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Franchini M, Focosi D, Mannucci PM. Tranexamic Acid: An Evergreen Hemostatic Agent. Semin Thromb Hemost 2024; 50:733-738. [PMID: 38335995 DOI: 10.1055/s-0044-1779632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
Tranexamic acid (TXA) is an important antifibrinolytic agent, which inhibits plasminogen activation and fibrinolysis. Several controlled randomized trials have investigated the role of TXA in preventing or decreasing blood loss across different surgical interventions or medical conditions characterized by excessive bleeding, consistently documenting its effectiveness and safety. Although the first clinical use of TXA dates back to more than 60 years ago, TXA remains the focus of intense research. This narrative review summarizes the more recent results and indications on the clinical use of TXA.
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Affiliation(s)
- Massimo Franchini
- Department of Transfusion Medicine and Hematology, Carlo Poma Hospital, Mantua, Italy
| | - Daniele Focosi
- North-Western Tuscany Blood Bank, Pisa University Hospital, Italy
| | - Pier Mannuccio Mannucci
- Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico and University of Milan, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
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2
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Prevention of Venous Thrombosis of Lower Limbs after Cesarean Section Based on Smart Medical Air Pressure Therapy Instrument. BIOMED RESEARCH INTERNATIONAL 2022; 2022:1451881. [PMID: 35941974 PMCID: PMC9356891 DOI: 10.1155/2022/1451881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/07/2022] [Accepted: 07/15/2022] [Indexed: 11/18/2022]
Abstract
Affected by the environment, the incidence of lower extremity venous thrombosis after cesarean section is gradually increasing, and postoperative nursing is becoming more and more important. The intelligent medical air pressure therapy instrument is a common and effective postpartum nursing method. This paper studies the role of pneumatic therapeutic apparatus in the prevention of lower extremity venous thrombosis after cesarean section in smart medicine, describes its importance in nursing, and analyzes the role of pneumatic therapeutic apparatus and smart medicine combined with the postoperative nursing situation of patients with cesarean section in our hospital. In this paper, we aggregate the description text of six levels of hospital intelligent service grading evaluation. In order to show the characteristics of each level and the requirements of each level of hospital intelligent service, we can roughly see the differences between different levels. Research shows that with the construction of medical information platform, more and more medical processes rely on hospital information system, which promotes the integration of medical platform and the interconnection of medical equipment, provides convenient services for patients, and provides patients with easier access to services. At the same time, the massive data generated by appointment, nursing, treatment, and other activities will be recorded, and the pneumatic therapeutic instrument can avoid the occurrence of 60% lower extremity venous thrombosis. The data of air pressure therapeutic instrument is dynamic, and its performance is mainly reflected in the recording of dynamic index data.
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Waberski Andrew T, Christopher B, Yves DD, Matisoff Andrew J. Massive clot formation following FEIBA and tranexamic acid administration in post-cardiopulmonary bypass hemorrhage. J Cardiothorac Vasc Anesth 2022; 36:3863-3866. [DOI: 10.1053/j.jvca.2022.06.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/30/2022] [Accepted: 06/15/2022] [Indexed: 11/11/2022]
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Escuriola Ettingshausen C, Yang R, Wu W, Meeks SL. Inhibitors: Diagnostic challenges, unknowns of inhibitor development, treatment of bleeding and surgery, and insights into diagnosis and treatment in China. Haemophilia 2022; 28 Suppl 4:111-118. [PMID: 35521731 DOI: 10.1111/hae.14553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/07/2022] [Accepted: 03/07/2022] [Indexed: 11/30/2022]
Abstract
Factor (F) VIII inhibitors develop in around 30% of previously untreated patients (PUPs) with severe haemophilia, to a lesser extend in moderate and mild haemophilia A and in up to 10% in severe haemophilia B. Diagnostic challenges and questions remain including access to high quality testing, the role for functional inhibitor testing and binding antibody testing, and the adaptations needed in the presence of non-factor replacement therapy. Despite significant gains in knowledge there are still many unanswered questions underlying the immunologic mechanisms of inhibitor development and tolerance. Therapeutic options include eradication of inhibitors using immune tolerance induction therapy (ITI), prophylaxis with bypassing agents (i.e., recombinant activated factor VII /rFVIIa or activated prothrombin complex concentrate/aPCC) or non-factor replacement therapies (e.g., emicizumab) and treatment of bleeds or coverage of surgeries/invasive procedure. Recently a haemophilia centre capacity building program was launched in China to further develop the infrastructure and support needed to improve the diagnosis of haemophilia, detection of inhibitors, and continue to improve the care of patients with haemophilia and inhibitors.
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Affiliation(s)
| | - Renchi Yang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Wenman Wu
- Department of Laboratory Medicine, Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Shannon L Meeks
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta and Department of Pediatrics, Emory University, Atlanta, Georgia, USA
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Carcao M, Gouider E, Wu R. Low dose prophylaxis and antifibrinolytics: Options to consider with proven benefits for persons with haemophilia. Haemophilia 2022; 28 Suppl 4:26-34. [PMID: 35521737 DOI: 10.1111/hae.14552] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/07/2022] [Accepted: 03/07/2022] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Prophylaxis has become standard of care for persons with severe phenotype haemophilia (PWsH). However, 'standard prophylaxis' with either factor or non-factor therapies (emicizumab) is prohibitively expensive for much of the world. We sought to evaluate whether haemophilia care can be provided at a lower cost yet achieve good results using Lower dose/Lower frequency prophylaxis (LDP) and with increasing use of antifibrinolytics (Tranexamic acid and Epsilon amino caproic acid). METHODS We identified 12 studies that collectively included 335 PWsH using LDP. Additionally, we undertook a literature search regarding the benefits of antifibrinolytics in haemophilia care. RESULTS Identified studies show that LDP is far superior to no prophylaxis (On demand [OD] therapy) resulting in significant patient benefits. Patients on LDP showed (in comparison to patients OD) on average: 72% less total bleeds; 75% less joint bleeds; 91% less days lost from school; 77% less hospital admission days; and improved quality of life measures. These benefits come at similar or only slightly higher (< 2-fold greater) costs than OD therapy. Antifibrinolytics are effective adjunctive agents in managing bleeds (oral, nasal, intracranial, possibly other) and providing haemostasis for surgeries (particularly oral surgeries). Antifibrinolytics can substitute for more expensive factor concentrates or can reduce the use of such concentrates. There is evidence to show that antifibrinolytics may be used in conjunction with factor concentrates/emicizumab for more effective/less costly prophylaxis. CONCLUSIONS The use of LDP along with appropriate and increased use of antifibrinolytics offers less resourced countries good options for managing patients with haemophilia.
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Affiliation(s)
- Manuel Carcao
- Haemophilia Clinic and Haemostasis Program, Division of Haematology/Oncology, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Emna Gouider
- Hemophilia Treatment Centre, Aziza Othmana Hospital, University Tunis El Manar, Tunis, Tunisia
| | - Runhui Wu
- Haemophilia Comprehensive Care Centre, Haematology Centre, Beijing Children's Hospital, National Centre for Children's Health, Capital Medical University, Beijing, China
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Assi H, Massé V, Saint-Yves H, Barry J, St-Louis J, Isler M. Bilateral Pseudoarthrodesis: A Case Report of Complex Bilateral Total Knee Replacement for a Severe Hemophilia A Patient with Inhibitors. JBJS Case Connect 2022; 12:01709767-202203000-00059. [PMID: 35239593 DOI: 10.2106/jbjs.cc.21.00485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
CASE We present a severe hemophilia A patient with high titers of inhibitors presenting stage IV knee arthropathy with functional bilateral arthrodesis. On presentation, his mode of ambulation was to project himself forward without the benefit of any significant ankle motion. Total knee arthroplasty was performed on both knees and allowed significant improvement in the range of motion of both knees from 5° to 100°. CONCLUSION Although hemophilic patients with inhibitors can represent complex cases, successful outcomes can be achieved in a multidisciplinary team setting. However, we would recommend performing this type of surgery at an earlier stage when less extensive muscle and tendon release is required.
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Affiliation(s)
- Hussein Assi
- Faculty of Medicine, University of Montreal, QC, Canada
| | - Vincent Massé
- Department of Orthopedic Surgery, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada
| | - Hugo Saint-Yves
- Department of Orthopedic Surgery, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada
| | - Janie Barry
- Department of Orthopedic Surgery, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada
| | - Jean St-Louis
- Department of Hematology, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada
| | - Marc Isler
- Department of Orthopedic Surgery, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada
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Li H, Liu D, Tang X, Wang N, Gong D, Wu Y, Zhang Y, Li W, Gou Y. [Efficacy and safety of intravenous combined with topical administration of tranexamic acid in reducing blood loss after intramedullary fixation of intertrochanteric femoral fractures]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:550-555. [PMID: 33998206 DOI: 10.7507/1002-1892.202010040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the efficacy and safety of intravenous combined with topical administration of tranexamic acid (TXA) in reducing blood loss after intramedullary fixation of intertrochanteric femoral fractures by a prospective controlled trial. Methods Patients with intertrochanteric femoral fractures, who were admitted for intramedullary fixation between June 2015 and July 2019, were selected as the study subjects, 120 of whom met the selection criteria. The patients were randomly assigned to 3 groups: intravenous administration group (group A, 41 cases), topical administration group (group B, 40 cases), and combined administrations group (group C, 39 cases). In group A, 4 patients occurred deep vein thrombosis of lower extremity before operation, 1 patient died of myocardial infarction on the 5th day after operation, and 1 patient developed severe pulmonary infection after operation. In group B, 2 patients occurred deep vein thrombosis of lower extremity before operation and 1 patient had iatrogenic fracture during operation. In group C, 3 patients occurred deep vein thrombosis of lower extremity before operation and 1 patient developed pulmonary infection before operation and gave up surgical treatment. All the above patients were excluded from the study, and the remaining 107 cases were included in the analysis, including 35, 37, and 35 cases in groups A, B, and C, respectively. There was no significant difference in gender, age, height, body mass, injury cause, fracture side and type, the interval between injury and operation, and preoperative hemoglobin (Hb), hematocrit between groups ( P>0.05). Intraoperative TXA (15 mg/kg) was injected intravenously in group A at 30 minutes before operation, and 1 g of TXA was injected into the medullary cavity in group B after the proximal femur was grooted and before the intramedullary nail implantation, respectively. TXA was given in group C before and during operation according to the administration methods and dosage of groups A and B. Total blood loss, maximum Hb decrease, blood transfusion rate, operation time, fracture healing time, and the incidence of complications were recorded and compared between groups. The hip joint function were evaluated by Harris score. Results There was no significant difference in operation time between groups ( P>0.05). The total blood loss, the maximum Hb decrease, and the blood transfusion rate in group B were the highest, followed by group A and group C, and the differences between groups were significant ( P<0.05). No incision infection or pulmonary embolism occurred in the 3 groups after operation. The incidence of anemia in group C was significantly lower than that in groups A and B, the difference was significant ( P<0.05). There was no significant difference in the incidence of subcutaneous hematoma, aseptic exudation, and deep vein thrombosis of lower extremity between groups ( P>0.05). All patients in the 3 groups were followed up 8-35 months, with an average of 16.2 months. The fracture healing time of groups A, B, and C was (6.12±1.78), (5.89±1.63), and (5.94±1.69) months, respectively, and there was no significant difference between groups ( P>0.05). At last follow-up, the Harris scores of the hip joints in groups A, B, and C were 83.18±7.76, 84.23±8.01, and 85.43±8.34, and the difference was not significant ( P>0.05). Conclusion Preoperative intravenous injection combined with intraoperative topical application of TXA can effectively reduce blood loss and blood transfusion after intramedullary fixation of femoral intertrochanteric fracture, without increasing the risk of deep vein thrombosis, and the efficacy is better than that of intravenous injection or topical administration.
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Affiliation(s)
- Haibo Li
- Department of Orthopaedics, West China-KongGang Hospital of Sichuan University (Chengdu Shuangliu District First People's Hospital), Chengdu Sichuan, 610200, P.R.China
| | - Dahai Liu
- Department of Orthopaedics, West China-KongGang Hospital of Sichuan University (Chengdu Shuangliu District First People's Hospital), Chengdu Sichuan, 610200, P.R.China
| | - Xuexia Tang
- Department of Orthopaedics, West China-KongGang Hospital of Sichuan University (Chengdu Shuangliu District First People's Hospital), Chengdu Sichuan, 610200, P.R.China
| | - Na Wang
- Department of Orthopaedics, West China-KongGang Hospital of Sichuan University (Chengdu Shuangliu District First People's Hospital), Chengdu Sichuan, 610200, P.R.China
| | - Dezhi Gong
- Department of Orthopaedics, West China-KongGang Hospital of Sichuan University (Chengdu Shuangliu District First People's Hospital), Chengdu Sichuan, 610200, P.R.China
| | - Yan Wu
- Department of Orthopaedics, West China-KongGang Hospital of Sichuan University (Chengdu Shuangliu District First People's Hospital), Chengdu Sichuan, 610200, P.R.China
| | - Yue Zhang
- Department of Orthopaedics, West China-KongGang Hospital of Sichuan University (Chengdu Shuangliu District First People's Hospital), Chengdu Sichuan, 610200, P.R.China
| | - Wen Li
- Department of Orthopaedics, West China-KongGang Hospital of Sichuan University (Chengdu Shuangliu District First People's Hospital), Chengdu Sichuan, 610200, P.R.China
| | - Yongsheng Gou
- Department of Orthopaedics, West China-KongGang Hospital of Sichuan University (Chengdu Shuangliu District First People's Hospital), Chengdu Sichuan, 610200, P.R.China
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Pasca S, Ambaglio C, Rocino A, Santoro C, Cantori I, Zanon E. Combined use of antifibrinolytics and activated prothrombin complex concentrate (aPCC) is not related to thromboembolic events in patients with acquired haemophilia A: data from FAIR Registry. J Thromb Thrombolysis 2018; 47:129-133. [PMID: 30267246 DOI: 10.1007/s11239-018-1750-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Antifibrinolytics combined with aPCC are not routinely administered to patients with acquired hemophilia A due to increased thrombotic risk. This association normalizes clot stability, and improves the efficacy of therapy, but can increase the risk of severe side effects. Due to these premises it has always raised doubts and perplexities in the clinics. We now report the data of the "FEIBA® on acquired haemophilia A Italian Registry (FAIR Registry)", a retrospective-prospective study that included 56 patients. This is the first study that assessed the clinical response of the combination of aPCC and antifibrinolytic agents in patients with acquired haemophilia A. A total of 101 acute bleeds were treated with aPCC. Antifibrinolytic agents were used in the treatment of 39.6% of total bleeds, based on both, a clinical assessment and an evaluation of bleeding. Twenty-five of the 30 patients (57.1%) treated with antifibrinolytic drugs showed serious co-morbidity. Among them, 40% presented severe cardiovascular diseases. All bleeds treated with combined therapy had a shorter duration of treatment (mean reduction 16.3%). All the treated patients presented a good tolerability and no arterial or venous thromboembolic events were reported. In our retrospective registry the combination of antifibrinolytics and aPCC appears safe and effective in the treatment of patients with AHA, especially in the case of severe and life-threatening bleeding, but this hypothesis needs to be confirmed in adequate, larger clinical trials.
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Affiliation(s)
- S Pasca
- Haemophilia Centre, University Hospital of Padua, Via Giustiniani, 35128, Padua, Italy.
| | - C Ambaglio
- Haemophilia Centre, S.Matteo Hospital of Pavia, Pavia, Italy
| | - A Rocino
- Haemophilia and Thrombosis Centre, S.Giovanni Bosco Hospital of Neaples, Naples, Italy
| | - C Santoro
- Cellular Biotecnology and Haematology Department, Umberto I University Hospital of Rome, Rome, Italy
| | - I Cantori
- Centre of Coagulation Diseases, Hospital of Macerata, Macerata, Italy
| | - E Zanon
- Haemophilia Centre, University Hospital of Padua, Via Giustiniani, 35128, Padua, Italy
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Teitel JM. Treatment and prevention of bleeding in congenital hemophilia A patients with inhibitors. Transfus Apher Sci 2018; 57:466-471. [DOI: 10.1016/j.transci.2018.07.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Beckman JD, Holle LA, Wolberg AS. Factor XIII cotreatment with hemostatic agents in hemophilia A increases fibrin α-chain crosslinking. J Thromb Haemost 2018; 16:131-141. [PMID: 29080382 PMCID: PMC5802369 DOI: 10.1111/jth.13887] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Indexed: 01/19/2023]
Abstract
Essentials Factor XIII (FXIII)-mediated fibrin crosslinking is delayed in hemophilia. We determined effects of FXIII cotreatment with hemostatic agents on clot parameters. FXIII cotreatment accelerated FXIII activation and crosslinking of fibrin and α2 -antiplasmin. These data provide biochemical rationale for FXIII cotreatment in hemophilia. SUMMARY Background Hemophilia A results from the absence, deficiency or inhibition of factor VIII. Bleeding is treated with hemostatic agents (FVIII, recombinant activated FVII [rFVIIa], anti-inhibitor coagulation complex [FEIBA], or recombinant porcine FVIII [rpFVIII]). Despite treatment, some patients have prolonged bleeding. FXIII-A2 B2 (FXIII) is a protransglutaminase. During clot contraction, thrombin-activated FXIII (FXIIIa) crosslinks fibrin and α2 -antiplasmin, which promotes red blood cell retention and increases clot stability and weight. We hypothesized that FXIII cotreatment in hemophilia would accelerate FXIII activation, leading to increased fibrin crosslinking. Methods FVIII-deficient plasma and whole blood were clotted with or without hemostatic agents (FVIII, rFVIIa, FEIBA, or recombinant B-domain-deleted porcine FVIII [rpFVIII]) and/or FXIII. The effects on FXIII activation, thrombin generation, fibrin and α2 -antiplasmin crosslinking, clot formation and clot weight were measured by western blotting, calibrated automated thrombography, thromboelastography, and clot contraction assays. Results As compared with FVIII-treated hemophilic plasma, FVIII + FXIII cotreatment accelerated FXIIIa formation without increasing thrombin generation. As compared with buffer-treated or FXIII-treated hemophilic plasma, FVIII treatment and FVIII + FXIII cotreatment increased the generation and amount of crosslinked fibrin, including α-chain-rich high molecular weight species and crosslinked α2 -antiplasmin. In the presence of FVIII inhibitors, as compared with hemostatic treatments (rFVIIa, FEIBA, or rpFVIII) alone, FXIII cotreatment increased whole blood clot weight. Conclusion In hemophilia A plasma and whole blood, FXIII cotreatment with hemostatic agents accelerated FXIIIa formation, increased the generation and amount of fibrin α-chain crosslinked species, accelerated α2 -antiplasmin crosslinking, and increased clot weight. FXIII cotreatment with hemostatic therapy may augment hemostasis through increased crosslinking of fibrin and α2 -antiplasmin.
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Affiliation(s)
- J D Beckman
- Department of Medicine, Division of Hematology and Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - L A Holle
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - A S Wolberg
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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11
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Strauss E, Mazzeffi M, Williams B, Key N, Tanaka K. Perioperative management of rare coagulation factor deficiency states in cardiac surgery. Br J Anaesth 2017; 119:354-368. [DOI: 10.1093/bja/aex198] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2017] [Indexed: 01/21/2023] Open
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13
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Rocino A, Franchini M, Coppola A. Treatment and Prevention of Bleeds in Haemophilia Patients with Inhibitors to Factor VIII/IX. J Clin Med 2017; 6:jcm6040046. [PMID: 28420167 PMCID: PMC5406778 DOI: 10.3390/jcm6040046] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 04/06/2017] [Accepted: 04/10/2017] [Indexed: 01/02/2023] Open
Abstract
The development of alloantibodies neutralising therapeutically administered factor (F) VIII/IX (inhibitors) is currently the most severe complication of the treatment of haemophilia. When persistent and at a high titre, inhibitors preclude the standard replacement treatment with FVIII/FIX concentrates, making patients’ management challenging. Indeed, the efficacy of bypassing agents, i.e., activated prothrombin complex concentrates (aPCC) and recombinant activated factor VII (rFVIIa), needed to overcome the haemostatic interference of the inhibitor, is not comparable to that of factor concentrates. In addition, the therapeutical response is unpredictable, with a relevant inter-individual and even intra-individual variability, and no laboratory assay is validated to monitor the efficacy and safety of the treatment. As a result, inhibitor patients have a worse joint status and quality of life compared to inhibitor-free subjects and the eradication of the inhibitor by immune tolerance induction is the preeminent therapeutic goal, particularly in children. However, over the last decades, treatment with bypassing agents has been optimised, allowing home treatment and the individualisation of regimens aimed at improving clinical outcomes. In this respect, a growing body of evidence supports the efficacy of prophylaxis with both bypassing agents in reducing bleeding rates and improving the quality of life, although the impact on long-term outcomes (in particular on preventing/reducing joint deterioration) is still unknown. This review offers an update on the current knowledge and practice of the use of bypassing agents in haemophiliacs with inhibitors, as well as on debated issues and unmet needs in this challenging setting.
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Affiliation(s)
- Angiola Rocino
- Haemophilia and Thrombosis Centre, San Giovanni Bosco Hospital, Napoli 80144, Italy.
| | - Massimo Franchini
- Department of Transfusion Medicine and Haematology, Carlo Poma Hospital, Mantova 46100, Italy.
| | - Antonio Coppola
- Regional Reference Centre for Coagulation Disorders, Federico II University Hospital, Napoli 80131, Italy.
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Hanley J, McKernan A, Creagh MD, Classey S, McLaughlin P, Goddard N, Briggs PJ, Frostick S, Giangrande P, Wilde J, Thachil J, Chowdary P. Guidelines for the management of acute joint bleeds and chronic synovitis in haemophilia. Haemophilia 2017; 23:511-520. [DOI: 10.1111/hae.13201] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2017] [Indexed: 12/16/2022]
Affiliation(s)
- J. Hanley
- Haemophilia Centre; Royal Victoria Infirmary; Newcastle upon Tyne UK
| | - A. McKernan
- Department of Haematology; Derby Hospitals NHS Foundation Trust; Derby UK
| | - M. D. Creagh
- Haemophilia Centre; Royal Cornwall Hospitals NHS Trust; Truro UK
| | - S. Classey
- Haemophilia Centre; Guys and St. Thomas' NHS Foundation Trust; London UK
| | - P. McLaughlin
- Katharine Dormandy Haemophilia and Thrombosis Centre; Royal Free Hospital; London UK
| | - N. Goddard
- Katharine Dormandy Haemophilia and Thrombosis Centre; Royal Free Hospital; London UK
| | - P. J. Briggs
- Haemophilia Centre; Royal Victoria Infirmary; Newcastle upon Tyne UK
| | - S. Frostick
- Institute of Translational Medicine; University of Liverpool; Liverpool UK
| | | | - J. Wilde
- Haemophilia Centre; Queen Elizabeth Hospital Birmingham; Birmingham UK
| | - J. Thachil
- Haemophilia Centre; Manchester Royal Infirmary; Manchester UK
| | - P. Chowdary
- Katharine Dormandy Haemophilia and Thrombosis Centre; Royal Free Hospital; London UK
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Dallaku K, Shakur H, Edwards P, Beaumont D, Roberts I, Huque S, Delius M, Mansmann U. Statistical analysis plan for the WOMAN-ETAPlaT study: Effect of tranexamic acid on platelet function and thrombin generation. Wellcome Open Res 2016. [DOI: 10.12688/wellcomeopenres.10105.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background. Postpartum haemorrhage (PPH) is a potentially life-threatening complication for women, and the leading cause of maternal mortality. Tranexamic acid (TXA) is an antifibrinolytic used worldwide to treat uterine haemorrhage and to reduce blood loss in general surgery. TXA may have effects on thrombin generation, platelet function and coagulation factors as a result of its inhibition on the plasmin. Methods. WOMAN ETAPlaT is a sub-study of the World Maternal Antifibrinolitic trial (WOMAN trial). All adult women clinically diagnosed with PPH after a vaginal delivery or caesarean section, are eligible for inclusion in the study. Blood samples will be collected at the baseline and 30 minutes after the first dose of study treatment is given. Platelet function will be evaluated in whole blood immediately after sampling with Multiplate® tests (ADPtest and TRAPtest). Thrombin generation, fibrinogen, D-dimer, and coagulation factors vW, V and VIII will be analysed using platelet poor plasma. Results. Recruitment to WOMAN ETAPlaT started on 04 November 2013 and closed on 13 January 2015, during this time 188 patients were recruited. The final participant follow-up was completed on 04 March 2015. This article introduces the statistical analysis plan for the study, without reference to unblinded data. Conclusion. The data from this study will provide evidence for the effect of TXA on thrombin generation, platelet function and coagulation factors in women with PPH. Trial registration: ClinicalTrials.gov Identifier: NCT00872469; ISRCTN76912190
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16
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Windyga J, Stefanska-Windyga E, Odnoczko E, Baran B, Czubak G. Activated prothrombin complex concentrate in combination with tranexamic acid: a single centre experience for the treatment of mucosal bleeding and dental extraction in haemophilia patients with inhibitors. Haemophilia 2016; 22:e465-8. [DOI: 10.1111/hae.13035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2016] [Indexed: 11/29/2022]
Affiliation(s)
- J. Windyga
- Department of Disorders of Hemostasis and Internal Medicine; Institute of Hematology and Transfusion Medicine; Warsaw Poland
- Laboratory of Hemostasis and Metabolic Diseases; Institute of Hematology and Transfusion Medicine; Warsaw Poland
| | - E. Stefanska-Windyga
- Outpatient Clinic for Patients with Coagulation Disorders; Institute of Hematology and Transfusion Medicine; Warsaw Poland
| | - E. Odnoczko
- Laboratory of Hemostasis and Metabolic Diseases; Institute of Hematology and Transfusion Medicine; Warsaw Poland
| | - B. Baran
- Laboratory of Hemostasis and Metabolic Diseases; Institute of Hematology and Transfusion Medicine; Warsaw Poland
| | - G. Czubak
- Outpatient Clinic for Patients with Coagulation Disorders; Institute of Hematology and Transfusion Medicine; Warsaw Poland
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