, Sunder-Plassmann R, Hoermann G, Eigenbauer E, Haslacher H, Kepa S, Kyrle PA, Eichinger S, Knöbl P, Eischer L, Mannhalter C, Ay C, Pabinger I. High proportion of patients with bleeding of unknown cause in persons with a mild-to-moderate bleeding tendency: Results from the Vienna Bleeding Biobank (VIBB). Haemophilia 2018; 24:405-413. [PMID: 29388750 DOI: 10.1111/hae.13422] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2017] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Data on clinical characteristics and the prevalence of underlying coagulopathies in patients with mild-to-moderate bleeding disorders (MBDs) are scarce. AIM We established the Vienna Bleeding Biobank (VIBB) to characterize and thoroughly investigate Austrian patients with MBDs. RESULTS Four hundred eighteen patients (female = 345, 82.5%) were included. A platelet function defect (PFD) was diagnosed in 26 (6.2%) and a possible PFD in 30 (7.2%) patients. Eight patients (1.9%) were diagnosed with von Willebrand disease (VWD) (type 1 n = 6; type 2 n = 2), and 29 patients had low VWF (30-50 IU/dL). Deficiencies in factor VIII, IX, XI or XIII were found in 11 (2.6%), 3 (0.7%), 3 (0.7%) and 1 patient(s), 2 patients had dysfibrinogenaemia, and further 2 had possible PFD and FXI deficiency. Probable causal mutations were detected in 8 of 11 patients with FVIII deficiency, 2 of 3 patients with FIX deficiency and 2 of 8 patients with VWD. Three hundred three patients (72.5%) had normal results in the coagulation assays and were categorized as patients with bleeding of unknown cause (BUC). The bleeding score did not differ between patients with and without established diagnosis. A diagnosis of a bleeding disorder was more frequently made in men than in women (49.3% vs 22.9%). Male sex (OR 3.55, 95% CI: 2.02-6.22; P < .001) and blood group 0 (OR 1.86, 95% CI: 1.17-2.94; P = .008) were independently associated with diagnosis of a bleeding disorder. CONCLUSION The high rate of patients with BUC despite in-depth haemostatic assessment underlines the incompleteness of available routine laboratory tests. Males with MBDs were more likely to be diagnosed with an established bleeding disorder than females.
Collapse
Affiliation(s)
- J Gebhart
- Department of Medicine I, Clinical Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - S Hofer
- Department of Medicine I, Clinical Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - S Panzer
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria
| | - P Quehenberger
- Department of Laboratory Medicine, Division of Medical and Chemical Laboratory Diagnostics, Medical University of Vienna, Vienna, Austria
| | - R Sunder-Plassmann
- Department of Laboratory Medicine, Division of Medical and Chemical Laboratory Diagnostics, Medical University of Vienna, Vienna, Austria
| | - G Hoermann
- Department of Laboratory Medicine, Division of Medical and Chemical Laboratory Diagnostics, Medical University of Vienna, Vienna, Austria
| | - E Eigenbauer
- IT-Systems and Communications, Medical University of Vienna, Vienna, Austria
| | - H Haslacher
- Department of Laboratory Medicine, Division of Medical and Chemical Laboratory Diagnostics, Medical University of Vienna, Vienna, Austria
| | - S Kepa
- Department of Medicine I, Clinical Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - P A Kyrle
- Department of Medicine I, Clinical Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - S Eichinger
- Department of Medicine I, Clinical Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - P Knöbl
- Department of Medicine I, Clinical Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - L Eischer
- Department of Medicine I, Clinical Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - C Mannhalter
- Department of Laboratory Medicine, Division of Medical and Chemical Laboratory Diagnostics, Medical University of Vienna, Vienna, Austria
| | - C Ay
- Department of Medicine I, Clinical Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - I Pabinger
- Department of Medicine I, Clinical Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
65
|
|
66
|
Knöfler R, Eberl W, Schulze H, Bakchoul T, Bergmann F, Gehrisch S, Geisen C, Gottstein S, Halimeh S, Harbrecht U, Kappert G, Kirchmaier C, Kehrel B, Lösche W, Krause M, Mahnel R, Meyer O, Pilgrimm AK, Pillitteri D, Rott H, Santoso S, Siegemund A, Schambeck C, Scheer M, Schmugge M, Scholl T, Strauss G, Zieger B, Zotz R, Hermann M, Streif W. Diagnose angeborener Störungen der Thrombozytenfunktion. Hamostaseologie 2017; 34:201-12. [DOI: 10.5482/hamo-13-04-0024] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 05/21/2014] [Indexed: 11/05/2022] Open
Abstract
ZusammenfassungAngeborene Störungen der Thrombozytenfunktion sind eine heterogene Gruppe von Erkrankungen, die oft erst bei Auftreten von Blutungen erkannt werden. Im klinischen Bereich haben sich nur wenige Methoden zur Diagnose und Klassifizierung von angeborenen Thrombozytenfunktionsstörungen bewährt. Für eine rationelle Diagnostik ist ein stufenweises Vorgehen empfehlenswert. Anamnese und klinische Untersuchung sind Grundvoraussetzungen. Das von-Willebrand-Syndrom und andere plasmatische Gerinnungsstörungen sollten vor einer spezifischen Thrombozytenfunktionsdiagnostik immer ausgeschlossen werden. Die Bestimmung von Zahl, Größe, Volumen (MPV) und Morphologie der Thrombozyten erlauben Rückschlüsse auf die zu Grunde liegende Störung.Die PFA-100®-Verschlusszeit eignet sich als Screening zum Ausschluss schwerer Thrombozytenfunktionsstörungen. Die Aggrego metrie ermöglicht die Untersuchung zahlreicher Aspekte der Thrombozytenfunktion. Die Durchflusszytometrie ist zur Diagnose von Thrombasthenie Glanzmann, Bernard-Soulier- Syndrom und Freisetzungsstörungen geeignet. Molekulargenetische Untersuchungen können die Verdachtsdiagnose bestätigen oder zum Nachweis nicht beschriebener Defekte verwendet werden. Hier wird die ungekürzte Version der inter -disziplinären Leitlinie* präsentiert.
Collapse
|
67
|
Cattaneo M. High on-treatment platelet reactivity – definition and measurement. Thromb Haemost 2017; 109:792-8. [DOI: 10.1160/th12-10-0758] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 01/23/2013] [Indexed: 12/31/2022]
Abstract
SummaryIn the last decade, several studies revealed inter-patient response variability to antiplatelet agents: patients who display negligible or no responses to these drugs are considered poor responders, or “resistant” to treatment. In order to identify poor responders to an antiplatelet drug, laboratory tests of platelet function that specifically explore the platelet activation pathway that is targeted by the drug should be utilised. In addition, they should be performed both at baseline and during treatment: however, most studies explored platelet function during antiplatelet treatment, in order to identify those patients with “high on-treatment platelet reactivity” (HPR), which exposes them to increased risk of major adverse cardiovascular events (MACE). Many tests of platelet function have been used, most of which are able to identify patients at risk of MACE. Unfortunately, universal cut-off values for HPR have not been clearly established yet. In addition, the concordance among different tests in the identification of patients at risk is very poor and the most effective and safe treatment for patients at risk is still unknown.
Collapse
|
68
|
Moenen FCJI, Vries MJA, Nelemans PJ, van Rooy KJM, Vranken JRRA, Verhezen PWM, Wetzels RJH, Ten Cate H, Schouten HC, Beckers EAM, Henskens YMC. Screening for platelet function disorders with Multiplate and platelet function analyzer. Platelets 2017; 30:81-87. [PMID: 29135309 DOI: 10.1080/09537104.2017.1371290] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Light transmission aggregation (LTA) is the gold standard for the diagnosis of platelet function disorders (PFDs), but it is time-consuming and limited to specialized laboratories. Whole-blood impedance aggregometry (Multiplate) and platelet function analyzer (PFA) may be used as rapid screening tools to exclude PFDs. The aim of this study is to assess the diagnostic performance of Multiplate and PFA for PFDs, as detected by LTA.Data from preoperative patients, patients referred to the hematologist for bleeding evaluation, and patients with a diagnosed bleeding disorder were used. PFDs were defined as ≥2 abnormal LTA curves. Diagnostic performance of Multiplate and PFA for detecting PFDs was expressed as sensitivity and specificity. The ability of Multiplate agonists and PFA kits to detect corresponding LTA curve abnormalities was expressed as area under the receiver operating characteristic curve. Prevalence of PFDs was 16/335 (4.8%) in preoperative patients, 10/54 (18.5%) in referred patients, and 3/25 (12%) in patients with a diagnosed bleeding disorder. In preoperative and referred patients, the sensitivity of Multiplate and PFA for detecting mild PFDs varied between 0% and 40% and AUCs for detecting corresponding LTA curve abnormalities were close to 0.50. In patients with a diagnosed bleeding disorder, both assays could detect Glanzmann thrombasthenia (GT) with sensitivity of 100% and AUCs of 0.70-1.00. Multiplate and PFA cannot discriminate between preoperative and referred patients with and without mild PFDs, meaning that they cannot be used as screening tests to rule out mild PFDs in these populations. Both Multiplate and PFA can detect GT in previously diagnosed patients.
Collapse
Affiliation(s)
- Floor C J I Moenen
- a Division of Haematology, Department of Internal Medicine , GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre +, Maastricht , The Netherlands
| | - Minka J A Vries
- b Department of Biochemistry , Maastricht University , Maastricht , The Netherlands
| | - Patricia J Nelemans
- c Department of Epidemiology , Maastricht University , Maastricht , The Netherlands
| | - Katrien J M van Rooy
- a Division of Haematology, Department of Internal Medicine , GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre +, Maastricht , The Netherlands
| | - Jeannique R R A Vranken
- d Central Diagnostic Laboratory, Unit for Hemostasis and Transfusion, Maastricht University Medical Centre+ , Maastricht , The Netherlands
| | - Paul W M Verhezen
- d Central Diagnostic Laboratory, Unit for Hemostasis and Transfusion, Maastricht University Medical Centre+ , Maastricht , The Netherlands
| | - Rick J H Wetzels
- d Central Diagnostic Laboratory, Unit for Hemostasis and Transfusion, Maastricht University Medical Centre+ , Maastricht , The Netherlands
| | - Hugo Ten Cate
- b Department of Biochemistry , Maastricht University , Maastricht , The Netherlands
| | - Harry C Schouten
- a Division of Haematology, Department of Internal Medicine , GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre +, Maastricht , The Netherlands
| | - Erik A M Beckers
- a Division of Haematology, Department of Internal Medicine , GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre +, Maastricht , The Netherlands
| | - Yvonne M C Henskens
- d Central Diagnostic Laboratory, Unit for Hemostasis and Transfusion, Maastricht University Medical Centre+ , Maastricht , The Netherlands
| |
Collapse
|
69
|
Gangaraju R, Rets A, Smock KJ, Heikal NM. Rare complication of treated immune thrombocytopenia. Am J Hematol 2017; 92:1262-1266. [PMID: 28801925 DOI: 10.1002/ajh.24884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 08/03/2017] [Accepted: 08/09/2017] [Indexed: 12/22/2022]
Affiliation(s)
- Radhika Gangaraju
- Division of Hematology-Oncology; Department of Medicine, University of Utah; Salt Lake City Utah
| | - Anton Rets
- Department of Pathology; University of Utah Health Sciences Center, and ARUP Laboratories Institute for Clinical and Experimental Pathology; Salt Lake City Utah 84108
| | - Kristi J. Smock
- Department of Pathology; University of Utah Health Sciences Center, and ARUP Laboratories Institute for Clinical and Experimental Pathology; Salt Lake City Utah 84108
| | - Nahla M. Heikal
- Department of Pathology; University of Utah Health Sciences Center, and ARUP Laboratories Institute for Clinical and Experimental Pathology; Salt Lake City Utah 84108
| |
Collapse
|
70
|
Platelet Aggregometry Testing: Molecular Mechanisms, Techniques and Clinical Implications. Int J Mol Sci 2017; 18:ijms18081803. [PMID: 28820484 PMCID: PMC5578190 DOI: 10.3390/ijms18081803] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 08/08/2017] [Accepted: 08/10/2017] [Indexed: 12/18/2022] Open
Abstract
Platelets play a fundamental role in normal hemostasis, while their inherited or acquired dysfunctions are involved in a variety of bleeding disorders or thrombotic events. Several laboratory methodologies or point-of-care testing methods are currently available for clinical and experimental settings. These methods describe different aspects of platelet function based on platelet aggregation, platelet adhesion, the viscoelastic properties during clot formation, the evaluation of thromboxane metabolism or certain flow cytometry techniques. Platelet aggregometry is applied in different clinical settings as monitoring response to antiplatelet therapies, the assessment of perioperative bleeding risk, the diagnosis of inherited bleeding disorders or in transfusion medicine. The rationale for platelet function-driven antiplatelet therapy was based on the result of several studies on patients undergoing percutaneous coronary intervention (PCI), where an association between high platelet reactivity despite P2Y12 inhibition and ischemic events as stent thrombosis or cardiovascular death was found. However, recent large scale randomized, controlled trials have consistently failed to demonstrate a benefit of personalised antiplatelet therapy based on platelet function testing.
Collapse
|
71
|
In vitro analysis of platelet function in acute aneurysmal subarachnoid haemorrhage. Neurosurg Rev 2017; 41:531-538. [DOI: 10.1007/s10143-017-0885-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 07/05/2017] [Accepted: 07/16/2017] [Indexed: 11/28/2022]
|
72
|
Akhlaghi F, Khaheshi I, Amirhassani S, Tabrizi R. Do antiplatelet drugs increase the risk of bleeding after tooth extraction? A case-crossover study. Int J Oral Maxillofac Surg 2017; 46:1475-1478. [PMID: 28663019 DOI: 10.1016/j.ijom.2017.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 04/25/2017] [Accepted: 06/05/2017] [Indexed: 10/19/2022]
Abstract
The aim of this study was to assess the risk of bleeding after tooth extraction in patients taking aspirin or clopidogrel. This case-crossover study evaluated patients taking aspirin (80mg/day) or clopidogrel (75mg/day) and undergoing tooth extraction. In the first session, extraction was performed without discontinuing aspirin (group 1) or clopidogrel (group 2). In the second session, patients ceased using antiplatelet drugs 5days prior to tooth extraction. Bleeding was evaluated using a visual analogue scale (VAS) for 72h after tooth extraction. The platelet function assay (PFA) was performed for group 1 and flow cytometry assessment of vasodilator-stimulated phosphoprotein (VASP) was performed for group 2, in both sessions. Thirty-eight patients were studied: 20 in group 1 and 18 in group 2. Analysis of the data did not demonstrate any difference in bleeding severity between sessions 1 and 2 in either group (P>0.05). There was a significant difference between sessions 1 and 2 in group 1 for the mean collagen/epinephrine membrane closure time (PFA) (P=0.001). A significant difference in platelet reactivity index (flow cytometry for VASP) was noted between sessions 1 and 2 in group 2 (P=0.001). According to this case-crossover study, dental extraction can be performed safely without withdrawal of aspirin or clopidogrel.
Collapse
Affiliation(s)
- F Akhlaghi
- Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - I Khaheshi
- Cardiovascular Research Centre, Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - S Amirhassani
- Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - R Tabrizi
- Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
73
|
Perez Botero J, Warad DM, He R, Uhl CB, Tian S, Otteson GE, Barness RL, Olson MC, Gossman SC, Charlesworth JE, Nichols WL, Pruthi RK, Chen D. Comprehensive Platelet Phenotypic Laboratory Testing and Bleeding History Scoring for Diagnosis of Suspected Hereditary Platelet Disorders. Am J Clin Pathol 2017; 148:23-32. [DOI: 10.1093/ajcp/aqx038] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
|
74
|
Synthesis of N -succinyl- and N -glutaryl-chitosan derivatives and their antioxidant, antiplatelet, and anticoagulant activity. Carbohydr Polym 2017; 166:166-172. [DOI: 10.1016/j.carbpol.2017.02.097] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 01/15/2017] [Accepted: 02/23/2017] [Indexed: 01/31/2023]
|
75
|
Practice patterns in the diagnosis of inherited platelet disorders within a single institution. Blood Coagul Fibrinolysis 2017; 28:303-308. [DOI: 10.1097/mbc.0000000000000596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
76
|
Yaoi H, Shida Y, Ogiwara K, Hosokawa K, Shima M, Nogami K. Role of red blood cells in the anemia-associated bleeding under high shear conditions. Haemophilia 2017; 23:750-758. [PMID: 28470853 DOI: 10.1111/hae.13252] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Red blood cells (RBCs) contribute to hemostasis under blood-flow, and anemia might contribute to a hemorrhagic diathesis. The majority of current laboratory techniques to assess hemostasis do not consider the effects of RBCs. An assay to determine the role of RBCs in hemostasis could be beneficial for clinical management. OBJECTIVES To investigate the influence of RBCs in hemostasis. METHODS Hemostasis was investigated using a novel microchip flow-chamber system (T-TAS® ) in an anemic patient with von Willebrand disease. Subsequently, the effects of RBCs in total thrombus analysis system (T-TAS) were examined using reconstituted whole blood at various hematocrit levels. RESULTS In vivo: When the patient was anemic and demonstrated persisted hemorrhagic symptoms despite the maintained adequate von Willebrand factor ristocetin cofactor activity levels, thrombus formation determined by T-TAS was delayed. However, transfusions of RBCs resolved bleeding symptom and, accordingly, the thrombus formation in T-TAS improved. In vitro: Thrombus formation determined by T-TAS at 1000 s-1 was dose-dependent on hematocrit (the time to reach 10 kPa (T10 ): 10.0 ± 0, 9.5 ± 1.4, 6.7 ± 2.4, 2.8 ± 1.6 min at hematocrits of 0%, 12.5%, 25% and 50%, respectively). Markedly defective thrombus formation (T10 >10 min) was confirmed at a hematocrit <25% at 2000 s-1 . CONCLUSION Red blood cells play an essential role in hemostasis under high shear, and RBC transfusions could be effective for refractory bleeding in patients with anemia. T-TAS measurements appear to reflect the hemostatic consequences of diminished red cell numbers under blood-flow, and could provide a valuable means for monitoring patients.
Collapse
Affiliation(s)
- H Yaoi
- Department of Pediatrics, Nara Medical University, Kashihara, Nara, Japan
| | - Y Shida
- Department of Pediatrics, Nara Medical University, Kashihara, Nara, Japan
| | - K Ogiwara
- Department of Pediatrics, Nara Medical University, Kashihara, Nara, Japan
| | - K Hosokawa
- Research Institute, Fujimori Kogyo Co., Ltd., Yokohama, Kanagawa, Japan
| | - M Shima
- Department of Pediatrics, Nara Medical University, Kashihara, Nara, Japan
| | - K Nogami
- Department of Pediatrics, Nara Medical University, Kashihara, Nara, Japan
| |
Collapse
|
77
|
Bogdanic D, Karanovic N, Mratinovic-Mikulandra J, Paukovic-Sekulic B, Brnic D, Marinovic I, Nonkovic D, Bogdanic N. The Role of Platelet Function Analyzer Testing in Cardiac Surgery Transfusion Management. Transfus Med Hemother 2017; 44:106-113. [PMID: 28503127 PMCID: PMC5425762 DOI: 10.1159/000452863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 10/19/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Identifying high-risk patients for transfusion after cardiac operations would alter postoperative management. The aim of this study was to investigate closure time (CT) measured by platelet function analyzer (PFA) for prediction of bleeding and transfusions. METHODS 66 patients were scheduled for coronary artery bypass graft (CABG) surgery and 30 patients for valve repair and replacement (non-CABG). Measurements of PFA-100® CT for collagen and adenosine diphosphate (cADP) and collagen and epinephrine (cEPI) were performed 15 min after protamine administration. Blood loss was measured, and the amount of transfusion products was recorded postoperatively. RESULTS The study demonstrated significant differences between CABG patients with cADP-CT ≥ 118 s and those with cADP-CT < 118 s with regard to blood loss for 24 h (p = 0.001) and blood loss for 25-48 h (p = 0.003) as well as fresh frozen plasma (p = 0.015), platelet (p > 0.001) and red blood cell (p = 0.002) units given in 48 postoperative h. There were no differences cardiopulmonary bypass when was applied. In non-CABG patients, there were no differences in blood loss and transfusion requirements with respect to cADP-CT and cEPI-CT. CONCLUSION Postoperative platelet dysfunction measured by a prolonged cADP-CT was significant predictor of blood loss and transfusion in CABG patients.
Collapse
Affiliation(s)
- Dejana Bogdanic
- Department of Transfusion Medicine, University Hospital Center Split, Split, Croatia
| | - Nenad Karanovic
- Department of Anesthesiology and Intensive Care, University Hospital Center Split, Split, Croatia
| | | | | | - Dijana Brnic
- Department of Diagnostic and Interventional Radiology, University Hospital Center Split, Split, Croatia
| | - Ivanka Marinovic
- Department of Physical Medicine, University Hospital Center Split, Split, Croatia
| | - Diana Nonkovic
- Department of Epidemiology, Teaching Institute of Public Health, Split, Croatia
| | | |
Collapse
|
78
|
Abstract
A patient underwent C2-T2 decompression and fusion with excessive intraoperative bleeding and no clear source. The patient denied the use of blood-thinning medications, but had consumed the equivalent of 12 g garlic daily in the days leading up to the surgery. He was treated with desmopressin acetate (DDAVP) and cryoprecipitate with adequate control of bleeding. Garlic is known to have an antiplatelet effect, although the dose range necessary to create a bleeding abnormality has not yet been well described nor has the effect of taking garlic with sertraline or other agents with an established or potential effect on coagulation.
Collapse
Affiliation(s)
- Anna Woodbury
- From the *Department of Anesthesiology, Veterans Affairs Medical Center-Atlanta, Decatur, Georgia; and †Department of Anesthesiology, Emory University, Atlanta, Georgia
| | | |
Collapse
|
79
|
Pearson C, Przyklenk K, Mika VH, Ayaz SI, Ellis M, Varade P, Tolomello R, Welch RD. Utility of point of care assessment of platelet reactivity (using the PFA-100®) to aid in diagnosis of stroke. Am J Emerg Med 2016; 35:802.e1-802.e5. [PMID: 27955971 DOI: 10.1016/j.ajem.2016.11.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 11/08/2016] [Accepted: 11/14/2016] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Rapid and accurate diagnosis of patients presenting with symptoms of stroke is needed to facilitate the timely delivery of proven effective treatment for patients with acute ischemic stroke (AIS). The aim of this study was to determine whether early assessment of platelet reactivity in patients presenting with symptoms of AIS was associated with a diagnosis of AIS, transient ischemic attack (TIA), or stroke mimic. METHODS This prospective study included patients with symptoms of AIS treated at an inner-city emergency department (ED). Blood samples were obtained and assayed for platelet reactivity (quantified by closure time). Patients were grouped by discharge diagnosis into: AIS, TIA, or stroke mimic. Binary logistic regression model was used to predict the association of closure time with the final diagnosis of 1) either AIS or TIA or, 2) stroke mimic. RESULTS Of 114 patients enrolled, 32 were diagnosed with AIS, 33 TIA, and 49 were diagnosed as a stroke mimic. There was no significant difference in closure times among patients with a diagnosis of AIS or TIA versus stroke mimic. A history of migraines and history of seizures were independently associated with lower odds of an AIS or TIA diagnosis (OR 0.31, 95% CI 0.10 to 0.94 and OR 0.08, 95% CI 0.01 to 0.88, respectively). CONCLUSION Closure time was not found to be a clinically reliable differentiator of patients with a diagnosis of AIS, TIA, or stroke mimic in the ED.
Collapse
Affiliation(s)
- Claire Pearson
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, USA.
| | - Karin Przyklenk
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, USA; Department of Physiology, Wayne State University School of Medicine, Detroit, MI, USA; Cardiovascular Research Institute, Wayne State University School of Medicine, Detroit, MI, USA
| | - Valerie H Mika
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Syed Imran Ayaz
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Morgan Ellis
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Preet Varade
- Department of Neurology/Neurocritical Care, Lehigh Valley Physician Group, Allentown, PA, USA
| | - Rosa Tolomello
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Robert D Welch
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, USA; Cardiovascular Research Institute, Wayne State University School of Medicine, Detroit, MI, USA
| |
Collapse
|
80
|
Griego-Valles M, Buriko Y, Prittie JE, Fox PR. An in vitro comparison of the effects of voluven (6% hydroxyethyl starch 130/0.4) and hespan (6% hydroxyethyl starch 670/0.75) on measures of blood coagulation in canine blood. J Vet Emerg Crit Care (San Antonio) 2016; 27:44-51. [PMID: 27712013 DOI: 10.1111/vec.12541] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 03/24/2015] [Accepted: 04/11/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To assess primary and secondary hemostasis following in vitro dilution of canine whole blood (WB) with hydroxyethyl starch (HES) 130/0.4 and HES 670/0.75. DESIGN In vitro experimental study. SETTING Private practice, teaching hospital. ANIMALS Twenty-five healthy dogs. INTERVENTIONS Each dog underwent venipuncture and 18 mL of venous blood was sampled once. MEASUREMENTS AND MAIN RESULTS Collected blood was separated in 4 aliquots. Aliquot A served as baseline sample. The remaining tubes of WB were diluted with 0.9% saline, HES 670/0.75 and HES 130/0.4 at a ratio of 1:5.5. Dilutional effects were evaluated using prothrombin time (PT), activated partial thromboplastin time (aPTT), packed cell volume (PCV), thromboelastography (TEG), and platelet closure time (Ct), which was measured using a platelet function analyzer (PFA). Clot strength (ie, G value) was calculated from measured TEG values. Significant increases in PT (P < 0.05) and aPTT (P < 0.05) were documented following WB dilution with saline. Dilution of WB with HES 670/0.75 and HES 130/0.4 resulted in significant hypocoagulable changes in K, MA and G (P < 0.05) compared to baseline and saline. When comparing saline to HES 670/0.75, both R and K values were significantly increased (P < 0.05). K value was significantly increased (P < 0.05) when comparing baseline to HES 130/0.4 and HES 670/0.75. Ct (P < 0.05) was significantly prolonged after WB dilution with HES solutions but not after saline. CONCLUSIONS Dilution of WB with HES 670/0.75 and HES 130/0.4 resulted in changes in primary and secondary hemostasis. Although there were small differences between saline and HES 670/0.75, no differences between HES solutions were evident in this small study. This may suggest there would be minimal increases in bleeding risk when either solution is administered to dogs at low doses. Clinical relevance of our findings requires further investigation.
Collapse
Affiliation(s)
- Michelle Griego-Valles
- Department of Emergency and Critical Care, The Animal Medical Center, New York, NY, 10065
| | - Yekaterina Buriko
- Department of Emergency and Critical Care, The Animal Medical Center, New York, NY, 10065
| | - Jennifer E Prittie
- Department of Emergency and Critical Care, The Animal Medical Center, New York, NY, 10065
| | - Philip R Fox
- Department of Emergency and Critical Care, The Animal Medical Center, New York, NY, 10065
| |
Collapse
|
81
|
Gresele P, Falcinelli E, Bury L. Inherited platelet function disorders. Diagnostic approach and management. Hamostaseologie 2016; 36:265-278. [PMID: 27484722 DOI: 10.5482/hamo-16-02-0002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 07/16/2016] [Indexed: 12/25/2022] Open
Abstract
Inherited platelet function disorders (IPFDs) make up a significant proportion of congenital bleeding diatheses, but they remain poorly understood and often difficult to diagnose. Therefore, a rational diagnostic approach, based on a standardized sequence of laboratory tests, with consecutive steps of increasing level of complexity, plays a crucial role in the diagnosis of most IPFDs. In this review we discuss a diagnostic approach through platelet phenotyping and genotyping and we give an overview of the options for the management of bleeding in these disorders and an account of the few systematic studies on the bleeding risk associated with invasive procedures and its treatment.
Collapse
Affiliation(s)
- Paolo Gresele
- Paolo Gresele, MD, PhD, Division of Internal and Cardiovascular Medicine Department of Medicine, University of Perugia, Via E. dal Pozzo, 06126 Perugia, Italy, Tel. +39/07 55 78 39 89, Fax +39/07 55 71 60 83, E-Mail:
| | | | | |
Collapse
|
82
|
Boender J, Kruip MJHA, Leebeek FWG. A diagnostic approach to mild bleeding disorders. J Thromb Haemost 2016; 14:1507-16. [PMID: 27208505 DOI: 10.1111/jth.13368] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Indexed: 01/02/2023]
Abstract
Mild inherited bleeding disorders are relatively common in the general population. Despite recent advances in diagnostic approaches, mild inherited bleeding disorders still pose a significant diagnostic challenge. Hemorrhagic diathesis can be caused by disorders in primary hemostasis (von Willebrand disease, inherited platelet function disorders), secondary hemostasis (hemophilia A and B, other (rare) coagulant factor deficiencies) and fibrinolysis, and in connective tissue or vascular formation. This review summarizes the currently available diagnostic methods for mild bleeding disorders and their pitfalls, from structured patient history to highly specialized laboratory diagnosis. A comprehensive framework for a diagnostic approach to mild inherited bleeding disorders is proposed.
Collapse
Affiliation(s)
- J Boender
- Department of Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - M J H A Kruip
- Department of Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - F W G Leebeek
- Department of Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands
| |
Collapse
|
83
|
Podda G, Femia EA, Cattaneo M. Current and emerging approaches for evaluating platelet disorders. Int J Lab Hematol 2016; 38 Suppl 1:50-8. [DOI: 10.1111/ijlh.12539] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 05/03/2016] [Indexed: 01/19/2023]
Affiliation(s)
- G. Podda
- Unità di Medicina III; ASST Santi Paolo e Carlo; Dipartimento di Scienze della Salute; Università degli Studi di Milano; Milan Italy
| | - E. A. Femia
- Unità di Medicina III; ASST Santi Paolo e Carlo; Dipartimento di Scienze della Salute; Università degli Studi di Milano; Milan Italy
| | - M. Cattaneo
- Unità di Medicina III; ASST Santi Paolo e Carlo; Dipartimento di Scienze della Salute; Università degli Studi di Milano; Milan Italy
| |
Collapse
|
84
|
Kurak J, Zając P, Czyżewski D, Kucharski R, Grzanka R, Kasperska-Zajac A, Koczy B. Evaluation of platelet function using PFA-100® in patients treated with Acetylsalicylic acid and qualified for Trauma and Orthopedic surgery procedures. Platelets 2016; 27:680-686. [DOI: 10.3109/09537104.2016.1158401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
85
|
Ramalingam G, Jones N, Besser M. Platelets for anaesthetists—part 1: physiology and pathology. BJA Educ 2016. [DOI: 10.1093/bjaed/mkv027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
86
|
McBride D, Hosgood G, Raisis A, Smart L. Platelet closure time in anesthetized Greyhounds with hemorrhagic shock treated with hydroxyethyl starch 130/0.4 or 0.9% sodium chloride infusions. J Vet Emerg Crit Care (San Antonio) 2016; 26:509-15. [PMID: 27002312 DOI: 10.1111/vec.12468] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 11/04/2014] [Accepted: 11/04/2014] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To measure platelet closure time (PCT) in dogs during controlled hemorrhagic shock and after fluid resuscitation with hydroxyethyl starch (HES) 130/0.4 or 0.9% sodium chloride. DESIGN Experimental interventional study. SETTING University veterinary teaching hospital. ANIMALS Eleven healthy Greyhounds. INTERVENTIONS Dogs were anesthetized and had 48 mL/kg of blood removed to induce hemorrhagic shock. Dogs received 20 mL/kg of HES 130/0.4 (n = 6) or 80 mL/kg of 0.9% sodium chloride (NaCl; n = 5) intravenously over 20 minutes. PCT was measured using the Platelet Function Analyzer-100 with collagen and adenosine-diphosphate cartridges at: T0 = 60 minutes after induction of anesthesia prior to hemorrhage, T1 = during hemorrhagic shock, and T2 = 40 minutes after completion of fluid bolus. Packed cell volume and platelet count were concurrently measured. MEASUREMENT AND MAIN RESULTS Hemorrhagic shock did not significantly change PCT, with no difference between T0 and T1. Both the HES 130/0.4 and 0.9% NaCl group had a significantly increased mean PCT at T2 of 91.4 seconds (95% CI 69.3-113.4) and 95.5 seconds (95% CI 78.2-112.8), respectively, compared to T1. The magnitude of change was significantly greater for the 0.9% NaCl group than the HES 130/0.4 group. There was no difference in the magnitude of change in PCV and platelet count between the 2 groups. The PCV and platelet count were >25% and >100,000/μL, respectively, in all dogs, except for dogs in the HES 130/0.4 group at T2 where platelet counts were <100,000/μL. CONCLUSION Controlled hemorrhagic shock in Greyhounds under anesthesia did not cause a significant change in PCT. Both HES 130/0.4 and 0.9% NaCl administration after induction of shock increased PCT. These results do not support that HES 130/0.4 causes relevant platelet dysfunction beyond hemodilution.
Collapse
Affiliation(s)
- Duana McBride
- Department of Clinical Sciences and Service, The Royal Veterinary College, University of London, North Mymms, Hertfordshire, UK
| | - Giselle Hosgood
- Department of Clinical Sciences and Service, The Royal Veterinary College, University of London, North Mymms, Hertfordshire, UK
| | - Anthea Raisis
- Department of Clinical Sciences and Service, The Royal Veterinary College, University of London, North Mymms, Hertfordshire, UK
| | - Lisa Smart
- School of Veterinary and Life Sciences, College of Veterinary Medicine, Murdoch University, Murdoch Drive, Western Australia, Australia
| |
Collapse
|
87
|
Ramipril and Losartan Exert a Similar Long-Term Effect upon Markers of Heart Failure, Endogenous Fibrinolysis, and Platelet Aggregation in Survivors of ST-Elevation Myocardial Infarction: A Single Centre Randomized Trial. BIOMED RESEARCH INTERNATIONAL 2016; 2016:9040457. [PMID: 27064499 PMCID: PMC4811062 DOI: 10.1155/2016/9040457] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 02/25/2016] [Indexed: 11/28/2022]
Abstract
Introduction. Blocking the renin-angiotensin-aldosterone system in ST-elevation myocardial infarction (STEMI) patients prevents heart failure and recurrent thrombosis. Our aim was to compare the effects of ramipril and losartan upon the markers of heart failure, endogenous fibrinolysis, and platelet aggregation in STEMI patients over the long term. Methods. After primary percutaneous coronary intervention (PPCI), 28 STEMI patients were randomly assigned ramipril and 27 losartan, receiving therapy for six months with dual antiplatelet therapy (DAPT). We measured N-terminal proBNP (NT-proBNP), ejection fraction (EF), plasminogen-activator-inhibitor type 1 (PAI-1), and platelet aggregation by closure times (CT) at the baseline and after six months. Results. Baseline NT-proBNP ≥ 200 pmol/mL was observed in 48.1% of the patients, EF < 55% in 49.1%, and PAI-1 ≥ 3.5 U/mL in 32.7%. Six-month treatment with ramipril or losartan resulted in a similar effect upon PAI-1, NT-proBNP, EF, and CT levels in survivors of STEMI, but in comparison to control group, receiving DAPT alone, ramipril or losartan treatment with DAPT significantly increased mean CT (226.7 ± 80.3 sec versus 158.1 ± 80.3 sec, p < 0.05). Conclusions. Ramipril and losartan exert a similar effect upon markers of heart failure and endogenous fibrinolysis, and, with DAPT, a more efficient antiplatelet effect in long term than DAPT alone.
Collapse
|
88
|
De Jong A, Eikenboom J. Developments in the diagnostic procedures for von Willebrand disease. J Thromb Haemost 2016; 14:449-60. [PMID: 26714181 DOI: 10.1111/jth.13243] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Indexed: 12/28/2022]
Abstract
Von Willebrand disease (VWD) is the most common inherited bleeding disorder but its diagnosis can be challenging due to the heterogeneity of the disease. VWD is mainly associated with mild mucocutaneous bleeding, although there are more severe phenotypes with bleeding from the gastrointestinal tract or even the joints. Also, surgical interventions and trauma may lead to critical bleeding events. These bleeding episodes are all related to quantitative or qualitative defects of von Willebrand factor (VWF), a multimeric glycoprotein produced by endothelial cells and megakaryocytes, which mediates platelet adhesion and aggregation and binds factor VIII (FVIII) in the circulation. This review describes the diagnostic procedures required for correct diagnosis. Accurate diagnosis and classification is required for proper treatment and counseling. Assessment of bleeding starts with the medical history. After a positive bleeding or family history, subsequent laboratory investigations will start with a panel of standard screening tests for hemostatic defects. Patients suspected of having VWD will be tested for plasma VWF antigen levels, the ability of VWF to bind platelets and FVIII activity. When VWD is confirmed, a set of subtyping tests can classify the patients as VWD types 1, 2 (A, B, M or N) or 3. The performance of some additional assays and analyses, such as VWF propeptide measurement or genetic analysis, may help in identifying the pathological mechanism behind certain defects or can guide in the choice of treatment.
Collapse
Affiliation(s)
- A De Jong
- Department of Thrombosis and Haemostasis, Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - J Eikenboom
- Department of Thrombosis and Haemostasis, Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, the Netherlands
| |
Collapse
|
89
|
Pearson K, Jensen H, Kander T, Schött U. Desmopressinin vitroeffects on platelet function, monitored with Multiplate, ROTEM and Sonoclot. Scand J Clin Lab Invest 2016; 76:282-90. [DOI: 10.3109/00365513.2016.1149615] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
90
|
Mărginean A, Bănescu C, Scridon A, Dobreanu M. Anti-platelet Therapy Resistance - Concept, Mechanisms and Platelet Function Tests in Intensive Care Facilities. J Crit Care Med (Targu Mures) 2016; 2:6-15. [PMID: 29967831 PMCID: PMC5939137 DOI: 10.1515/jccm-2015-0021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Accepted: 07/10/2015] [Indexed: 01/22/2023] Open
Abstract
It is well known that critically ill patients require special attention and additional consideration during their treatment and management. The multiple systems and organ dysfunctions, typical of the critical patient, often results in different patterns of enteral absorption in these patients. Anti-platelet drugs are the cornerstone in treating patients with coronary and cerebrovascular disease. Dual anti-platelet therapy with aspirin and clopidogrel is the treatment of choice in patients undergoing elective percutaneous coronary interventions and is still widely used in patients with acute coronary syndromes. However, despite the use of dual anti-platelet therapy, some patients continue to experience cardiovascular ischemic events. Recurrence of ischemic events is partly attributed to the fact that some patients have poor inhibition of platelet reactivity despite treatment. These patients are considered low- or non-responders to therapy. The underlying mechanisms leading to resistance are not yet fully elucidated and are probably multifactorial, cellular, genetic and clinical factors being implicated. Several methods have been developed to asses platelet function and can be used to identify patients with persistent platelet reactivity, which have an increased risk of thrombosis. In this paper, the concept of anti-platelet therapy resistance, the underlying mechanisms and the methods used to identify patients with low responsiveness to anti-platelet therapy will be highlighted with a focus on aspirin and clopidogrel therapy and addressing especially critically ill patients.
Collapse
Affiliation(s)
- Alina Mărginean
- University of Medicine and Pharmacy of Tîrgu Mures, Tîrgu Mures, Romania
- Emergency Military Hospital “Dr. Constantin Papilian”, Cluj-Napoca, Romania
| | - Claudia Bănescu
- University of Medicine and Pharmacy of Tîrgu Mures, Tîrgu Mures, Romania
| | - Alina Scridon
- University of Medicine and Pharmacy of Tîrgu Mures, Tîrgu Mures, Romania
| | - Minodora Dobreanu
- University of Medicine and Pharmacy of Tîrgu Mures, Tîrgu Mures, Romania
| |
Collapse
|
91
|
|
92
|
Bartels A, Sarpong Y, Coberly J, Hughes N, Litt J, Quick J, Kessel J, Nelson C, Coughenour J, Barnes SL, Litofsky NS, Hammer RD, Ahmad S. Failure of the Platelet Function Assay (PFA)-100 to detect antiplatelet agents. Surgery 2015; 158:1012-8; discussion 1018-9. [DOI: 10.1016/j.surg.2015.07.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 07/07/2015] [Accepted: 07/14/2015] [Indexed: 11/26/2022]
|
93
|
Blois SL, Lang ST, Wood RD, Monteith G. Biologic variability and correlation of platelet function testing in healthy dogs. Vet Clin Pathol 2015; 44:503-10. [DOI: 10.1111/vcp.12290] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Shauna L. Blois
- Department of Clinical Studies; Ontario Veterinary College; University of Guelph; Guelph ON Canada
| | - Sean T. Lang
- Department of Clinical Studies; Ontario Veterinary College; University of Guelph; Guelph ON Canada
| | - R. Darren Wood
- Department of Pathobiology; Ontario Veterinary College; University of Guelph; Guelph ON Canada
| | - Gabrielle Monteith
- Department of Clinical Studies; Ontario Veterinary College; University of Guelph; Guelph ON Canada
| |
Collapse
|
94
|
Abstract
The International Federation of Gynecology and Obstetrics and the American Congress of Obstetricians and Gynecologists support the use of new terminology for abnormal uterine bleeding (AUB) to consistently categorize AUB by etiology. The term AUB can be further classified as AUB/heavy menstrual bleeding (HMB) (replacing the term "menorrhagia") or AUB/intermenstrual bleeding (replacing the term "metrorrhagia"). Although many cases of AUB in adolescent women are attributable to immaturity of the hypothalamic-pituitary-ovarian axis, underlying bleeding disorders should be considered in women with AUB/HMB. This article reviews the new terminology for AUB, discusses important relevant features of history and examination, presents the laboratory evaluation of HMB, and describes hormonal (oral contraceptive pills, progestin-only methods, long-acting reversible contraceptives including intrauterine systems), hematologic (tranexamic acid and desmopressin), and surgical management options for AUB/HMB.
Collapse
|
95
|
Ramalingam G, Jones N, Besser M. Platelets for anaesthetists—part 1: physiology and pathology. BJA Educ 2015. [DOI: 10.1093/bjaceaccp/mkv027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
96
|
Minami H, Nogami K, Ogiwara K, Furukawa S, Hosokawa K, Shima M. Use of a microchip flow-chamber system as a screening test for platelet storage pool disease. Int J Hematol 2015; 102:157-62. [DOI: 10.1007/s12185-015-1819-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 05/19/2015] [Accepted: 06/02/2015] [Indexed: 11/30/2022]
|
97
|
Schmitt C, Abt M, Ciorciaro C, Kling D, Jamois C, Schick E, Solier C, Benghozi R, Gaudreault J. First-in-Man Study With Inclacumab, a Human Monoclonal Antibody Against P-selectin. J Cardiovasc Pharmacol 2015; 65:611-9. [PMID: 25714598 PMCID: PMC4461388 DOI: 10.1097/fjc.0000000000000233] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 01/20/2015] [Indexed: 11/25/2022]
Abstract
Inclacumab, a novel monoclonal antibody against P-selectin in development for the treatment and prevention of atherosclerotic cardiovascular diseases, was administered in an ascending single-dose study as intravenous infusion to evaluate safety, pharmacokinetics, and pharmacodynamics. Fifty-six healthy subjects were enrolled in this randomized, double-blind placebo-controlled study. Each dose level (0.03-20 mg/kg) was investigated in separate groups of 8 subjects (6 on inclacumab, 2 on placebo). Platelet-leukocyte aggregates, free/total soluble P-selectin concentration ratio, drug concentrations, bleeding time, platelet aggregation, antibody formation, and routine laboratory parameters were measured frequently until 32 weeks. Pharmacokinetic profiles were indicative of target-mediated drug disposition. Platelet-leukocyte aggregate inhibition and soluble P-selectin occupancy showed dose dependency and were strongly correlated to inclacumab plasma concentrations, with IC50 of 740 and 4600 ng/mL, respectively. Inclacumab was well tolerated by the majority of subjects and did neither affect bleeding time nor platelet aggregation. These findings allowed the investigation of the potential beneficial therapeutic use of inclacumab in patient study.
Collapse
Affiliation(s)
| | - Markus Abt
- F. Hoffmann-La Roche AG, Basel, Switzerland; and
| | | | | | | | | | | | | | | |
Collapse
|
98
|
Dovlatova N. Current status and future prospects for platelet function testing in the diagnosis of inherited bleeding disorders. Br J Haematol 2015; 170:150-61. [PMID: 25920378 DOI: 10.1111/bjh.13405] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Platelets play a crucial role in haemostasis by preventing bleeding at the site of vascular injury. Several defects in platelet morphology and function have been identified and described over the years. Although a range of methodologies is available to assess platelet function, a significant proportion of subjects with bleeding symptoms and normal coagulation parameters still appear to have normal results on platelet function testing. This might suggest that the reason for bleeding is multifactorial and is due to a combination of several minor defects in platelet function and/or other parts of the haemostatic system or might indicate that the currently available platelet function tests do not provide optimal diagnostic power. This review will summarize the established platelet function tests used for diagnosing inherited platelet abnormalities in adults and children, and discuss the newly developed methodologies as well as unmet challenges and potential areas for further improvement in this field.
Collapse
Affiliation(s)
- Natalia Dovlatova
- Division of Clinical Neuroscience, Thrombosis and Haemostasis Research Group, Queens Medical Centre, University of Nottingham, Nottingham, UK
| |
Collapse
|
99
|
Floyd CN, Goodman T, Becker S, Chen N, Mustafa A, Schofield E, Campbell J, Ward M, Sharma P, Ferro A. Increased platelet expression of glycoprotein IIIa following aspirin treatment in aspirin-resistant but not aspirin-sensitive subjects. Br J Clin Pharmacol 2015; 78:320-8. [PMID: 25099258 DOI: 10.1111/bcp.12335] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 01/18/2014] [Indexed: 12/27/2022] Open
Abstract
AIMS Aspirin is widely used as an anti-platelet agent for cardiovascular prophylaxis. Despite aspirin treatment, many patients experience recurrent thrombotic events, and aspirin resistance may contribute to this. We examined the prevalence of aspirin resistance in a healthy population, and investigated whether the platelet proteome differed in aspirin-resistant subjects. METHODS Ninety-three healthy subjects received aspirin 300 mg daily for 28 days. Before and at the end of treatment, urine was taken to determine 11-dehydrothromboxane B2 , and blood was taken to measure arachidonic acid (AA)-induced aggregation of platelet-rich plasma and to interrogate the platelet proteome by mass spectrometric analysis with further confirmation of findings using Western blotting. RESULTS In two of the 93 subjects, neither AA-induced aggregation nor urinary 11-dehydrothromboxane B2 was effectively suppressed by aspirin, despite measurable plasma salicylate concentrations, suggesting the presence of true aspirin resistance. Despite no detectable differences in the platelet proteome at baseline, following aspirin a marked increase was seen in platelet glycoprotein IIIa expression in the aspirin-resistant but not aspirin-sensitive subjects. An increase in platelet glycoprotein IIIa expression with aspirin resistance was confirmed in a separate cohort of 17 patients with stable coronary artery disease on long term aspirin treatment, four of whom exhibited aspirin resistance. CONCLUSIONS In a healthy population, true aspirin resistance is uncommon but exists. Resistance is associated with an increase in platelet glycoprotein IIIa expression in response to aspirin. These data shed new light on the mechanism of aspirin resistance, and provide the potential to identify aspirin-resistant subjects using a novel biomarker.
Collapse
Affiliation(s)
- Christopher N Floyd
- Department of Clinical Pharmacology, Cardiovascular Division, British Heart Foundation Centre of Research Excellence, King's College London, London, UK
| | | | | | | | | | | | | | | | | | | |
Collapse
|
100
|
Abstract
In physiological hemostasis a prompt recruitment of platelets on the vessel damage prevents the bleeding by the rapid formation of a platelet plug. Qualitative and/or quantitative platelet defects promote bleeding, whereas the high residual reactivity of platelets in patients on antiplatelet therapies moves forward thromboembolic complications. The biochemical mechanisms of the different phases of platelet activation – adhesion, shape change, release reaction, and aggregation – have been well delineated, whereas their complete translation into laboratory assays has not been so fulfilled. Laboratory tests of platelet function, such as bleeding time, light transmission platelet aggregation, lumiaggregometry, impedance aggregometry on whole blood, and platelet activation investigated by flow cytometry, are traditionally utilized for diagnosing hemostatic disorders and managing patients with platelet and hemostatic defects, but their use is still limited to specialized laboratories. To date, a point-of-care testing (POCT) dedicated to platelet function, using pertinent devices much simpler to use, has now become available (ie, PFA-100, VerifyNow System, Multiplate Electrode Aggregometry [MEA]). POCT includes new methodologies which may be used in critical clinical settings and also in general laboratories because they are rapid and easy to use, employing whole blood without the necessity of sample processing. Actually, these different platelet methodologies for the evaluation of inherited and acquired bleeding disorders and/or for monitoring antiplatelet therapies are spreading and the study of platelet function is strengthening. In this review, well-tried and innovative platelet function tests and their methodological features and clinical applications are considered.
Collapse
Affiliation(s)
- Rita Paniccia
- Department of Experimental and Clinical Medicine, Thrombosis Center, University of Florence, Florence, Italy ; Department of Heart and Vessels, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Raffaella Priora
- Department of Experimental and Clinical Medicine, Thrombosis Center, University of Florence, Florence, Italy ; Department of Heart and Vessels, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | | | - Rosanna Abbate
- Department of Experimental and Clinical Medicine, Thrombosis Center, University of Florence, Florence, Italy ; Department of Heart and Vessels, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| |
Collapse
|