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Yu DD, Liu W, Zhang L. [Pathophysiology, diagnosis, and therapy for the management of acquired clotting factor deficiency]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2023; 44:956-962. [PMID: 38185529 PMCID: PMC10753255 DOI: 10.3760/cma.j.issn.0253-2727.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Indexed: 01/09/2024]
Affiliation(s)
- D D Yu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, Tianjin 300020, China Tianjin Institutes of Health Science, Tianjin 301600, China
| | - W Liu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, Tianjin 300020, China Tianjin Institutes of Health Science, Tianjin 301600, China
| | - L Zhang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, Tianjin 300020, China Tianjin Institutes of Health Science, Tianjin 301600, China
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Butelet A, Poulain S, Jeanpierre E, Srour M, Nudel M, Chauvet P, Bauters A, Susen S, Dupont A, de Charette M. Successful and safe response to ibrutinib alone in treating relapsed Waldenström macrogobulinemia and related acquired von Willebrand syndrome: an option to consider. Leuk Lymphoma 2022; 63:3100-3104. [PMID: 36528585 DOI: 10.1080/10428194.2022.2113534] [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: 01/11/2023]
Abstract
Ibrutinib, a first-class Bruton tyrosine kinase inhibitor, is known to be associated with adverse bleeding events and has been recently approved for the treatment of relapse Waldenström macroglobulinemia (WM). Here, we report the exhaustive clinical and biological follow-up of 2 patients treated by ibrutinib alone in the context of relapsed WM with an acquired von Willebrand syndrome (AVWS) complication. In two cases, ibrutinib has been shown to be quickly efficient and safe for treating both AVWS and its underlying condition the WM, without bleeding complications. Interestingly, ibrutinib treatment brings a rapid and extended over time normalization of von Willebrand factor clearance. These observations show that ibrutinib is a valuable therapeutic option in relapsed WM patients associated with AVWS and highlighting the need for further cohort studies with long-term follow-up of patients to confirm the efficacy and safety of a treatment by ibrutinib for WM patients with AVWS complication.
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Affiliation(s)
- Alexandre Butelet
- Hemostasis and transfusion department, Biology Pathology Center, University hospital of Lille, Lille, France
| | - Stéphanie Poulain
- Laboratory of Hematology, Biology Pathology Center, CHU of Lille, INSERM UMR-S 1177, Team 4, Cancer Research Institute, Univ. Lille, France
| | - Emmanuelle Jeanpierre
- Hemostasis and transfusion department, Biology Pathology Center, University hospital of Lille, Lille, France
| | - Micha Srour
- Service des Maladies du Sang, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Morgane Nudel
- Service des Maladies du Sang, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Paul Chauvet
- Service des Maladies du Sang, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Anne Bauters
- Hemostasis and transfusion department, Biology Pathology Center, University hospital of Lille, Lille, France
| | - Sophie Susen
- Hemostasis and transfusion department, Biology Pathology Center, University hospital of Lille, Lille, France
| | - Annabelle Dupont
- Hemostasis and transfusion department, Biology Pathology Center, University hospital of Lille, Lille, France
| | - Marie de Charette
- Service des Maladies du Sang, Centre Hospitalier Universitaire de Lille, Lille, France.,Service d'hématologie, Centre Hospitalier Universitaire de la Réunion, Saint Denis, France
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Feher M, Saguner AM, Kirstein B, Vogler J, Eitel C, Phan HL, Keelani A, Cimen T, Hatahet S, Trajanoski D, Samara O, Kuck KH, Tilz RR, Heeger CH. Safety and Feasibility of Catheter Ablation Procedures in Patients with Bleeding Disorders. J Clin Med 2022; 11:jcm11236956. [PMID: 36498531 PMCID: PMC9739729 DOI: 10.3390/jcm11236956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/14/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
Aims/Objectives: Patients with bleeding disorders are a rare and complex population in catheter ablation (CA) procedures. The most common types of bleeding disorders are von Willebrand disease (VWD) and hemophilia A (HA). Patients with VWD or HA tend to have a higher risk of bleeding complications compared to other patients. There is a lack of data concerning peri- and postinterventional coagulation treatment. We sought to assess the optimal management of patients with VWD and HA referred for catheter ablation procedures. Methods and Results: In this study, we analyzed patients with VWD or HA undergoing CA procedures at two centers in Germany and Switzerland between 2016 and 2021. Clotting factors were administered in conjunction with hemostaseological recommendations. CA was performed as per the institutional standard. During the procedure, unfractionated heparin (UFH) was given intravenously with respect to the activated clotting time (ACT). Primary endpoints included the feasibility of the procedure, bleeding complications, and thromboembolic events during the procedure. Secondary endpoints included bleeding complications and thromboembolic events up to one year after catheter ablation. A total of seven patients (three VWD Type I, one VWD Type IIa, three HA) underwent 10 catheter ablation procedures (pulmonary vein isolation (PVI): two × radiofrequency (RF), one × laser balloon (LB), one × cryoballoon (CB); PVI + cavotricuspid isthmus (CTI): one × RF; PVI + left atrial appendage isolation (LAAI): one × RF; Premature ventricular contraction (PVC): three × RF; Atrioventricular nodal reentrant tachycardia (AVNRT): one × RF). VWD patients received 2000−3000 IE Wilate i.v. 30 to 45 min prior to ablation. Patients with HA received 2000−3000 IE factor VIII before the procedure. All patients undergoing PVI received UFH (cumulative dose 9000−18,000 IE) with a target ACT of >300 s. All patients after PVI were started on oral anticoagulation (OAC) 12 h after ablation. Two patients received aspirin (acetylsalicylic acid; ASA) for 4 weeks after the ablation of left-sided PVCs. No anticoagulation was prescribed after slow pathway modulation in a case with AVNRT. No bleeding complications or thromboembolic events were reported. During a follow-up of one year, one case of gastrointestinal bleeding occurred following OAC withdrawal after LAA occlusion. Conclusions: After the substitution of clotting factors, catheter ablation in patients with VWD and HA seems to be safe and feasible.
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Affiliation(s)
- Marcel Feher
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
| | - Ardan M. Saguner
- Department of Cardiology, Universitätsspital Zurich, 8091 Zurich, Switzerland
| | - Bettina Kirstein
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
| | - Julia Vogler
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
| | - Charlotte Eitel
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
| | - Huong-Lan Phan
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
| | - Ahmad Keelani
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
| | - Tolga Cimen
- Department of Cardiology, Universitätsspital Zurich, 8091 Zurich, Switzerland
| | - Sascha Hatahet
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
| | - Darko Trajanoski
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
| | - Omar Samara
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
| | - Karl-Heinz Kuck
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
- LANS Cardio, 20354 Hamburg, Germany
| | - Roland R. Tilz
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
- LANS Cardio, 20354 Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Lübeck, 20246 Hamburg, Germany
| | - Christian-H. Heeger
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Lübeck, 20246 Hamburg, Germany
- Correspondence: ; Tel.: +49-451-500-75293
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