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Ruiz-Argüelles GJ. Professor Peter Kubisz (1942-2022)-Un hommage à trois étincelles. Semin Thromb Hemost 2023; 49:209-211. [PMID: 36572022 DOI: 10.1055/s-0042-1760198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Moore GW, Castoldi E, Teruya J, Morishita E, Adcock DM. Factor V Leiden-independent activated protein C resistance: Communication from the plasma coagulation inhibitors subcommittee of the International Society on Thrombosis and Haemostasis Scientific and Standardisation Committee. JOURNAL OF THROMBOSIS AND HAEMOSTASIS : JTH 2023; 21:164-174. [PMID: 36695379 DOI: 10.1016/j.jtha.2022.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/30/2022] [Accepted: 10/06/2022] [Indexed: 01/09/2023]
Abstract
Activated protein C resistance (APC-R) due to the single-nucleotide polymorphism factor V Leiden (FVL) is the most common cause of hereditary thrombophilia. It is found predominantly in Caucasians and is uncommon or absent in other populations. Although FVL is responsible for >90% of cases of hereditary APC-R, a number of other F5 variants that also confer various degrees of APC-R and thrombotic risk have been described. Acquired APC-R due to increased levels of coagulation factors, reduced levels of inhibitors, or the presence of autoantibodies occurs in a variety of conditions and is an independent risk factor for thrombosis. It is common for thrombophilia screening protocols to restrict assessment for APC-R to demonstrating the presence or absence of FVL. The aim of this Scientific and Standardisation Committee communication is to detail the causes of FVL-independent APC-R to widen the diagnostic net, particularly in situations in which in vitro APC-R is encountered in the absence of FVL. Predilution clotting assays are not FVL specific and are used to detect clinically significant F5 variants conferring APC-R, whereas different forms of acquired APC-R are preferentially detected using the classical activated partial thromboplastin time-based APC-R assay without predilution and/or endogenous thrombin potential APC-R assays. Resource-specific recommendations are given to guide the detection of FVL-independent APC-R.
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Affiliation(s)
- Gary W Moore
- Department of Haematology, Specialist Haemostasis Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; Faculty of Science and Technology, Middlesex University, London, UK.
| | - Elisabetta Castoldi
- Department of Biochemistry, CARIM, Maastricht University, Maastricht, the Netherlands
| | - Jun Teruya
- Department of Pathology & Immunology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA; Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA; Department of Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Eriko Morishita
- Department of Hematology, Kanazawa University Hospital, Kanazawa, Japan
| | - Dorothy M Adcock
- Laboratory Corporation of America Holdings, Burlington, North Carolina, USA
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Minutti-Zanella C, Villarreal-Martínez L, Ruiz-Argüelles GJ. Primary Thrombophilia XVII: A Narrative Review of Sticky Platelet Syndrome in México. J Clin Med 2022; 11:jcm11144100. [PMID: 35887863 PMCID: PMC9315593 DOI: 10.3390/jcm11144100] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 07/12/2022] [Accepted: 07/14/2022] [Indexed: 02/01/2023] Open
Abstract
Sticky Platelet Syndrome (SPS) is a disorder characterized by platelet hyperaggregability, diagnosed by studying in vitro platelet aggregation with ADP and epinephrine. It is the second most common cause of thrombophilia in Mexican Mestizos and manifests as an autosomal dominant trait which, combined with other coagulopathies, contributes significantly to the morbidity and mortality of patients with primary thrombophilia. It is easily treatable with antiplatelet drugs; however, the methods for diagnosis are not readily available in all clinical laboratories and the disorder is often overlooked by most clinicians. Herein, we present the results of more than 20 years of Mexican experience with the study of SPS in a Mestizo population.
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Affiliation(s)
- Claudia Minutti-Zanella
- Laboratorios RUIZ-Escuela de Ciencias Médicas, Universidad Popular Autónoma del Estado de Puebla (UPAEP), Puebla 72530, Mexico;
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Stasko J, Holly P, Kubisz P. A new decade awaits sticky platelet syndrome: where are we now, how do we manage and what are the complications? Expert Rev Hematol 2022; 15:53-63. [PMID: 35034520 DOI: 10.1080/17474086.2022.2030217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Sticky platelet syndrome is a less known platelet function disorder with a familiar occurrence and likely genetic background. Clinically, it is characterized by an increased risk of venous and arterial thromboembolic events and obstetric placenta-mediated complications. The increased aggregation after low-dose ADP and/or epinephrine is its distinctive laboratory feature. Though described for almost 40 years, several issues regarding its etiology, involved pathomechanisms, genetic background, optimal diagnostic and treatment approach remain controversial. AREAS COVERED The work aims to summarize published studies, the actual definition of the syndrome, and point out its drawbacks. A literature search on Medline, Embase, and archives from EHA congresses was performed (terms: 'sticky platelet syndrome' - 'platelet hyperreactivity' - 'platelet hyperaggregability'). The authors added in their unpublished data. The introductory overview of the present understanding is followed by the discussion of the pathophysiologic, diagnostic, and therapeutic problems. EXPERT OPINION Despite the growing evidence provided by case reports and series, the lack of robust studies limits the decision-making on diagnostics and management. The diagnostic issues, particularly the standardization of light transmission aggregometry, represent the crucial problem for the broader acceptance of the syndrome.
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Affiliation(s)
- Jan Stasko
- Department of Hematology and Transfusion Medicine, National Center of Hemostasis and Thrombosis, Jessenius Faculty of Medicine in Martin of the Comenius University in Bratislava, University Hospital in Martin, Martin, Slovakia
| | - Pavol Holly
- Department of Hematology and Transfusion Medicine, National Center of Hemostasis and Thrombosis, University Hospital in Martin, Martin, Slovakia
| | - Peter Kubisz
- Department of Hematology and Transfusion Medicine, National Center of Hemostasis and Thrombosis, Jessenius Faculty of Medicine in Martin of the Comenius University in Bratislava, University Hospital in Martin, Martin, Slovakia
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García-Villaseñor E, Bojalil-Álvarez L, Murrieta-Álvarez I, Cantero-Fortiz Y, Ruiz-Delgado GJ, Ruiz-Argüelles GJ. Primary Thrombophilia XVI: A Look at the Genotype of the Sticky Platelet Syndrome Phenotype. Clin Appl Thromb Hemost 2021; 27:10760296211044212. [PMID: 34617458 PMCID: PMC8674482 DOI: 10.1177/10760296211044212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The sticky platelet syndrome (SPS) was described by Mammen in 1983. Since then,
scientists in several countries have identified the condition and published
cases or series of patients, thus enabling the description of the prevalence of
the inherited condition, its salient clinical features, and the treatment of the
disease. The diagnosis of the SPS phenotype requires fresh blood samples and
special equipment which is not available in all coagulation laboratories. In the
era of molecular biology, up to now it has not been possible to define a clear
association of the SPS phenotype with a specific molecular marker. Some
molecular changes which have been described in platelet proteins in some persons
with the phenotype of the SPS are here discussed. Nowadays, the SPS phenotype
may be considered as a risk factor for thrombosis and most cases of the SPS
developing vaso-occlussive episodes are the result of its coexistence with other
thrombosis-prone conditions, some of the inherited and some of them acquired,
thus leading to the concept of multifactorial thrombophilia. Ignoring all these
evidence-based concepts is inappropriate, same as stating that the SPS is a
nonentity simply because not all laboratories are endowed with adequate
equipment to support the diagnosis.
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Affiliation(s)
- Elizabeth García-Villaseñor
- Centro de Hematología y Medicina Interna de Puebla, Puebla, México.,3972Benemérita Universidad Autónoma de Puebla, Puebla, México
| | - Lorena Bojalil-Álvarez
- Centro de Hematología y Medicina Interna de Puebla, Puebla, México.,27861Universidad Popular Autónoma del Estado de Puebla, Puebla, México
| | - Iván Murrieta-Álvarez
- Centro de Hematología y Medicina Interna de Puebla, Puebla, México.,27861Universidad Popular Autónoma del Estado de Puebla, Puebla, México
| | - Yahveth Cantero-Fortiz
- Centro de Hematología y Medicina Interna de Puebla, Puebla, México.,27806Universidad de las Américas Puebla, Puebla, México
| | - Guillermo J Ruiz-Delgado
- Centro de Hematología y Medicina Interna de Puebla, Puebla, México.,27861Universidad Popular Autónoma del Estado de Puebla, Puebla, México.,56079Laboratorios Clínicos de Puebla, Puebla, México
| | - Guillermo J Ruiz-Argüelles
- Centro de Hematología y Medicina Interna de Puebla, Puebla, México.,27861Universidad Popular Autónoma del Estado de Puebla, Puebla, México.,56079Laboratorios Clínicos de Puebla, Puebla, México
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High Prevalence of Sticky Platelet Syndrome in Patients with Infertility and Pregnancy Loss. J Clin Med 2019; 8:jcm8091328. [PMID: 31466364 PMCID: PMC6780264 DOI: 10.3390/jcm8091328] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 08/23/2019] [Accepted: 08/26/2019] [Indexed: 11/16/2022] Open
Abstract
Platelet hyperaggregability, known as sticky platelet syndrome (SPS), is a prothrombotic disorder that has been increasingly associated with pregnancy loss. In this retrospective study, we aimed to investigate the clinical and diagnostic relevance of SPS in 208 patients with infertility and unexplained pregnancy loss history. We studied 208 patients that had been referred to undergo a dose-dependent platelet aggregation response to adenosine diphosphate and epinephrine using light transmission aggregometry modified by Mammen during an 11-year period. Patients’ platelet aggregation response was compared with platelet function in 29 female healthy controls of fertile age with no previous history of pregnancy loss. We found a prevalence of SPS type II (33.2%) in 208 female patients with infertility and pregnancy loss. ∆-epinephrine-induced platelet aggregation in patients with SPS was significantly decreased (median 7% and range −21 to 43%) compared to patients without SPS (median 59%, range 7–88% and p < 0.0001) and healthy controls (median 57%, range 8–106% and p < 0.0001). The optimum SPS-diagnostic cutoff value for ∆-epinephrine aggregation was ≤32% (sensitivity 95.7%, specificity 95.2%). SPS patients with low-dose acetylsalicylic acid (ASA) therapy (n = 56) showed improved pregnancy outcome (32 pregnancies; live births n = 18 (56%)) compared to SPS patients without low-dose ASA (n = 13) (3 pregnancies; live births n = 1 (33%)). Our study demonstrates the clinical and diagnostic relevance of platelet hyperaggregation in women with infertility and pregnancy loss history. Further studies should investigate the potential of SPS as a novel decisional tool with both diagnostic and clinical implications in infertility and pregnancy loss.
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Azamar-Solis B, Cantero-Fortiz Y, Olivares-Gazca JC, Olivares-Gazca JM, Gómez-Cruz GB, Murrieta-Álvarez I, Ruiz-Delgado GJ, Ruiz-Argüelles GJ. Primary Thrombophilia in Mexico XIII: Localization of the Thrombotic Events in Mexican Mestizos With the Sticky Platelet Syndrome. Clin Appl Thromb Hemost 2019; 25:1076029619841700. [PMID: 30968703 PMCID: PMC6714947 DOI: 10.1177/1076029619841700] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The sticky platelet syndrome (SPS) is a common cause of both arterial and venous
thrombosis, being a dominant autosomal disease with qualitative platelet alterations and
familial occurrence. It is characterized by platelet hyperreactivity with increased
platelet aggregability in response to low concentrations of platelet agonists:
epinephrine, adenosine diphosphate, or both. The clinical manifestations involve venous or
arterial thrombosis, recurrent pregnancy loss, and fetal growth retardation. To analyze
the localization of the thrombotic episodes in a cohort of Mexican mestizo patients with
SPS. Between 1992 and 2016, 86 Mexican mestizo patients with SPS as the single
thrombophilic condition were prospectively identified; all of them had a history of
thrombosis. There were 15 males and 71 females. The thrombotic episodes were arterial in
26 cases and venous in 60 (70%). Arterial thrombosis was mainly pulmonary thromboembolism,
whereas venous thromboses were identified most frequently in the lower limbs. Mexican
mestizo population with SPS is mainly female; the type I of the condition is the most
frequent; both arterial and venous thrombosis can occur, and they are mainly pulmonary
embolism and lower limbs venous thrombosis, respectively.
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Affiliation(s)
- Brizeida Azamar-Solis
- 1 Universidad Popular Autónoma del Estado de Puebla, Puebla, Mexico.,2 Laboratorios Clínicos de Puebla, Puebla, Mexico
| | - Yahveth Cantero-Fortiz
- 3 Universidad de las Américas Puebla, Puebla, Mexico.,4 Centro de Hematología y Medicina Interna de Puebla, Puebla, Mexico
| | - Juan Carlos Olivares-Gazca
- 1 Universidad Popular Autónoma del Estado de Puebla, Puebla, Mexico.,4 Centro de Hematología y Medicina Interna de Puebla, Puebla, Mexico
| | - Jesús Mauricio Olivares-Gazca
- 1 Universidad Popular Autónoma del Estado de Puebla, Puebla, Mexico.,4 Centro de Hematología y Medicina Interna de Puebla, Puebla, Mexico
| | - Gisela Berenice Gómez-Cruz
- 4 Centro de Hematología y Medicina Interna de Puebla, Puebla, Mexico.,5 Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | - Iván Murrieta-Álvarez
- 1 Universidad Popular Autónoma del Estado de Puebla, Puebla, Mexico.,4 Centro de Hematología y Medicina Interna de Puebla, Puebla, Mexico
| | - Guillermo J Ruiz-Delgado
- 1 Universidad Popular Autónoma del Estado de Puebla, Puebla, Mexico.,2 Laboratorios Clínicos de Puebla, Puebla, Mexico.,4 Centro de Hematología y Medicina Interna de Puebla, Puebla, Mexico
| | - Guillermo J Ruiz-Argüelles
- 1 Universidad Popular Autónoma del Estado de Puebla, Puebla, Mexico.,2 Laboratorios Clínicos de Puebla, Puebla, Mexico.,4 Centro de Hematología y Medicina Interna de Puebla, Puebla, Mexico
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Shafia S, Zargar MH, Khan N, Ahmad R, Shah ZA, Asimi R. High prevalence of factor V Leiden and prothrombin G20101A mutations in Kashmiri patients with venous thromboembolism. Gene 2018; 654:1-9. [PMID: 29454086 DOI: 10.1016/j.gene.2018.02.031] [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: 11/03/2017] [Revised: 02/05/2018] [Accepted: 02/12/2018] [Indexed: 10/18/2022]
Abstract
AIM The genetic variants of the factor V (G1691A), prothrombin (G20210A) and MTHFR (C677T) genes have been widely implicated as inherited risk factors for developing venous thrombosis. This study was undertaken to reveal the frequency of these mutations in Kashmiri patients with venous thromboembolism. METHODOLOGY A case-control study was designed with 250 VTE patients and 250 healthy controls. The mutations were analysed using ARMS-PCR and PCR-RFLP approach. RESULT The factor V Leiden G1691A mutation was found in 17/250 (6.8%) VTE patients and prothrombin G20210A mutation was found in 7/250 (2.8%) VTE patients while no mutation was found in any of the healthy controls. Both the mutations were found to be significantly associated with the increased risk of VTE (p = 0.0001 and 0.0150 respectively) while no association of VTE risk with MTHFR C677T polymorphism was found (p = 0.53). CONCLUSION The increased frequency of factor V Leiden G1691A and prothrombin G20210A mutation in VTE patients indicates a significant role of these mutations in the development of VTE in our population. We therefore suggest the routine screening of these two mutations as thrombophilic markers in Kashmiri patients with venous thromboembolism.
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Affiliation(s)
- Syed Shafia
- Advanced Centre for Human Genetics, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, J&K PIN: 190011, India
| | - Mahrukh H Zargar
- Advanced Centre for Human Genetics, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, J&K PIN: 190011, India.
| | - Nabeela Khan
- Advanced Centre for Human Genetics, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, J&K PIN: 190011, India
| | - Rehana Ahmad
- Advanced Centre for Human Genetics, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, J&K PIN: 190011, India
| | - Zafar Amin Shah
- Department of Immunology and Molecular Medicine, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, J&K PIN: 190011, India
| | - Ravouf Asimi
- Department of Neurology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, J&K PIN: 190011, India
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Primary Thrombophilia in México XI: Activated Protein C Resistance Phenotypes are Multifactorial. Indian J Hematol Blood Transfus 2017; 33:375-379. [DOI: 10.1007/s12288-016-0767-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 12/15/2016] [Indexed: 10/20/2022] Open
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Ruiz-Delgado GJ, Cantero-Fortiz Y, Mendez-Huerta MA, Leon-Gonzalez M, Nuñez-Cortes AK, Leon-Peña AA, Olivares-Gazca JC, Ruiz-Argüelles GJ. Primary Thrombophilia in Mexico XII: Miscarriages Are More Frequent in People with Sticky Platelet Syndrome. Turk J Haematol 2017; 34:239-243. [PMID: 28179211 PMCID: PMC5544043 DOI: 10.4274/tjh.2016.0411] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: Sticky platelet syndrome (SPS) is an inherited condition that leads to arterial and venous thrombosis. There is scant information about the association between SPS and obstetric complications. This study aimed to assess the relationship between SPS and fetal loss at a single institution. Materials and Methods: The obstetric histories of all consecutive female patients prospectively studied in a 324-month period at a single institution with a history of thrombosis and a clinical marker of primary thrombophilia were reviewed. Results: Between 1989 and 2016, 268 consecutive patients with a clinical marker of primary thrombophilia and a history of arterial or venous thrombosis were studied; of these, 108 were female patients. Within this subset of thrombophilic females, 77 (71%) had been pregnant at some point. Twenty-eight of these 77 patients (37%) had had a spontaneous abortion and 24 of those (86%) were found to have SPS. On the other hand, in a subset of 73 female patients with SPS who had been pregnant, 32% had miscarriages. These figures are significantly higher than the prevalence of spontaneous abortions in the general Mexican population of pregnant women, which is 12%-13% (chi-square: 7.47; p=0.0063). Accordingly, the relative risk of having a miscarriage is 2.66 times higher in female patients with SPS than in the general population (p=0.0014). Conclusion: In Mexico, female patients with SPS experience significantly more spontaneous abortions than the general population. Since the treatment of SPS is simple and effective and could in turn prevent adverse obstetric outcomes, its investigation in women treated for obstetric complications may be useful and deserves further research.
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Lacayo-Leñero D, Hernández-Hernández D, Valencia-Martínez A, Barrales-Benítez O, Vargas-Ruiz AG. Primary thrombophilia in Mexico. Blood Coagul Fibrinolysis 2016; 27:920-924. [DOI: 10.1097/mbc.0000000000000518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kubisz P, Stanciakova L, Stasko J, Dobrotova M, Skerenova M, Ivankova J, Holly P. Sticky platelet syndrome: an important cause of life-threatening thrombotic complications. Expert Rev Hematol 2015; 9:21-35. [PMID: 26567442 DOI: 10.1586/17474086.2016.1121095] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Sticky platelet syndrome (SPS) is a prothrombotic thrombocytopathy with familial occurrence, characterized by hyperaggregability of platelets in response to adenosine diphosphate (ADP), epinephrine (EPI) or both. The syndrome has been identified in approximately 21% of unexplained arterial thrombotic episodes, regarded to be the most common thrombophilia in arterial thrombosis and 13.2% of unexplained venous thromboembolism (VTE). The relatively young age at the first manifestation, relation to fertility and pregnancy, seriousness of the symptoms, easy and effective management of the disorder indicate to the necessity to take it into account in the differential diagnosis of the underlying cause of the thrombotic event. As the various localizations of the thrombosis in SPS have been reported, its management often requires a multidisciplinary approach. This review deals with the clinical aspects of thrombophilia, its etiopathogenesis, diagnosis as well as novel advances in the treatment and outlines the challenges for the further research.
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Affiliation(s)
- Peter Kubisz
- a National Center of Hemostasis and Thrombosis, Clinic of Hematology and Transfusiology, Jessenius Faculty of Medicine in Martin , Comenius University in Bratislava, Martin University Hospital , Martin , Slovak Republic
| | - Lucia Stanciakova
- a National Center of Hemostasis and Thrombosis, Clinic of Hematology and Transfusiology, Jessenius Faculty of Medicine in Martin , Comenius University in Bratislava, Martin University Hospital , Martin , Slovak Republic
| | - Jan Stasko
- a National Center of Hemostasis and Thrombosis, Clinic of Hematology and Transfusiology, Jessenius Faculty of Medicine in Martin , Comenius University in Bratislava, Martin University Hospital , Martin , Slovak Republic
| | - Miroslava Dobrotova
- a National Center of Hemostasis and Thrombosis, Clinic of Hematology and Transfusiology, Jessenius Faculty of Medicine in Martin , Comenius University in Bratislava, Martin University Hospital , Martin , Slovak Republic
| | - Maria Skerenova
- b Department of Clinical Biochemistry, Jessenius Faculty of Medicine in Martin , Comenius University in Bratislava, Martin University Hospital , Martin , Slovak Republic
| | - Jela Ivankova
- a National Center of Hemostasis and Thrombosis, Clinic of Hematology and Transfusiology, Jessenius Faculty of Medicine in Martin , Comenius University in Bratislava, Martin University Hospital , Martin , Slovak Republic
| | - Pavol Holly
- a National Center of Hemostasis and Thrombosis, Clinic of Hematology and Transfusiology, Jessenius Faculty of Medicine in Martin , Comenius University in Bratislava, Martin University Hospital , Martin , Slovak Republic
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Zavala-Hernández C, Hernández-Zamora E, Martínez-Murillo C, Majluf-Cruz A, Vela-Ojeda J, García-Chávez J, Reyes-Maldonado E. Risk Factors for Thrombosis Development in Mexican Patients. Ann Vasc Surg 2015; 29:1625-32. [DOI: 10.1016/j.avsg.2015.05.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 05/01/2015] [Accepted: 05/23/2015] [Indexed: 11/17/2022]
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Thrombin generation and international normalized ratio in inherited thrombophilia patients receiving thromboprophylactic therapy. Thromb Res 2015; 136:1291-8. [PMID: 26493603 DOI: 10.1016/j.thromres.2015.10.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 09/30/2015] [Accepted: 10/13/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Thrombin generation assay (TGA) is useful as a global functional test for assessing bleeding or thrombotic risk and its modification with therapy. We investigated TGA to assess anticoagulation status compared with the international normalized ratio (INR) system in patients with primary thrombophilia receiving and not undergoing thromboprophylaxis. MATERIALS AND METHODS We studied 50 patients with at least one thrombotic event and a confirmed diagnosis of inherited thrombophilia. Thrombin generation was measured in platelet-poor plasma by calibrated automated thrombography (CAT). RESULTS Patients in optimal anticoagulation (INR: 2.0-3.0) showed an endogenous thrombin potential (ETP) of 14-56% of normal and a peak of 18-55% of normal. A significant inverse relationship between INR and thrombin generation parameters (ETP, peak and velocity index) and a linear correlation for lag time was found in patients treated with vitamin-K antagonists (VKA). Receiver-operating characteristics (ROC) analysis showed that the optimal cutoff for ETP was 1600.2 nM · min (111.6% of normal, with a sensitivity of 96.6% and a specificity of 92.9%) and for the peak was 298.3 nM (112.1% of normal, with a sensitivity of 96.4% and a specificity of 100%). According to this analysis, ETP was able to identify patients with increased thrombotic and hemorrhagic risk, correlating with severe clinical complications. CONCLUSION TGA showed excellent sensitivity and specificity for assessing anticoagulation status in patients with primary thrombophilia receiving VKA, with significant advantages with regard to INR. Clinical data strongly support ETP as a valuable indicator of thrombotic or hemorrhagic risk in patients receiving or not receiving thromboprophylaxis.
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Rodríguez-Leal GA, Morán S, Corona-Cedillo R, Brom-Valladares R. Portal vein thrombosis with protein C-S deficiency in a non-cirrhotic patient. World J Hepatol 2014; 6:532-537. [PMID: 25068006 PMCID: PMC4110546 DOI: 10.4254/wjh.v6.i7.532] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 03/11/2014] [Accepted: 05/29/2014] [Indexed: 02/06/2023] Open
Abstract
There are several conditions that can lead to portal vein thrombosis (PVT), including including infection, malignancies, and coagulation disorders. Anew condition of interest is protein C and S deficiencies, associated with hypercoagulation and recurrent venous thromboembolism. We report the case of a non-cirrhotic 63-year-old male diagnosed with acute superior mesenteric vein thrombosis and PVT and combined deficiencies in proteins C and S, recanalized by short-term low molecular heparin plus oral warfarin therapy.
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Affiliation(s)
- Benjamín Moncada
- Hospital Central ‘Ignacio Morones Prieto’, Internal Medicine Division, Universidad Autónoma de San Luis Potosí, San Luis Potosí, México
| | | | - Claudio Castillo-Martínez
- Hospital Central ‘Ignacio Morones Prieto’, Internal Medicine Division, Universidad Autónoma de San Luis Potosí, San Luis Potosí, México
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Velázquez-Sánchez-de-Cima S, Zamora-Ortiz G, Hernández-Reyes J, Vargas-Espinosa J, García-Chavez J, Rosales-Padrón J, Ruiz-Delgado GJ, Ruiz-Arguelles A, Ruiz-Argüelles GJ. Primary Thrombophilia in México X. Clin Appl Thromb Hemost 2013; 21:91-5. [DOI: 10.1177/1076029613501543] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: The sticky platelet syndrome (SPS) is a common cause of thrombosis. There are no prospective studies concerning treatment. Objective: To analyze changes in platelet hyperaggregability of patients with SPS who were given antiplatelet drugs and to assess its association with rethrombosis. Methods: A total of 55 patients with a history of thrombosis and SPS phenotype were prospectively studied before and after treatment with aspirin and/or clopidogrel. Results: Patients were followed for 1 to 129 months, median 13. Of 55 patients, 40 received aspirin, 13 received aspirin + clopidogrel, and 2 received only clopidogrel. The platelet aggregation response to adenosine diphosphate and epinephrine significantly diminished after treatment, and only 2 patients developed rethrombosis 52 and 129 months after starting therapy, with the freedom from rethrombosis rate of the patients being 96.4% at 129 months. Conclusion: Using antiplatelet drugs, the platelet hyperreactivity of patients with the SPS phenotype was reverted; and this translated into a substantial decrease in the rethrombosis rate.
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Affiliation(s)
- Sara Velázquez-Sánchez-de-Cima
- Centro de Hematología y Medicina Interna de Puebla, Puebla, México
- Laboratorios Clínicos de Puebla, Díaz Ordaz 808, Puebla, México
- Facultad de Medicina, Universidad Popular Autónoma del Estado de Puebla, Santiago, Puebla, México
| | - Gabriela Zamora-Ortiz
- Centro de Hematología y Medicina Interna de Puebla, Puebla, México
- Laboratorios Clínicos de Puebla, Díaz Ordaz 808, Puebla, México
- Facultad de Medicina, Universidad de Las Américas Puebla, Cholula, Puebla, México
| | - Jesús Hernández-Reyes
- Centro de Hematología y Medicina Interna de Puebla, Puebla, México
- Laboratorios Clínicos de Puebla, Díaz Ordaz 808, Puebla, México
- Facultad de Medicina, Universidad del Valle de México, Villahermosa, México
| | - Jocelyn Vargas-Espinosa
- Centro de Hematología y Medicina Interna de Puebla, Puebla, México
- Facultad de Medicina, Universidad Popular Autónoma del Estado de Puebla, Santiago, Puebla, México
| | - Jessica García-Chavez
- Centro de Hematología y Medicina Interna de Puebla, Puebla, México
- Facultad de Medicina, Universidad de Las Américas Puebla, Cholula, Puebla, México
| | - Jaime Rosales-Padrón
- Centro de Hematología y Medicina Interna de Puebla, Puebla, México
- Facultad de Medicina, Universidad de Las Américas Puebla, Cholula, Puebla, México
| | - Guillermo J. Ruiz-Delgado
- Centro de Hematología y Medicina Interna de Puebla, Puebla, México
- Laboratorios Clínicos de Puebla, Díaz Ordaz 808, Puebla, México
- Facultad de Medicina, Universidad Popular Autónoma del Estado de Puebla, Santiago, Puebla, México
| | - Alejandro Ruiz-Arguelles
- Centro de Hematología y Medicina Interna de Puebla, Puebla, México
- Laboratorios Clínicos de Puebla, Díaz Ordaz 808, Puebla, México
- Facultad de Medicina, Universidad Popular Autónoma del Estado de Puebla, Santiago, Puebla, México
| | - Guillermo J. Ruiz-Argüelles
- Centro de Hematología y Medicina Interna de Puebla, Puebla, México
- Laboratorios Clínicos de Puebla, Díaz Ordaz 808, Puebla, México
- Facultad de Medicina, Universidad Popular Autónoma del Estado de Puebla, Santiago, Puebla, México
- Facultad de Medicina, Universidad de Las Américas Puebla, Cholula, Puebla, México
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Garcés-Eisele J, González-Carrillo ML, Reyes-Núñez V, Ruiz-Argüelles GJ. Primary thrombophilia in México VII: the V617F mutation of JAK2 is not a frequent cause of thrombosis. Hematology 2013; 13:244-6. [DOI: 10.1179/102453308x316077] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Yagmur E, Frank RD, Neulen J, Floege J, Mühlfeld AS. Platelet Hyperaggregability is Highly Prevalent in Patients With Chronic Kidney Disease. Clin Appl Thromb Hemost 2013; 21:132-8. [DOI: 10.1177/1076029613490828] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Platelet hyperaggregation is known to be associated with arterial and venous thromboembolic events. The prevalence of platelet hyperaggregation in patients with chronic kidney disease (CKD) has not been described to date. Methods: Platelet hyperaggregation in patients with renal disease was defined by comparison of platelet aggregation patterns to non-CKD patients without thromboembolic disorders and healthy controls. Results: Among the 30 hemodialysis patients and 34 renal transplant recipients, 20 (67%) and 28 (82%) showed significantly decreased median Δ-epinephrine aggregation and increased 0.5 mol/L epinephrine response (65% and 54%) compared to healthy controls and non-CKD patients. In concordance to the laboratory finding of platelet hyperaggregability, renal transplant recipients showed a high rate of thromboembolic events (normal platelet aggregation: 0 events and platelet hyperaggregation: 30 events in 13 of 28 patients). Conclusions: Patients with CKD exhibit a hitherto unappreciated high prevalence of platelet hyperaggregability indicating sticky platelet syndrome. Laboratory testing of platelet hyperaggregability may supplement the assessment of thromboembolic complications in patients with CKD.
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Affiliation(s)
- Eray Yagmur
- Laboratory Diagnostics Center, RWTH-University Hospital Aachen, Aachen and Medical Care Center, Dr Stein and colleagues, Mönchengladbach, Germany
| | - Rolf Dario Frank
- Clinic for Internal Medicine and Clinical Intensive Care Medicine, Sankt Antonius Hospital Eschweiler, Eschweiler, Germany
| | - Joseph Neulen
- Department of Gynecological Endocrinology and Reproductive Medicine, RWTH-University Hospital Aachen, Aachen, Germany
| | - Jürgen Floege
- Division of Nephrology and Clinical Immunology, RWTH-University Hospital Aachen, Aachen, Germany
| | - Anja Susanne Mühlfeld
- Division of Nephrology and Clinical Immunology, RWTH-University Hospital Aachen, Aachen, Germany
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Tekgündüz E, Demir M, Akyol Erikçi A, Akpınar S, Oztürk E, Kırkızlar O. Sticky platelet syndrome in patients with uninduced venous thrombosis. Turk J Haematol 2013; 30:48-52. [PMID: 24385753 PMCID: PMC3781662 DOI: 10.5152/tjh.2011.79] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2011] [Accepted: 08/10/2011] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Sticky platelet syndrome (SPS) is a common autosomal dominant inherited platelet disorder. SPS is characterized by platelet hyperreactivity and is associated with arterial and venous thrombosis. The aim of this study was to determine the role of SPS in patients with uninduced venous thrombosis. MATERIAL AND METHODS The study included 28 patients (15 male and 13 female) with uninduced venous thrombosis. SPS was defined according to Mammen's aggregation method, which is described in detail elsewhere. RESULTS According to the defined ranges for platelet hyperreactivity, 3 (50%) patients, 2 (33%), and 1 (17%) (n =6 [21%]) with a confirmed diagnosis were classified as type II, I, and III SPS, respectively. In 1 patient SPS was the only hereditary abnormality noted. The other 5 patients carried other inherited coagulation defects, in addition to SPS. CONCLUSION The present findings indicate that the prevalence of SPS was 21% in the patients with uninduced venous thrombosis. We therefore suggest that SPS should be considered in the differential diagnosis of such cases. CONFLICT OF INTEREST None declared.
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Affiliation(s)
- Emre Tekgündüz
- Ankara Oncology Education and Research Hospital, Department of Hematology and Bone Marrow Transplantation Unit, Ankara, Turkey
| | - Muzaffer Demir
- Trakya University, School of Medicine, Department of Internal Medicine, Division of Hematology, Edirne, Turkey
| | - Alev Akyol Erikçi
- Gülhane Military Medical School, Haydarpaşa Training Hospital, Department of Hematology, İstanbul, Turkey
| | - Seval Akpınar
- Trakya University, School of Medicine, Department of Internal Medicine, Division of Hematology, Edirne, Turkey
| | - Erman Oztürk
- Göztepe Education and Research Hospital, Department of Hematology, İstanbul, Turkey
| | - Onur Kırkızlar
- Trakya University, School of Medicine, Department of Internal Medicine, Division of Hematology, Edirne, Turkey
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21
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Sokol J, Biringer K, Skerenova M, Hasko M, Bartosova L, Stasko J, Danko J, Kubisz P. Platelet aggregation abnormalities in patients with fetal losses: the GP6 gene polymorphism. Fertil Steril 2012; 98:1170-4. [DOI: 10.1016/j.fertnstert.2012.07.1108] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 07/08/2012] [Accepted: 07/12/2012] [Indexed: 11/16/2022]
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Arenas-Sordo MDLL, Zavala-Hernández C, Casiano-Rosas C, Reyes-Maldonado E, Ríos C, Hernández-Zamora E, Del Valle-Cabrera MG, Yamamoto-Furusho JK. Leiden V Factor and Spastic Cerebral Palsy in Mexican Children. Genet Test Mol Biomarkers 2012; 16:978-80. [DOI: 10.1089/gtmb.2012.0017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | | | | | - Camilo Ríos
- Neurochemical Department, INNN, Mexico City, México
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Ruiz-Argüelles GJ, Garcés-Eisele J, Camacho-Alarcón C, Reyes-Nuñez V, Moncada-González B, Valdés-Tapia P, León-Montes N, Ruiz-Delgado GJ. Primary thrombophilia in Mexico IX. Clin Appl Thromb Hemost 2012; 19:689-92. [DOI: 10.1177/1076029612448418] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Introduction: The sticky platelet syndrome (SPS) seems to be a common cause of thrombosis, although no molecular substrate to explain platelet hyperaggregability has been found. Objective: To analyze an association between the SPS phenotype and the platelet glycoprotein (GP) IIIa PLA1/A2 (human platelet antigen [HPA]-1a/b) gene polymorphism. Methods: Along an 18-month period, Mexican mestizo thrombophilic patients were prospectively accrued. The SPS phenotype was assessed by aggregometry, whereas a tetra-primer amplification refractory mutation system (ARMS) polymerase chain reaction analysis was used to detect the PLA1 and PLA2 alleles. Results: A total of 95 individuals with SPS and 127 healthy donors were studied; in 11 of the donors and 16 of the patients with SPS the A2 allele of the GP IIb/IIIA was found, yielding a weak and nonsignificant association (odds ratio 2.14, 95% CI 0.94-4.85). Conclusion: In Mexican mestizo patients, the platelet GP IIIa PLA1/A2 gene polymorphism does not lead to the SPS phenotype.
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Affiliation(s)
- Guillermo J. Ruiz-Argüelles
- Centro de Hematología y Medicina Interna de Puebla, Mexico
- Laboratorios Clínicos de Puebla, Mexico
- Universidad Popular Autónoma del Estado de Puebla, Mexico
| | - Javier Garcés-Eisele
- Laboratorios Clínicos de Puebla, Mexico
- Universidad Popular Autónoma del Estado de Puebla, Mexico
| | | | | | | | | | | | - Guillermo J. Ruiz-Delgado
- Centro de Hematología y Medicina Interna de Puebla, Mexico
- Laboratorios Clínicos de Puebla, Mexico
- Universidad Popular Autónoma del Estado de Puebla, Mexico
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Epidemiology of Prothrombin G20210A Mutation in the Mediterranean Region. Mediterr J Hematol Infect Dis 2011; 3:e2011054. [PMID: 22220251 PMCID: PMC3248331 DOI: 10.4084/mjhid.2011.054] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2011] [Accepted: 10/07/2011] [Indexed: 11/08/2022] Open
Abstract
There are many genetic and acquired risk factors that are known to cause venous thromboembolic disorders (VTE). One of these is the Prothrombin G20210A mutation, which has been identified in 1996. Prothrombin G20210A mutation causes higher levels of the clotting factor prothrombin in the blood of carriers, which creates a higher tendency towards blood clotting (hypercoagulability), and therefore the carriers become at higher risk of developing VTE. High prevalence of Prothrombin G20210A mutation was reported in Caucasian populations, but the prevalence was almost absent in non-Caucasians. That was most obvious in countries of South Europe and the Mediterranean region. This review article discusses Prothrombin G20210A mutation, how it causes VTE, the origin of the mutation, and its distribution worldwide with special concentration on the Mediterranean area.
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Majluf-Cruz A. Response to Factor V Leiden in Mexico. Clin Appl Thromb Hemost 2009; 15:478. [DOI: 10.1177/1076029609338709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Abraham Majluf-Cruz
- Unidad de Investigación Médica en Trombosis, Hemostasia y Aterogénesis Instituto Mexicano del Seguro Social Mexico City, Mexico
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Ruiz-Argüelles GJ, Coconi-Linares LN, Garcés-Eisele J, Reyes-Núñez V. Methotrexate-induced mucositis in acute leukemia patients is not associated with the MTHFR 677T allele in Mexico. ACTA ACUST UNITED AC 2007; 12:387-91. [PMID: 17891601 DOI: 10.1080/10245330701448479] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Methylenetetrahydrofolate reductase (MTHFR) has two common variants with reduced activity due to polymorphisms at nucleotides 677 and 1298. Both affect folate metabolism and thus remethylation of homocysteine, but are also thought to affect nucleotide synthesis and DNA methylation. Methotrexate (MTX), which interrupts folate metabolism, is used in the treatment of a variety of diseases including acute lymphoblastic leukemia (ALL), but exerts in some patients toxic effects on fast dividing tissues such as mucosal epithelia. The enhanced toxicity may be due to cooperative effects between MTX and MTHFR variants. Accordingly, it has been reported that carrying the 677T allele of the MTHFR is a risk factor for MTX-associated mucositis. As in the Mexican population, which is characterized by a high prevalence of the 677T MTHFR variant, several of its commonly associated defects have not been observed, we investigated the relationship between MTX toxicity and the 677T allele. Out of 28 patients with ALL (CC: 2, CT: 10, TT: 16), 16 had episodes of MTX-associated mucositis (CC: 0, CT: 6, TT: 10). Neither at the gene level nor at the genotype level was a significant association with mucositis found. It may be postulated that the risk of higher MTX toxicity in patients with decreased MTHFR activity could be neutralized by the normally folate rich diet in Mexico.
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Pathare A, Al Kindi S, Al Haddabi H, Dennison D, Bayoumi R, Muralitharan S. Hereditary thrombophilia in ethnic Omani patients. Am J Hematol 2006; 81:101-6. [PMID: 16432849 DOI: 10.1002/ajh.20525] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Hereditary thrombophilias are a group of inherited conditions that predispose to thrombosis. Mutations like factor V Leiden, prothrombin gene variant 20210A, and hereditary hyperhomocysteinemia are associated with an increased risk for thromboembolism as compared to mutations in natural inhibitors of coagulation. There is also evidence that multiple defects co-exists in persons with a tendency for thrombosis. We studied prothrombotic determinants, namely protein C, protein S, and AT along with factor V Leiden (1691G-->A), prothrombin gene mutation (20210G-->A), CBS 844ins68 mutation, and MTHFR mutation (677C-->T) in consecutive ethnic Omani patients with first episode of a thrombophilic event, namely, deep vein thrombosis (DVT), and/or pulmonary embolism (PE) or thrombosis at an unusual site. Fasting plasma homocysteine was also analyzed. Factor V Leiden and the prothrombin gene mutation were not seen in any patient nor in any control subject studied. The thermolabile MTHFR mutation (677C-->T) was present in 14 patients (35.89%) whereas the CBS 844ins68 mutation was documented in 6 patients (15.38%); 3 patients were common in both groups. Six patients had low protein C (15.38%), two patients had low protein S (5.12%), but none had low AT levels. Interestingly, one patient had triple abnormality, namely, PC deficiency with both CBS 844ins68 mutation as well as the MTHFR mutation (677C-->T) whereas another two patients had the latter two mutations together. This data set, although small, reflects the importance of multiple screening strategies. The yield appears high, emphasizing the referral pattern to a tertiary health center. Of these patients, 43.58% had either or both the hyperhomocysteinemic mutations studied, whereas in 38.46% of these patients, no underlying cause for thrombophilia could be documented.
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Affiliation(s)
- Anil Pathare
- Department of Haematology, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman.
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