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Stoutenburg E, Sherman S, Bravo M, Howard V, Mukaz DK, Cushman M, Zakai NA, Judd S, Plante TB. Factor VIII and Incident Hypertension in Black and White Adults: The REasons for Geographic and Racial Differences in Stroke (REGARDS) Cohort. Am J Hypertens 2024; 37:580-587. [PMID: 38642910 DOI: 10.1093/ajh/hpae046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 04/10/2024] [Accepted: 04/11/2024] [Indexed: 04/22/2024] Open
Abstract
BACKGROUND Nearly half of all Americans have hypertension, and Black adults experience a disproportionate burden. Hypercoagulability may relate to hypertension risk, and higher levels of factor VIII increase thrombosis risk. Black adults have higher factor VIII and more hypertension than other groups. Whether higher factor VIII associates with incident hypertension is unknown. METHODS The Biomarkers as Mediators of Racial Disparities in Risk Factors (BioMedioR) study measured certain biomarkers in a sex-race stratified sample of 4,400 REGARDS participants who attended both visits. We included BioMedioR participants, excluding those with prevalent hypertension, missing factor VIII level, or covariates of interest. Modified Poisson regression estimated risk ratios (RR) for incident hypertension by higher log-transformed factor VIII level per SD (SD of log-transformed factor VIII, 0.33). Weighting was applied to take advantage of REGARDS sampling design. RESULTS Among the 1,814 participants included (55% female, 24% Black race), the median follow-up was 9.5 years and 35% (2,146/6,138) developed hypertension. Black participants had a higher median (IQR) factor VIII level (105.6%; 87.1%-126.9%) than White participants (95.6%; 79.8%-115.9%; P < 0.001). The age- and sex-adjusted Black-White hypertension RR was 1.45 (95% CI 1.28, 1.63). Higher factor VIII was not associated with more hypertension (final model RR 1.01; 95% CI 0.94, 1.07). CONCLUSIONS In a prospective study of Black and White adults without prevalent hypertension, factor VIII was not associated with greater hypertension risk.
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Affiliation(s)
- Eric Stoutenburg
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA
| | - Sarah Sherman
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Maria Bravo
- Department of Biochemistry, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA
| | - Virginia Howard
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Debora Kamin Mukaz
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA
| | - Mary Cushman
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA
- Department of Pathology and Laboratory Science, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA
| | - Neil A Zakai
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA
- Department of Pathology and Laboratory Science, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA
| | - Suzanne Judd
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Timothy B Plante
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA
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Yuan L, Han J, van der Velden AIM, Vink H, de Mutsert R, Rosendaal FR, van Hylckama Vlieg A, Li-Gao R, Rabelink TJ, van den Berg BM. Sex-specific association between microvascular health and coagulation parameters: the Netherlands Epidemiology of Obesity study. J Thromb Haemost 2023; 21:2585-2595. [PMID: 37301258 DOI: 10.1016/j.jtha.2023.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 05/16/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Microvascular dysfunction is a growing determinant of sex differences in coronary heart disease (CHD). Dysregulation of the coagulation system is involved in CHD pathogenesis and can be induced by endothelial glycocalyx (EG) perturbation. However, little is known about the link between EG function and coagulation parameters in population-based studies on sex specificity. OBJECTIVES We sought to examine the sex differences in the relationship between EG function and coagulation parameters in a middle-aged Dutch population. METHODS Using baseline measurements of 771 participants from the Netherlands Epidemiology of Obesity study (age, 56 years [IQR, 51-61 years]; 53% women; body mass index, 27.9 kg/m2 [IQR, 25.1-30.9 kg/m2]), associations between glycocalyx-related perfused boundary region (PBR) derived using sidestream dark-field imaging and coagulation parameters (factor [F]VIII/IX/XI; thrombin generation parameters; and fibrinogen) were investigated using linear regression analyses, adjusting for possible confounders (including C-reactive protein, leptin, and glycoprotein acetyls), followed by sex-stratified analyses. RESULTS There was a sex difference in the associations between PBR and coagulation parameters. Particularly in women, 1-SD PBR (both total and feed vessel, indicating poorer glycocalyx status) was associated with higher FIX activity ([1.8%; 95% CI, 0.3%-3.3%] and [2.0%; 95% CI, 0.5%-3.4%], respectively) and plasma fibrinogen levels ([5.1 mg/dL; 95% CI, 0.4-9.9 mg/dL] and [5.8 mg/dL; 95% CI, 1.1-10.6 mg/dL], respectively). Furthermore, 1-SD PBRcapillary was associated with higher FVIII activity (3.5%; 95% CI, 0.4%-6.5%) and plasma fibrinogen levels (5.3 mg/dL; 95% CI, 0.6-10.0 mg/dL). CONCLUSION We revealed a sex-specific association between microcirculatory health and procoagulant status, which suggests that microvascular health be considered during early development of CHD in women.
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Affiliation(s)
- Lushun Yuan
- Einthoven Laboratory for Vascular and Regenerative Medicine, Department of Internal Medicine, Nephrology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jihee Han
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Anouk I M van der Velden
- Einthoven Laboratory for Vascular and Regenerative Medicine, Department of Internal Medicine, Nephrology, Leiden University Medical Center, Leiden, the Netherlands
| | - Hans Vink
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands; MicroVascular Health Solutions LLC, Alpine, Utah, USA
| | - Renée de Mutsert
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Frits R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Ruifang Li-Gao
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands; Metabolon Inc, Morrisville, North Carolina, USA
| | - Ton J Rabelink
- Einthoven Laboratory for Vascular and Regenerative Medicine, Department of Internal Medicine, Nephrology, Leiden University Medical Center, Leiden, the Netherlands
| | - Bernard M van den Berg
- Einthoven Laboratory for Vascular and Regenerative Medicine, Department of Internal Medicine, Nephrology, Leiden University Medical Center, Leiden, the Netherlands.
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Colantonio LD, Goonewardena SN, Wang Z, Jackson EA, Farkouh ME, Li M, Malick W, Kent ST, López JAG, Muntner P, Bittner V, Rosenson RS. Incident CHD and ischemic stroke associated with lipoprotein(a) by levels of Factor VIII and inflammation. J Clin Lipidol 2023; 17:529-537. [PMID: 37331900 DOI: 10.1016/j.jacl.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 05/16/2023] [Accepted: 06/06/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Inflammation and coagulation may contribute to the increased risk for atherosclerotic cardiovascular disease (ASCVD) associated with high lipoprotein(a). The association of lipoprotein(a) with ASCVD is stronger in individuals with high versus low high-sensitivity C-reactive protein (hs-CRP), a marker of inflammation. OBJECTIVES Determine the association of lipoprotein(a) with incident ASCVD by levels of coagulation Factor VIII controlling for hs-CRP. METHODS We analyzed data from 6,495 men and women 45 to 84 years of age in the Multi-Ethnic Study of Atherosclerosis (MESA) without prevalent ASCVD at baseline (2000-2002). Lipoprotein(a) mass concentration, Factor VIII coagulant activity, and hs-CRP were measured at baseline and categorized as high or low (≥75th or <75th percentile of the distribution). Participants were followed for incident coronary heart disease (CHD) and ischemic stroke through 2015. RESULTS Over a median follow-up of 13.9 years, there were 390 CHD and 247 ischemic stroke events. The hazard ratio (95%CI) for CHD associated with high lipoprotein(a) (≥40.1 versus <40.1 mg/dL) including adjustment for hs-CRP among participants with low and high Factor VIII was 1.07 (0.80-1.44) and 2.00 (1.33-3.01), respectively (p-value for interaction 0.016). The hazard ratio (95%CI) for CHD associated with high lipoprotein(a) including adjustment for Factor VIII was 1.16 (0.87-1.54) and 2.00 (1.29-3.09) among participants with low and high hs-CRP, respectively (p-value for interaction 0.042). Lp(a) was not associated with ischemic stroke regardless of Factor VIII or hs-CRP levels. CONCLUSION High lipoprotein(a) is a risk factor for CHD in adults with high levels of hemostatic or inflammatory markers.
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Affiliation(s)
- Lisandro D Colantonio
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA (Drs Colantonio, Wang, Li, Muntner, Rosenson).
| | - Sascha N Goonewardena
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA (Dr Goonewardena)
| | - Zhixin Wang
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA (Drs Colantonio, Wang, Li, Muntner, Rosenson)
| | - Elizabeth A Jackson
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA (Drs Jackson, Bittner)
| | - Michael E Farkouh
- Peter Munk Cardiac Centre, University of Toronto and Heart and Stroke Richard Lewar Centre of Excellence, Toronto, ON, Canada (Dr Farkouh)
| | - Mei Li
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA (Drs Colantonio, Wang, Li, Muntner, Rosenson)
| | - Waqas Malick
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY, USA (Drs Malick, Rosenson)
| | - Shia T Kent
- Center for Observational Research, Amgen Inc., Thousand Oaks, CA, USA (Dr Kent)
| | | | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA (Drs Colantonio, Wang, Li, Muntner, Rosenson)
| | - Vera Bittner
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA (Drs Jackson, Bittner)
| | - Robert S Rosenson
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY, USA (Drs Malick, Rosenson)
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Barakzie A, Jansen AG, ten Cate H, de Maat MP. Coagulation biomarkers for ischemic stroke. Res Pract Thromb Haemost 2023; 7:100160. [PMID: 37274178 PMCID: PMC10236221 DOI: 10.1016/j.rpth.2023.100160] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 03/24/2023] [Accepted: 03/25/2023] [Indexed: 06/06/2023] Open
Abstract
A State of the Art lecture titled "coagulation biomarkers for ischemic stroke" was presented at the International Society on Thrombosis and Haemostasis (ISTH) Congress in 2022. Ischemic stroke (IS) is a common disease with major morbidity and mortality. It is a challenge to determine which patients are at risk for IS or have poor clinical outcome after IS. An imbalance of coagulation markers may contribute to the progression and prognosis of IS. Therefore, we now discuss studies on the association of selected coagulation biomarkers from the hemostasis, inflammation, and immunothrombosis systems with the risk of IS, stroke severity at the acute phase, and clinical outcome after treatment. We report on coagulation biomarker-induced risk of IS, stroke severity, and outcomes following IS derived from prospective population studies, case-control studies, and acute-phase IS studies. We found indications that many coagulation and inflammation biomarkers are associated with IS, but it is early to conclude that any of these biomarkers can be applied in a therapeutic setting to predict patients at risk of IS, stroke severity at the acute phase, and clinical outcome after treatment. The strongest evidence for a role in IS was found for beta-thromboglobulin, von Willebrand factor, factor VIII, fibrinogen, thrombin-activatable fibrinolysis inhibitor, D-dimer, and neutrophil extracellular traps, and therefore, they are promising candidates. Further research and validation in large-size populations using well-defined study designs are warranted. Finally, we provide a selection of recent data relevant to this subject that was presented at the 2022 ISTH Congress.
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Affiliation(s)
- Aarazo Barakzie
- Department of Hematology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - A.J. Gerard Jansen
- Department of Hematology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Hugo ten Cate
- CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre, The Netherlands
- Thrombosis Expertise Center and Department of Internal Medicine, Maastricht University Medical Centre, The Netherlands
| | - Moniek P.M. de Maat
- Department of Hematology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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5
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Twine CP, Kakkos SK, Aboyans V, Baumgartner I, Behrendt CA, Bellmunt-Montoya S, Jilma B, Nordanstig J, Saratzis A, Reekers JA, Zlatanovic P, Antoniou GA, de Borst GJ, Bastos Gonçalves F, Chakfé N, Coscas R, Dias NV, Hinchliffe RJ, Kolh P, Lindholt JS, Mees BME, Resch TA, Trimarchi S, Tulamo R, Vermassen FEG, Wanhainen A, Koncar I, Fitridge R, Matsagkas M, Valgimigli M. Editor's Choice - European Society for Vascular Surgery (ESVS) 2023 Clinical Practice Guidelines on Antithrombotic Therapy for Vascular Diseases. Eur J Vasc Endovasc Surg 2023; 65:627-689. [PMID: 37019274 DOI: 10.1016/j.ejvs.2023.03.042] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 04/05/2023]
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6
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Dunster JL, Wright JR, Samani NJ, Goodall AH. A System-Wide Investigation and Stratification of the Hemostatic Proteome in Premature Myocardial Infarction. Front Cardiovasc Med 2022; 9:919394. [PMID: 35845083 PMCID: PMC9281867 DOI: 10.3389/fcvm.2022.919394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 05/26/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Advancing understanding of key factors that determine the magnitude of the hemostatic response may facilitate the identification of individuals at risk of generating an occlusive thrombus as a result of an atherothrombotic event such as an acute Myocardial Infarction (MI). While fibrinogen levels are a recognized risk factor for MI, the association of thrombotic risk with other coagulation proteins is inconsistent. This is likely due to the complex balance of pro- and anticoagulant factors in any individual. Methods We compared measured levels of pro- and anticoagulant proteins in plasma from 162 patients who suffered an MI at an early age (MI <50 y) and 186 age- and gender-matched healthy controls with no history of CAD. We then used the measurements from these individuals as inputs for an established mathematical model to investigate how small variations in hemostatic factors affect the overall amplitude of the hemostatic response and to identify differential key drivers of the hemostatic response in male and female patients and controls. Results Plasma from the MI patients contained significantly higher levels of Tissue Factor (P = 0.007), the components of the tenase (FIX and FVIII; P < 0.0001 for both) and the prothrombinase complexes (FX; P = 0.003), and lower levels of Tissue Factor Pathway Inhibitor (TFPI; P = 0.033) than controls. The mathematical model, which generates time-dependent predictions describing the depletion, activation, and interaction of the main procoagulant factors and inhibitors, identified different patterns of hemostatic response between MI patients and controls, and additionally, between males and females. Whereas, in males, TF, FVIII, FIX, and the inhibitor TFPI contribute to the differences seen between case and controls, and in females, FII, FVIII, and FIX had the greatest influence on the generation of thrombin. We additionally show that further donor stratification may be possible according to the predicted donor response to anticoagulant therapy. Conclusions We suggest that modeling could be of value in enhancing our prediction of risk of premature MI, recurrent risk, and therapeutic efficacy.
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Affiliation(s)
- Joanne L. Dunster
- School of Biological Sciences, Institute for Cardiovascular and Metabolic Research, Reading, United Kingdom
| | - Joy R. Wright
- Department of Cardiovascular Sciences, University of Leicester & NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Nilesh J. Samani
- Department of Cardiovascular Sciences, University of Leicester & NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Alison H. Goodall
- Department of Cardiovascular Sciences, University of Leicester & NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
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7
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Kleindorfer DO, Towfighi A, Chaturvedi S, Cockroft KM, Gutierrez J, Lombardi-Hill D, Kamel H, Kernan WN, Kittner SJ, Leira EC, Lennon O, Meschia JF, Nguyen TN, Pollak PM, Santangeli P, Sharrief AZ, Smith SC, Turan TN, Williams LS. 2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline From the American Heart Association/American Stroke Association. Stroke 2021; 52:e364-e467. [PMID: 34024117 DOI: 10.1161/str.0000000000000375] [Citation(s) in RCA: 1350] [Impact Index Per Article: 337.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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8
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Salehi Omran S, Hartman A, Zakai NA, Navi BB. Thrombophilia Testing After Ischemic Stroke: Why, When, and What? Stroke 2021; 52:1874-1884. [PMID: 33874743 DOI: 10.1161/strokeaha.120.032360] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Thrombophilia testing is frequently performed after an ischemic stroke, particularly when cryptogenic. However, there is minimal evidence supporting a significant association between most conditions assessed through thrombophilia testing and ischemic stroke, and the rationale for thrombophilia testing in many clinical situations remains uncertain. In this topical review, we review and contextualize the existing data on the risks, predictors, and outcomes of thrombophilic conditions in patients with ischemic stroke. We report that inherited thrombophilias have an uncertain relationship with ischemic stroke. Conversely, antiphospholipid syndrome, an acquired immune-mediated thrombophilia, seems to be a strong risk factor for arterial thromboembolic events, including ischemic stroke, and especially among young patients. Our findings suggest that certain circumstances may warrant targeted thrombophilia testing, such as stroke in the young, cryptogenic stroke, and high estrogen states. Future prospective studies should investigate the utility and cost effectiveness of thrombophilia testing in various stroke settings, including among patients with patent foramen ovale; as well as the optimal secondary stroke prevention regimen in patients with confirmed thrombophilia, particularly if no other potential stroke mechanism is identified.
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Affiliation(s)
- Setareh Salehi Omran
- Department of Neurology, University of Colorado School of Medicine, Aurora (S.S.O., A.H.)
| | - Adam Hartman
- Department of Neurology, University of Colorado School of Medicine, Aurora (S.S.O., A.H.)
| | - Neil A Zakai
- Department of Medicine and Department of Pathology and Laboratory Medicine, Larner College of Medicine University of Vermont, Burlington (N.A.Z.)
| | - Babak B Navi
- Clinical and Translational Neuroscience Unit, Department of Neurology, Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York (B.B.N.)
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9
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Liver Fibrosis is Associated with Ischemic Stroke Risk in Women but not Men: The REGARDS Study. J Stroke Cerebrovasc Dis 2021; 30:105788. [PMID: 33866274 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105788] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 03/11/2021] [Accepted: 03/23/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Nonalcoholic fatty liver disease is inconsistently associated with ischemic stroke, with one study suggesting an association in women and not men. The relative importance of liver fibrosis, as opposed to fatty liver, for cardiovascular risk is increasingly appreciated. We hypothesized that advanced liver fibrosis is associated with incident ischemic stroke risk, and especially in women. METHODS We performed a case-cohort study in the REasons for Geographic and Racial Differences in Stroke cohort. Black and white individuals aged 45 and older were recruited between 2003 and 2007 and followed for ischemic stroke. The Fibrosis-4 (FIB-4) score and Nonalcoholic Fatty Liver Disease Fibrosis Score (NFS) were calculated using baseline data for stroke cases and a cohort random sample; advanced liver fibrosis was classified using validated cutoffs. Cox proportional hazards models were used to estimate hazard ratios (HR) of stroke after adjusting for potential confounders. Sex differences were assessed. RESULTS There were 572 incident ischemic strokes (285 in women) over 5.4 (SD, 2.2) years. Advanced liver fibrosis was not significantly associated with ischemic stroke overall using the FIB-4 (HR 1.44; 95% CI 0.49-4.28) or NFS (HR 1.76; 95% CI 0.67-4.61). However, liver fibrosis was associated with stroke in women (HR 3.51; 95% CI 1.00-12.34) but not men (HR 0.70, 95% CI 0.16-3.16) (P = 0.098 for interaction) when using FIB-4. A similar but non-significant sex difference was seen for NFS. CONCLUSION Advanced liver fibrosis may be associated with a higher risk of ischemic stroke in women but not men.
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10
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How I treat unexplained arterial thrombosis. Blood 2021; 136:1487-1498. [PMID: 32584955 DOI: 10.1182/blood.2019000820] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 05/22/2020] [Indexed: 12/27/2022] Open
Abstract
Most arterial thrombotic events have a clear atherosclerotic or cardioembolic etiology, but hematologists are frequently asked to assist in the diagnosis and management of a patient with a nonatherosclerotic and noncardioembolic arterial event, referred to here as an unexplained arterial thrombosis. Because there is an assorted list of factors that can precipitate an arterial event, we present a systematic diagnostic approach to ensure consideration of not only primary hypercoagulable disorders, but also pro-thrombotic medications or substances, vascular and anatomic abnormalities, and undiagnosed systemic disorders, such as malignancy and autoimmune diseases. We also review existing literature of the role of hypercoagulable disorders in arterial thrombosis and discuss our approach to thrombophilia workup in patients after an unexplained arterial event. We conclude with 3 representative cases to both illustrate the application of the outlined diagnostic schema and discuss common management considerations, specifically the selection of anticoagulation vs antiplatelet therapy for secondary prevention.
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11
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Mukaz DK, Zakai NA, Cruz-Flores S, McCullough LD, Cushman M. Identifying Genetic and Biological Determinants of Race-Ethnic Disparities in Stroke in the United States. Stroke 2020; 51:3417-3424. [PMID: 33104469 PMCID: PMC7594163 DOI: 10.1161/strokeaha.120.030425] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
In the United States, causes of racial differences in stroke and its risk factors remain only partly understood, and there is a long-standing disparity in stroke incidence and mortality impacting Black Americans. Only half of the excess risk of stroke in the United States Black population is explained by traditional risk factors, suggesting potential effects of other factors including genetic and biological characteristics. Here, we nonsystematically reviewed candidate laboratory biomarkers for stroke and their relationships to racial disparities in stroke. Current evidence indicates that IL-6 (interleukin-6), a proinflammatory cytokine, mediates racial disparities in stroke through its association with traditional risk factors. Only one reviewed biomarker, Lp(a) (lipoprotein[a]), is a race-specific risk factor for stroke. Lp(a) is highly genetically determined and levels are substantially higher in Black than White people; clinical and pharmaceutical ramifications for stroke prevention remain uncertain. Other studied stroke risk biomarkers did not explain racial differences in stroke. More research on Lp(a) and other biological and genetic risk factors is needed to understand and mitigate racial disparities in stroke.
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Affiliation(s)
- Debora Kamin Mukaz
- Department of Medicine, Vermont Center on Cardiovascular and Brain Health, Larner College of Medicine at the University of Vermont, Burlington, VT
| | - Neil A. Zakai
- Department of Medicine, Vermont Center on Cardiovascular and Brain Health, Larner College of Medicine at the University of Vermont, Burlington, VT
- Department of Pathology & Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT
| | - Salvador Cruz-Flores
- Department of Neurology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso
| | - Louise D. McCullough
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX
| | - Mary Cushman
- Department of Medicine, Vermont Center on Cardiovascular and Brain Health, Larner College of Medicine at the University of Vermont, Burlington, VT
- Department of Pathology & Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT
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12
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Raffield LM, Lu AT, Szeto MD, Little A, Grinde KE, Shaw J, Auer PL, Cushman M, Horvath S, Irvin MR, Lange EM, Lange LA, Nickerson DA, Thornton TA, Wilson JG, Wheeler MM, Zakai NA, Reiner AP. Coagulation factor VIII: Relationship to cardiovascular disease risk and whole genome sequence and epigenome-wide analysis in African Americans. J Thromb Haemost 2020; 18:1335-1347. [PMID: 31985870 PMCID: PMC7274883 DOI: 10.1111/jth.14741] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 01/02/2020] [Accepted: 01/21/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Prospective studies have suggested higher factor VIII (FVIII) levels are an independent risk factor for coronary heart disease (CHD) and stroke. However, limited information, including on genetic and epigenetic contributors to FVIII variation, is available specifically among African Americans (AAs), who have higher FVIII levels than Europeans. OBJECTIVES We measured FVIII levels in ~3400 AAs from the community-based Jackson Heart Study and assessed genetic, epigenetic, and epidemiological correlates of FVIII, as well as incident cardiovascular disease (CVD) associations. METHODS We assessed cross-sectional associations of FVIII with CVD risk factors as well as incident CHD, stroke, heart failure, and mortality associations. We additionally assessed associations with TOPMed whole genome sequencing data and an epigenome-wide methylation array. RESULTS Our results confirmed associations between FVIII and risk of incident CHD events and total mortality in AAs; mortality associations were largely independent of traditional risk factors. We also demonstrate an association of FVIII with incident heart failure, independent of B-type natriuretic peptide. Two genomic regions were strongly associated with FVIII (ABO and VWF). The index variant at VWF is specific to individuals of African descent and is distinct from the previously reported European VWF association signal. Epigenome-wide association analysis showed significant FVIII associations with several CpG sites in the ABO region. However, after adjusting for ABO genetic variants, ABO CpG sites were not significant. CONCLUSIONS Larger sample sizes of AAs will be required to discover additional genetic and epigenetic contributors to FVIII phenotypic variation, which may have consequences for CVD health disparities.
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Affiliation(s)
- Laura M Raffield
- Department of Genetics, University of North Carolina, Chapel Hill, North Carolina
| | - Ake T Lu
- Department of Human Genetics, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Mindy D Szeto
- Division of Biomedical Informatics and Personalized Medicine, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Amarise Little
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Kelsey E Grinde
- Department of Mathematics, Statistics, and Computer Science, Macalester College, St. Paul, Minnesota
| | - Jessica Shaw
- Division of Biomedical Informatics and Personalized Medicine, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Paul L Auer
- Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin
| | - Mary Cushman
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont
- Department of Pathology & Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont
| | - Steve Horvath
- Department of Human Genetics, David Geffen School of Medicine, UCLA, Los Angeles, California
- Department of Biostatistics, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Marguerite R Irvin
- Department of Epidemiology, University of Alabama at Birmingham (UAB) School of Public Health, Birmingham, Alabama
| | - Ethan M Lange
- Division of Biomedical Informatics and Personalized Medicine, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Leslie A Lange
- Division of Biomedical Informatics and Personalized Medicine, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | | | - Timothy A Thornton
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - James G Wilson
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, Mississippi
| | | | - Neil A Zakai
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont
- Department of Pathology & Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont
| | - Alex P Reiner
- Department of Epidemiology, University of Washington, Seattle, Washington
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Obradovic S, Begic E, Jankovic S, Romanovic R, Djenic N, Dzudovic B, Jovic Z, Malovic D, Subota V, Stavric M, Ljuca F, Kusljugic Z. Association of PC and AT levels in the early phase of STEMI treated with pPCI with LV systolic function and 6-month MACE. Acta Clin Belg 2020; 76:1-7. [PMID: 32436782 DOI: 10.1080/17843286.2020.1766850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To examine a relationship between protein C (PC) and antithrombin III (AT III) activities with ejection fraction of left ventricle (EFLV), in the early phase of acute ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI), and to investigate whether PC and AT III are associated with major adverse cardiovascular events (MACE) within 6 months following from pPCI. PATIENTS AND METHODS The research had a prospective character and included 357 patients who had, following the diagnosis of the STEMI, undergone pPCI at the Clinic of Cardiology and Emergency Internal Medicine, Military Medical Academy, Belgrade, Serbia, from January 2010 until April 2019. RESULTS The EFLV positively correlated with PC values (rho = 0.229). There was a statistically significant increase in the PC values between patients with MACE compared with those without MACE at 6 months' follow-up evaluation (p < 0.0001). Also, significant difference in PC values between patients who died in hospital and those who were alive at 6 months' follow-up (p < 0.01) was observed. PC values were different across different EFLV groups (p < 0.001), increasing from the 1st to the 4th EFLV quartiles: the median and the interquartile values for the 1st, 2nd, 3rd and 4th quartiles were 1.0400IU/l ± 0.15, 1.1400IU/l ± 0.15, 1.1350IU/l ± 0.16 and 1.2200IU/l ± 0.14, respectively. CONCLUSION Increased PC activity in the early phase of STEMI is associated with higher EFLV 5 days after the pPCI as well as with MACE at 6 months after the pPCI.
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Affiliation(s)
- Slobodan Obradovic
- Clinic of Cardiology and Emergency Internal Medicine, Military Medical Academy, University of Defense, Belgrade, Serbia
- School of Medicine, University of Defense, Belgrade, Serbia
| | - Edin Begic
- Department of Cardiology, General Hospital "Prim.Dr. Abdulah Nakas", Sarajevo, Bosnia and Herzegovina
- Department of Pharmacology, Sarajevo Medical School, Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina
| | - Slobodan Jankovic
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Radoslav Romanovic
- Clinic of Cardiology and Emergency Internal Medicine, Military Medical Academy, University of Defense, Belgrade, Serbia
- School of Medicine, University of Defense, Belgrade, Serbia
| | - Nemanja Djenic
- Clinic of Cardiology and Emergency Internal Medicine, Military Medical Academy, University of Defense, Belgrade, Serbia
- School of Medicine, University of Defense, Belgrade, Serbia
| | - Boris Dzudovic
- Clinic of Cardiology and Emergency Internal Medicine, Military Medical Academy, University of Defense, Belgrade, Serbia
| | - Zoran Jovic
- Clinic of Cardiology and Emergency Internal Medicine, Military Medical Academy, University of Defense, Belgrade, Serbia
- School of Medicine, University of Defense, Belgrade, Serbia
| | - Dragana Malovic
- Clinic of Cardiology and Emergency Internal Medicine, Military Medical Academy, University of Defense, Belgrade, Serbia
| | - Vesna Subota
- School of Medicine, University of Defense, Belgrade, Serbia
- Institute of Biochemistry, Military Medical Academy, University of Defense, Belgrade, Serbia
| | - Milena Stavric
- Institute of Biochemistry, Military Medical Academy, University of Defense, Belgrade, Serbia
| | - Farid Ljuca
- Department of Physiology, Faculty of Medicine Tuzla, Tuzla, Bosnia and Herzegovina
| | - Zumreta Kusljugic
- Department for Science, Teaching and Clinical Trials, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina
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Majid Z, Tahir F, Ahmed J, Bin Arif T, Haq A. Protein C Deficiency as a Risk Factor for Stroke in Young Adults: A Review. Cureus 2020; 12:e7472. [PMID: 32351850 PMCID: PMC7188017 DOI: 10.7759/cureus.7472] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Protein C (PC) is a 62-kD vitamin K dependent glycoprotein produced by the liver as a zymogen and is activated by binding to the thrombin-thrombomodulin complex, with protein S (PS) acting as a cofactor. Among its various functions, PC acts as a naturally occurring anticoagulant and its deficiency, either homozygous or heterozygous, predisposes the individual to a state of thrombosis, particularly venous thromboembolism, and mainfests as myocardial infarction (MI), deep venous thrombosis, pulmonary embolism, or stroke. This review discusses the pathophysiology of the anticoagulatory effect of PC, mode of inheritance of its deficiency, the arterial and venous involvement in patients with stroke, and its risk factors. A detailed analysis of published case reports on PC deficiency as a causative agent of stroke in young adults has also been included along with the management of such patients.
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Affiliation(s)
- Zainab Majid
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Faryal Tahir
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Jawad Ahmed
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Taha Bin Arif
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Anwarul Haq
- Neurology, Baylor University Medical Center, Dallas, USA
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15
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Aberer F, Pferschy PN, Tripolt NJ, Sourij C, Obermayer AM, Prüller F, Novak E, Reitbauer P, Kojzar H, Prietl B, Kofler S, Brunner M, Svehlikova E, Stojakovic T, Scharnagl H, Oulhaj A, Aziz F, Riedl R, Sourij H. Hypoglycaemia leads to a delayed increase in platelet and coagulation activation markers in people with type 2 diabetes treated with metformin only: Results from a stepwise hypoglycaemic clamp study. Diabetes Obes Metab 2020; 22:212-221. [PMID: 31595635 PMCID: PMC6972619 DOI: 10.1111/dom.13889] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 09/11/2019] [Accepted: 09/27/2019] [Indexed: 12/13/2022]
Abstract
AIMS To investigate the effect of hypoglycaemia on platelet and coagulation activation in people with type 2 diabetes. MATERIALS AND METHODS This monocentric, open, single-arm, mechanistic trial included 14 people with established type 2 diabetes (four women, 10 men, age 55 ± 7 years, glycated haemoglobin concentration 51 ± 7 mmol/mol) receiving metformin monotherapy. A stepwise hyperinsulinaemic-hypoglycaemic clamp experiment (3.5 and 2.5 mmol/L, for 30 minutes respectively) was performed, aiming to investigate platelet and coagulation activity during predefined plateaus of hypoglycaemia, as well as 1 day and 7 days later. RESULTS While platelet activation assessed by light transmittance aggregometry did not significantly increase after the hypoglycaemic clamp procedure, the more sensitive flow cytometry-based measurement of platelet surface activation markers showed hypoglycaemia-induced activation 24 hours (PAC1pos CD62Ppos , PAC1pos CD63Ppos and PAC1pos CD62Ppos CD63pos ; P < .01) and 7 days after the hypoglycaemic clamp (P < .001 for PAC1pos CD63pos ; P < .01 for PAC1pos CD62Ppos and PAC1pos CD62Ppos CD63pos ) in comparison to baseline. Coagulation markers, such as fibrinogen, D-dimer, plasminogen activator inhibitor-1, von Willebrand factor activity and factor VIII, were also significantly increased, an effect that was most pronounced 24 hours after the hypoglycaemic clamp. CONCLUSION A single event of insulin-induced hypoglycaemia led to an increase in markers of platelet activation and coagulation in people with early stages of type 2 diabetes on metformin therapy. However, the activation occurred with a delay and was evident 24 hours and 7 days after the actual hypoglycaemic episode.
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Affiliation(s)
- Felix Aberer
- Division of Endocrinology and DiabetologyMedical University of GrazGrazAustria
| | - Peter N. Pferschy
- Division of Endocrinology and DiabetologyMedical University of GrazGrazAustria
- CBmed GmbH, Centre for Biomarker Research in MedicineGrazAustria
| | - Norbert J. Tripolt
- Division of Endocrinology and DiabetologyMedical University of GrazGrazAustria
| | - Caren Sourij
- Division of Endocrinology and DiabetologyMedical University of GrazGrazAustria
| | - Anna M Obermayer
- Division of Endocrinology and DiabetologyMedical University of GrazGrazAustria
- CBmed GmbH, Centre for Biomarker Research in MedicineGrazAustria
| | - Florian Prüller
- Medical University of Graz, Clinical Institute of Medical and Chemical Laboratory DiagnosticsGrazAustria
| | - Eva Novak
- Division of Endocrinology and DiabetologyMedical University of GrazGrazAustria
| | - Philipp Reitbauer
- Division of Endocrinology and DiabetologyMedical University of GrazGrazAustria
| | - Harald Kojzar
- Division of Endocrinology and DiabetologyMedical University of GrazGrazAustria
- CBmed GmbH, Centre for Biomarker Research in MedicineGrazAustria
| | - Barbara Prietl
- Division of Endocrinology and DiabetologyMedical University of GrazGrazAustria
- CBmed GmbH, Centre for Biomarker Research in MedicineGrazAustria
| | - Selina Kofler
- Division of Endocrinology and DiabetologyMedical University of GrazGrazAustria
- CBmed GmbH, Centre for Biomarker Research in MedicineGrazAustria
| | - Martina Brunner
- Division of Endocrinology and DiabetologyMedical University of GrazGrazAustria
| | - Eva Svehlikova
- Division of Endocrinology and DiabetologyMedical University of GrazGrazAustria
| | - Tatjana Stojakovic
- Medical University of Graz, Clinical Institute of Medical and Chemical Laboratory DiagnosticsGrazAustria
| | - Hubert Scharnagl
- Medical University of Graz, Clinical Institute of Medical and Chemical Laboratory DiagnosticsGrazAustria
| | - Abderrahim Oulhaj
- College of Medicine and Health SciencesUnited Arab Emirates University, Institute of Public HealthAl AinUAE
| | - Faisal Aziz
- Division of Endocrinology and DiabetologyMedical University of GrazGrazAustria
- CBmed GmbH, Centre for Biomarker Research in MedicineGrazAustria
| | - Regina Riedl
- Medical University of Graz, Institute for Medical Informatics, Statistics and DocumentationGrazAustria
| | - Harald Sourij
- Division of Endocrinology and DiabetologyMedical University of GrazGrazAustria
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16
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Chiasakul T, De Jesus E, Tong J, Chen Y, Crowther M, Garcia D, Chai‐Adisaksopha C, Messé SR, Cuker A. Inherited Thrombophilia and the Risk of Arterial Ischemic Stroke: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2019; 8:e012877. [PMID: 31549567 PMCID: PMC6806047 DOI: 10.1161/jaha.119.012877] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 09/04/2019] [Indexed: 01/01/2023]
Abstract
Background Inherited thrombophilias are well-established predisposing factors for venous thromboembolism, but their role in arterial thrombosis, such as arterial ischemic stroke, remains uncertain. We aimed to evaluate the association between inherited thrombophilia (factor V Leiden, prothrombin G20210A mutation, protein C deficiency, protein S deficiency, and antithrombin deficiency) and risk of arterial ischemic stroke in adults. Methods and Results We searched PubMed, EMBASE, and Cochrane Library Databases from inception to December 31, 2018. We included case-control or cohort studies of adults reporting the prevalence of inherited thrombophilias in those with arterial ischemic stroke and subjects without arterial ischemic stroke. Two reviewers (T.C., E.D.) independently searched the literature and extracted data. Pooled odds ratios (ORs) and 95% CIs were calculated using random-effects model. We identified 68 eligible studies, which collectively enrolled 11 916 stroke patients and 96 057 controls. The number of studies reporting factor V Leiden, prothrombin G20210A mutation, protein C deficiency, protein S deficiency, and antithrombin deficiency were 56, 45, 15, 17, and 12, respectively. Compared with controls, patients with arterial ischemic stroke were significantly more likely to have the following inherited thrombophilias: factor V Leiden (OR, 1.25; 95% CI, 1.08-1.44; I2=0%), prothrombin G20210A mutation (OR, 1.48; 95% CI, 1.22-1.80; I2=0%), protein C deficiency (OR, 2.13; 95% CI, 1.16-3.90; I2=0%), and protein S deficiency (OR, 2.26; 95% CI, 1.34-3.80; I2=8.8%). Statistical significance was not reached for antithrombin deficiency (OR, 1.25; 95% CI, 0.58-2.67; I2=8.8%). Conclusions Inherited thrombophilias (factor V Leiden, prothrombin G20210A mutation, protein C deficiency, and protein S deficiency) are associated with an increased risk of arterial ischemic stroke in adults. The implications of these findings with respect to clinical management of patients with ischemic stroke require further investigation.
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Affiliation(s)
- Thita Chiasakul
- Division of HematologyDepartment of MedicineFaculty of MedicineChulalongkorn University and King Chulalongkorn Memorial HospitalThai Red Cross SocietyBangkokThailand
| | | | - Jiayi Tong
- Department of Biostatistics and EpidemiologyPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPA
| | - Yong Chen
- Department of Biostatistics and EpidemiologyPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPA
| | - Mark Crowther
- Department of MedicineMcMaster UniversityHamiltonOntarioCanada
| | - David Garcia
- Department of MedicineUniversity of Washington School of MedicineSeattleWA
| | | | - Steven R. Messé
- Department of NeurologyPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPA
| | - Adam Cuker
- Department of MedicinePerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPA
- Department of Pathology and Laboratory MedicinePerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPA
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17
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Schütte LM, de Rooij N, Hazendonk HCAM, Mathôt RAA, van Hest RM, Leebeek FWG, Cnossen MH, Kruip MJHA. Current dosing practices for perioperative factor VIII concentrate treatment in mild haemophilia A patients result in FVIII levels above target. Haemophilia 2019; 25:960-968. [PMID: 31487098 DOI: 10.1111/hae.13838] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 07/28/2019] [Accepted: 07/29/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND In patients with haemophilia A (HA) perioperative dosing of factor VIII (FVIII) concentrate is based on body weight, historical FVIII level, in vivo recovery and FVIII level target values. In moderate and severe HA patients, this dosing regimen frequently leads to perioperative FVIII levels below and above target. This has not yet been evaluated in mild HA patients. OBJECTIVES To evaluate perioperative FVIII concentrate treatment in mild HA patients and to assess the frequency of FVIII levels below or above target. PATIENTS/METHODS This retrospective single-centre study collected data from medical files of mild HA patients undergoing surgery and treated with FVIII concentrate. FVIII levels were compared to their target ranges and predictive factors for levels outside the target ranges were determined by logistic regression. RESULTS Fifty surgeries performed in 34 patients were evaluated. Median age was 47 years and median historical FVIII level was 0.14 IU/mL. Preoperative peak FVIII level was above or below the target range in 80% and 6.7% of surgeries, respectively. Postoperatively, the percentages above and below target trough ranges were 55.8% and 12.8%. Patients with blood group 0 had the highest risk on the preoperative peak FVIII level being above target. In addition, patients who had a preoperative baseline FVIII level of >0.10 IU/mL higher than their historical FVIII level had a higher preoperative peak FVIII level than patients without this increase. CONCLUSIONS Dosing above FVIII target ranges with FVIII concentrates occurs frequently during perioperative treatment of mild HA patients. These results underline the necessity for better patient-tailored treatment.
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Affiliation(s)
- Lisette M Schütte
- Department of Haematology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Nils de Rooij
- Department of Haematology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Hendrika C A M Hazendonk
- Department of Paediatric Haematology, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Ron A A Mathôt
- Department of Hospital Pharmacy, Amsterdam UMC, Amsterdam, The Netherlands
| | - Reinier M van Hest
- Department of Hospital Pharmacy, Amsterdam UMC, Amsterdam, The Netherlands
| | - Frank W G Leebeek
- Department of Haematology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Marjon H Cnossen
- Department of Paediatric Haematology, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Marieke J H A Kruip
- Department of Haematology, Erasmus University Medical Centre, Rotterdam, The Netherlands
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18
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Strategies for Individualized Dosing of Clotting Factor Concentrates and Desmopressin in Hemophilia A and B. Ther Drug Monit 2019; 41:192-212. [DOI: 10.1097/ftd.0000000000000625] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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19
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Gillett SR, McClure LA, Callas PW, Thacker EL, Unverzagt FW, Wadley VG, Letter AJ, Cushman M. Hemostasis biomarkers and incident cognitive impairment: the REGARDS study. J Thromb Haemost 2018; 16:1259-1267. [PMID: 29733497 PMCID: PMC6031469 DOI: 10.1111/jth.14138] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Indexed: 01/30/2023]
Abstract
Essentials Cognitive disorders are increasing and vascular risk factors play a role in this. We performed a nested case control study of hemostasis biomarkers and cognitive impairment (CI). Higher baseline fibrinogen, factor VIII and D-dimer were related to incident CI over 3.5 years. Adjusted for other risk factors, 2+ abnormal markers (but not single ones) led to higher risk. SUMMARY Background Vascular risk factors are associated with cognitive impairment, a condition that imposes a substantial public health burden. We hypothesized that hemostasis biomarkers related to vascular disease would be associated with the risk of incident cognitive impairment. Methods We performed a nested case-control study including 1082 participants with 3.5 years of follow-up in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a longitudinal cohort study of 30 239 black and white Americans aged ≥ 45 years. Participants were free of stroke or cognitive impairment at baseline. Baseline D-dimer, fibrinogen, factor VIII and protein C levels were measured in 495 cases who developed cognitive impairment during follow-up (based on abnormal scores on two or more of three cognitive tests) and 587 controls. Results Unadjusted odds ratios (ORs) for incident cognitive impairment were 1.32 (95% confidence interval [CI] 1.02-1.70) for D-dimer > 0.50 μg mL-1 , 1.83 (95% CI 1.24-2.71) for fibrinogen > 90th percentile, 1.63 (95% CI 1.11-2.38) for FVIII > 90th percentile, and 1.10 (95% CI 0.73-1.65) for protein C < 10th percentile. There were no differences in associations by race or region. Adjustment for demographic, vascular and health behavior risk factors attenuated these associations. However, having at least two elevated biomarkers was associated with incident cognitive impairment, with an adjusted OR of 1.73 (95% CI 1.10-2.69). Conclusion Elevated D-dimer, fibrinogen and FVIII levels were not associated with the occurrence of cognitive impairment after multivariable adjustment; however, having at least two abnormal biomarkers was associated with the occurrence of cognitive impairment, suggesting that the burden of these biomarkers is relevant.
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Affiliation(s)
- S R Gillett
- Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - L A McClure
- Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, PA, USA
| | - P W Callas
- Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - E L Thacker
- Department of Health Science, Brigham Young University, Provo, UT, USA
| | - F W Unverzagt
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - V G Wadley
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - A J Letter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - M Cushman
- Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, VT, USA
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