1
|
Khalil F, Ali M, Ellithi M. Impact of Acute Coronary Syndrome on Clinical Outcomes in Patients With Thrombotic Thrombocytopenic Purpura. Cureus 2023; 15:e35878. [PMID: 37033586 PMCID: PMC10079805 DOI: 10.7759/cureus.35878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2023] [Indexed: 03/09/2023] Open
Abstract
Thrombotic thrombocytopenic purpura (TTP) is a life-threatening clinical syndrome characterized by microangiopathy and a variable degree of end-organ ischemic damage. Cardiac involvement has been recognized as a major cause of mortality in these patients. In this study, we queried the National Inpatient Sample (NIS) for all patients hospitalized with thrombotic microangiopathy from 2002 to 2017, who also received plasma exchange (PLEX) during the same admission. A total of 6,214 patients with TTP were identified. We stratified patients based on whether or not they had acute coronary syndrome (ACS) during admission. ACS was documented in 6.3% of patients. Compared with patients without ACS, those with ACS were relatively older (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.02-1.03) and had a relatively higher prevalence of heart failure (OR, 2.02; 95% CI, 1.53-2.67) and coronary artery disease (OR, 2.69; 95% CI, 2.03-3.57). Certain complications were more prevalent in the ACS group including acute cerebrovascular accident (OR, 3.33; 95% CI, 2.94-3.78), acute heart failure (OR, 1.91; 95% CI, 1.67-2.19), acute kidney injury (OR, 1.76; 95% CI, 1.59-1.95), cardiogenic shock (OR, 2.15; 95% CI, 1.72-2.69), and respiratory failure (OR, 1.48; 95% CI, 1.32-1.66). Despite wider utilization of therapeutic plasmapheresis and improved supportive management of patients with TTP, associated morbidity and mortality remain significant. We demonstrate from this large retrospective cohort that ACS is an independent predictor of higher morbidity and mortality in TTP patients.
Collapse
|
2
|
Xu Y, Gu C, Wang R, Qi J, Wang J, Jiang T, Jiang M, Wu D, You T, Fu J. Prognostic value of dynamic cardiac biomarkers in patients with acquired refractory thrombocytopenic purpura: A retrospective study in Chinese population. J Clin Lab Anal 2022; 36:e24547. [PMID: 35689538 PMCID: PMC9280007 DOI: 10.1002/jcla.24547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 03/17/2022] [Accepted: 05/25/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Thrombotic thrombocytopenic purpura (TTP) is becoming a curable disease with the introduction of therapeutic plasma exchange (TPE). However, cardiovascular complications remain essential causes of mortality in patients with refractory TTP, while the association of cardiac biomarkers with the prognosis of TTP warrants further investigation. Methods Patients admitted to the First Affiliated Hospital of Soochow University for refractory TTP from 2013 through 2020 were included in this retrospective study. Clinical characteristics were collected from electronic health records. Biomarker levels on admission and post TPE were recorded. Logistic regression was adopted to identify risk factors for mortality. Results A total of 78 patients with refractory TTP were included in this study. Twenty‐one patients died during hospitalization, with a mortality rate of 26.9%. High‐sensitivity cardiac troponin T (hs‐cTnT), N‐terminal probrain natriuretic peptide (NT‐proBNP), and aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ratios (AAR) were increased in deceased patients compared with the survival group. Multivariate analysis showed that AAR after TPE was associated with overall mortality (OR: 4.45, 95% CI 1.09–18.19). The areas under the receiver operator characteristic curve (AUC) of AAR, hs‐cTnT, and NT‐proBNP for the association with mortality were 0.814, 0.840, and 0.829, respectively. Conclusion Higher post‐TPE cardiac biomarker levels are associated with increased in‐hospital mortality in patients with refractory TTP.
Collapse
Affiliation(s)
- Yinan Xu
- Hematological Intensive Care Unit,Department of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China.,Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Chengyuan Gu
- Hematological Intensive Care Unit,Department of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Ruju Wang
- Hematological Intensive Care Unit,Department of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jiaqian Qi
- Hematological Intensive Care Unit,Department of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jun Wang
- Department of Intensive Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Tingbo Jiang
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Min Jiang
- Department of Blood Transfusion, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Depei Wu
- Hematological Intensive Care Unit,Department of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Tao You
- Hematological Intensive Care Unit,Department of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jianhong Fu
- Hematological Intensive Care Unit,Department of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
| |
Collapse
|
3
|
Kichloo A, Chugh SS, Gupta S, Pandav J, Chander P. Atypical Hemolytic Uremic Syndrome Presenting as Acute Heart Failure-A Rare Presentation: Diagnosis Supported by Skin Biopsy. J Investig Med High Impact Case Rep 2020; 7:2324709619842905. [PMID: 31010328 PMCID: PMC6480996 DOI: 10.1177/2324709619842905] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Atypical hemolytic uremic syndrome (aHUS) is a rare disorder of uncontrolled complement activation that manifests classically as anemia, thrombocytopenia, and renal failure, although extrarenal manifestations are observed in 20% of the patient most of which involving central nervous system, with relatively rare involvement of the heart. In this article, we report the case of a 24-year-old male with no history of heart disease presenting with acute systolic heart failure along with microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury. Given his presentation of thrombotic microangiopathy (TMA), along with laboratory results significant for low haptoglobin, platelets, hemoglobin, C3, C4, CH50, and normal ADAMTS13 levels, with no diarrhea and negative STEC polymerase chain reaction in stool, aHUS diagnosis was established with strong clinical suspicion, and immediate initiation of treatment was advised. Kidney biopsy to confirm diagnosis of aHUS was inadvisable because of thrombocytopenia, so the skin biopsy of a rash on his arm was done, which came to be consistent with thrombotic microangiopathy. Our case highlights a relatively rare association between aHUS and cardiac involvement, and the use of skin biopsy to support diagnosis of aHUS in patients who cannot undergo renal biopsy because of thrombocytopenia.
Collapse
Affiliation(s)
- Asim Kichloo
- 1 CMU Medical Education Partners, Saginaw, MI, USA
| | | | | | - Jay Pandav
- 2 Westchester Medical Center, Valhalla, NY, USA
| | | |
Collapse
|
4
|
Azoulay E, Bauer PR, Mariotte E, Russell L, Knoebl P, Martin-Loeches I, Pène F, Puxty K, Povoa P, Barratt-Due A, Garnacho-Montero J, Wendon J, Munshi L, Benoit D, von Bergwelt-Baildon M, Maggiorini M, Coppo P, Cataland S, Veyradier A, Van de Louw A. Expert statement on the ICU management of patients with thrombotic thrombocytopenic purpura. Intensive Care Med 2019; 45:1518-1539. [PMID: 31588978 DOI: 10.1007/s00134-019-05736-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 08/07/2019] [Indexed: 12/11/2022]
Abstract
Thrombotic thrombocytopenic purpura (TTP) is fatal in 90% of patients if left untreated and must be diagnosed early to optimize patient outcomes. However, the very low incidence of TTP is an obstacle to the development of evidence-based clinical practice recommendations, and the very wide variability in survival rates across centers may be partly ascribable to differences in management strategies due to insufficient guidance. We therefore developed an expert statement to provide trustworthy guidance about the management of critically ill patients with TTP. As strong evidence was difficult to find in the literature, consensus building among experts could not be reported for most of the items. This expert statement is timely given the recent advances in the treatment of TTP, such as the use of rituximab and of the recently licensed drug caplacizumab, whose benefits will be maximized if the other components of the management strategy follow a standardized pattern. Finally, unanswered questions are identified as topics of future research on TTP.
Collapse
Affiliation(s)
- Elie Azoulay
- Centre National Maladie rare des Microangiopathies Thrombotiques, Médecine Intensive et Réanimation, APHP, Saint-Louis Hospital and Paris University, Paris, France.
| | - Philippe R Bauer
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Eric Mariotte
- Centre National Maladie rare des Microangiopathies Thrombotiques, Médecine Intensive et Réanimation, APHP, Saint-Louis Hospital and Paris University, Paris, France
| | - Lene Russell
- Department of Intensive Care, Copenhagen University Hospital, RigshospitaletCopenhagen Academy for Medical Simulation and Education, University of Copenhagen, and the Capital Region of Denmark, Copenhagen, Denmark
| | - Paul Knoebl
- Division of Hematology and Hemostasis Department of Medicine 1, Medical University of Vienna, Vienna, Austria
| | - Ignacio Martin-Loeches
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital, St James Street, Dublin 8, Ireland
| | - Frédéric Pène
- Centre National Maladie Rare des Microangiopathies Thrombotiques, Médecine Intensive et Réanimation, Cochin Hospital and Paris University, Paris, France
| | - Kathryn Puxty
- Department of Intensive Care, Glasgow Royal Infirmary, Glasgow, UK
| | - Pedro Povoa
- Polyvalent Intensive Care Unit, Hospital de São Francisco Xavier, Lisbon, Portugal.,NOVA Medical School, New University of Lisbon, Lisbon, Portugal.,Center for Clinical Epidemiology and Research, Unit of Clinical Epidemiology, Odense University Hospital Odense, Odense, Denmark
| | - Andreas Barratt-Due
- Department of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Jose Garnacho-Montero
- Intensive Care Clinical Unit, Hospital Universitario Virgen Macarena, Seville, Spain
| | | | - Laveena Munshi
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Michael von Bergwelt-Baildon
- Intensive Care in Hematologic and Oncologic Patients, Munich, Germany.,Medizinische Klinik und Poliklinik III, Klinikum der Universität München, Munich, Germany
| | - Marco Maggiorini
- Medical Intensive Care Unit, University Hospital of Zurich, Zurich, Switzerland
| | - Paul Coppo
- Centre National Maladie Rare des Microangiopathies Thrombotiques, Service d'Hématologie, Saint-Antoine Hospital and Paris University, Paris, France
| | - Spero Cataland
- Department of Medicine, Ohio State University, Columbus, OH, USA
| | - Agnès Veyradier
- Centre National Maladies Rares des Microangiopathies Thrombotiques, Service d'Hématologie, Lariboisière Hospital and Paris University, Paris, France
| | - Andry Van de Louw
- Division of Pulmonary and Critical Care, Penn State University College of Medicine, Hershey, PA, USA
| | | |
Collapse
|
5
|
Wiernek SL, Jiang B, Gustafson GM, Dai X. Cardiac implications of thrombotic thrombocytopenic purpura. World J Cardiol 2018; 10:254-266. [PMID: 30622684 PMCID: PMC6314883 DOI: 10.4330/wjc.v10.i12.254] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 11/20/2018] [Accepted: 11/26/2018] [Indexed: 02/06/2023] Open
Abstract
Thrombotic thrombocytopenic purpura (TTP) is a multisystem disorder that essentially can affect any organ in the human body. The hallmark of the pathogenesis in TTP is the large von Willebrand factor multimers on platelet-mediated micro-thrombi formation, leading to microvascular thrombosis. Autopsy studies showed that cardiac arrest and myocardial infarction are the most common immediate causes of death in these patients. Clinical manifestations of cardiac involvement in TTP vary dramatically, from asymptomatic elevation of cardiac biomarkers, to heart failure, MI and sudden cardiac death. There is limited knowledge about optimal cardiac evaluation and management in patients with TTP. The absence of typical cardiac symptoms, combined with complicated multi-organ involvement in TTP, may contribute to the under-utilization of cardiac evaluation and treatment. Prompt diagnosis and timely initiation of effective therapy could be critically important in selected cases. Based on our experience and this review of the literature, we developed several recommendations for focused cardiac evaluation for patients with acute TTP: (1) patients with suspected or confirmed TTP should be screened for the potential presence of cardiac involvement with detailed history and physical, electrocardiogram and cardiac enzymes; (2) clinical deterioration of TTP patients warrants immediate cardiac reevaluation; (3) TTP patients with clinical evidence of cardiac involvement should be monitored for telemetry, cardiac biomarkers and evaluated with transthoracic echocardiography. These patients require urgent targeted TTP treatment as well as cardiac-specific treatment. Aspirin therapy is indicated for all TTP patients. Since epicardial coronary artery involvement is rare, cardiac catheterization is usually not required, given the high risk for hemorrhage and kidney injury; (4) we recommend evidence-based medical therapy for ischemic symptoms and heart failure. TTP patients with evidence of cardiac involvement would also benefit from routine cardiology follow up during remission.
Collapse
Affiliation(s)
- Szymon L Wiernek
- Division of Cardiology, McAllister Heart Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States
| | - Bo Jiang
- Division of Cardiology, McAllister Heart Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States
| | - Gregory M Gustafson
- Division of Cardiology, Lang Research Center, New York Presbyterian Medical Group – Queens Hospital, Flushing, NY 11355, United States
| | - Xuming Dai
- Division of Cardiology, Lang Research Center, New York Presbyterian Medical Group – Queens Hospital, Flushing, NY 11355, United States
| |
Collapse
|
6
|
Fourmont AM, Zafrani L, Mariotte E, Galicier L, Joly B, Merceron S, Bertinchamp R, Lemiale V, de Jong A, Valade S, Darmon M, Veyradier A, Azoulay E. The clinical features of cardiac involvement in patients with severe thrombotic thrombocytopenic purpura. Intensive Care Med 2018; 44:963-965. [PMID: 29752524 DOI: 10.1007/s00134-018-5216-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2018] [Indexed: 11/25/2022]
Affiliation(s)
- Aude-Marie Fourmont
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis, Paris, France
- ECSTRA team, and Clinical Epidemiology, UMR 1153, Center of Epidemiology and Biostatistics, Sorbonne Paris Cité, CRESS), INSERM, Paris Diderot Sorbonne University, Paris, France
| | - Lara Zafrani
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis, Paris, France
- ECSTRA team, and Clinical Epidemiology, UMR 1153, Center of Epidemiology and Biostatistics, Sorbonne Paris Cité, CRESS), INSERM, Paris Diderot Sorbonne University, Paris, France
| | - Eric Mariotte
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis, Paris, France
- ECSTRA team, and Clinical Epidemiology, UMR 1153, Center of Epidemiology and Biostatistics, Sorbonne Paris Cité, CRESS), INSERM, Paris Diderot Sorbonne University, Paris, France
| | - Lionel Galicier
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis, Paris, France
- ECSTRA team, and Clinical Epidemiology, UMR 1153, Center of Epidemiology and Biostatistics, Sorbonne Paris Cité, CRESS), INSERM, Paris Diderot Sorbonne University, Paris, France
| | - Bérangère Joly
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis, Paris, France
- ECSTRA team, and Clinical Epidemiology, UMR 1153, Center of Epidemiology and Biostatistics, Sorbonne Paris Cité, CRESS), INSERM, Paris Diderot Sorbonne University, Paris, France
| | - Sybille Merceron
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis, Paris, France
- ECSTRA team, and Clinical Epidemiology, UMR 1153, Center of Epidemiology and Biostatistics, Sorbonne Paris Cité, CRESS), INSERM, Paris Diderot Sorbonne University, Paris, France
| | - Rémi Bertinchamp
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis, Paris, France
- ECSTRA team, and Clinical Epidemiology, UMR 1153, Center of Epidemiology and Biostatistics, Sorbonne Paris Cité, CRESS), INSERM, Paris Diderot Sorbonne University, Paris, France
| | - Virginie Lemiale
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis, Paris, France
- ECSTRA team, and Clinical Epidemiology, UMR 1153, Center of Epidemiology and Biostatistics, Sorbonne Paris Cité, CRESS), INSERM, Paris Diderot Sorbonne University, Paris, France
| | - Audrey de Jong
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis, Paris, France
- ECSTRA team, and Clinical Epidemiology, UMR 1153, Center of Epidemiology and Biostatistics, Sorbonne Paris Cité, CRESS), INSERM, Paris Diderot Sorbonne University, Paris, France
| | - Sandrine Valade
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis, Paris, France
- ECSTRA team, and Clinical Epidemiology, UMR 1153, Center of Epidemiology and Biostatistics, Sorbonne Paris Cité, CRESS), INSERM, Paris Diderot Sorbonne University, Paris, France
| | - Michael Darmon
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis, Paris, France
- ECSTRA team, and Clinical Epidemiology, UMR 1153, Center of Epidemiology and Biostatistics, Sorbonne Paris Cité, CRESS), INSERM, Paris Diderot Sorbonne University, Paris, France
| | - Agnès Veyradier
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis, Paris, France
- ECSTRA team, and Clinical Epidemiology, UMR 1153, Center of Epidemiology and Biostatistics, Sorbonne Paris Cité, CRESS), INSERM, Paris Diderot Sorbonne University, Paris, France
| | - Elie Azoulay
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis, Paris, France.
- ECSTRA team, and Clinical Epidemiology, UMR 1153, Center of Epidemiology and Biostatistics, Sorbonne Paris Cité, CRESS), INSERM, Paris Diderot Sorbonne University, Paris, France.
| |
Collapse
|
7
|
Mouabbi JA, Zein R, Kafri Z, Al-Katib A, Hadid T. Thrombotic thrombocytopenic purpura presenting as acute coronary syndrome. Clin Case Rep 2016; 4:736-9. [PMID: 27525072 PMCID: PMC4974416 DOI: 10.1002/ccr3.606] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 04/23/2016] [Accepted: 05/24/2016] [Indexed: 11/29/2022] Open
Abstract
In patients presenting with thrombotic thrombocytopenia purpura and non‐ST elevation myocardial infarction, prompt initiation of plasma exchange takes precedence over other invasive diagnostic procedures for coronary artery disease. Such procedures should be delayed until clinical condition and laboratory parameters have been stabilized.
Collapse
Affiliation(s)
- Jason Aboudi Mouabbi
- Internal Medicine St John Hospital and Medical Center Grosse Pointe Woods Michigan USA
| | - Rami Zein
- Internal Medicine St John Hospital and Medical Center Grosse Pointe Woods Michigan USA
| | - Zyad Kafri
- Van Elslander Cancer Center St John Hospital & Medical Center Grosse Pointe Woods Michigan USA
| | - Ayad Al-Katib
- Hematology Oncology St John Hospital and Medical Center Grosse Pointe Woods Michigan USA
| | - Tarik Hadid
- Van Elslander Cancer Center St John Hospital & Medical Center Grosse Pointe Woods Michigan USA
| |
Collapse
|
8
|
Verdoia M, Dell'Era G, Di Giovine G, Bortnik M, Zigrossi P, Gaidano G, Marino P. An anomalous case of acute coronary syndrome: the unexpected autoimmune duo. J Cardiovasc Med (Hagerstown) 2015; 17 Suppl 2:e118-e121. [PMID: 26090919 DOI: 10.2459/jcm.0000000000000277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
: Acute coronary syndrome represents one of the most common causes of admittance to emergency rooms in Western countries. Despite being in the majority of cases the mirror of coronary atherosclerosis, more rare causes could be hidden beyond this presentation, whose identification is often crucial for patients' outcome. We hereby present the case of a 44-year-old woman, with a history of relapsing-remitting multiple sclerosis in treatment with natalizumab, who was admitted to our division for an acute coronary syndrome. At arrival, anaemia and severe thrombocytopenia were observed; thus, no antiplatelet agent was administered. Within a few hours, aphasia occurred. Clinical presentation and the identification of schistocytes at blood smear led to the suspicion of thrombotic thrombocytopenic purpura, which was then confirmed by laboratory analysis. Immediate high-dose steroids and plasma exchange allowed discharging of the patient within a few days without neurological or cardiac sequelae.
Collapse
Affiliation(s)
- Monica Verdoia
- aDivision of Cardiology bDivision of Haematology, Ospedale Maggiore della Carità, Università del Piemonte Orientale, Novara, Italy
| | | | | | | | | | | | | |
Collapse
|
9
|
Tuter DS, Kopylov FY, Kozlovskaya NL, Demyanova KA, Shchekochikhin DY, Shilov EM, Syrkin AL. Cardiac involvement in thrombotic microangiopathies. TERAPEVT ARKH 2015; 87:17-25. [DOI: 10.17116/terarkh201587917-25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
10
|
Noris M, Remuzzi G. Cardiovascular complications in atypical haemolytic uraemic syndrome. Nat Rev Nephrol 2014; 10:174-80. [DOI: 10.1038/nrneph.2013.280] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
11
|
|
12
|
Humane-Immundefizienz-Virus-assoziierte thrombotisch-thrombozytopenische Purpura. Rechtsmedizin (Berl) 2013. [DOI: 10.1007/s00194-013-0917-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
13
|
Bennett M, Chubar Y, Gavish I, Aviv A, Stemer G, Chap-Marshak D. Experiences in a family with the Upshaw-Schulman syndrome over a 44-year period. Clin Appl Thromb Hemost 2013; 20:296-303. [PMID: 23872162 DOI: 10.1177/1076029613495309] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A family with a novel c.717_del frameshift and a c.3655C > T missense mutation of a disintegrin and metalloproteinase with thrombospondin type I motif, member 13 protein (ADAMTS13) is described. Family members have been under observation for 44 years. Two double heterozygotes have severe early-onset Upshaw-Schulman syndrome and require prophylactic plasma infusions. Analysis reveals that 2 weekly plasma infusions are not sufficient in preventing laboratory evidence of a thrombotic thrombocytopenic purpura (TTP) attack. Both the double heterozygotes also have a heterozygous factor V Leiden G1291A mutation. One underwent splenectomy, which did not reduce the frequency of TTP episodes but resulted in a recurrent pulmonary embolism and has necessitated lifelong anticoagulant therapy. The other has mild chronic renal failure and has had episodes of atrial fibrillation and cerebral infarction. Of the 3 heterozygotes in the family, 1 has had episodes of mild thrombocytopenia.
Collapse
Affiliation(s)
- Michael Bennett
- 1Department of Haematology, The Emek Medical Centre, Afula, Israel
| | | | | | | | | | | |
Collapse
|
14
|
Atreya AR, Arora S, Sivalingam SK, Giugliano GR. ST segment elevation myocardial infarction as a presenting feature of thrombotic thrombocytopenic purpura. J Cardiovasc Dis Res 2012; 3:167-9. [PMID: 22629041 PMCID: PMC3354466 DOI: 10.4103/0975-3583.95377] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Myocardial infarction with ST segment elevation (STE) on electrocardiography (ECG) is a common presentation in emergency rooms across the world. Myocardial injury and necrosis are infrequently the initial presentation in patients with thrombotic thrombocytopenic purpura (TTP). A 48-year-old woman presented with STE myocardial infarction from outside hospital for primary percutaneous coronary intervention. However, her clinical picture was not consistent. Rapid evaluation revealed symptoms associated with microangiopathic hemolytic anemia, thrombocytopenia, acute kidney injury with waxing and waning mental status. A diagnosis of TTP was made with low ADAMST-13 activity. Plasmapheresis was initiated along with intravenous steroid therapy. The patient had a full recovery and went home after full recovery of left ventricular ejection fraction and normal myocardial perfusion studies. Rapid evaluation is needed to identify infrequent causes of STE myocardial infarction. As swift protocols are activated in the emergency room and catheterization laboratories to ensure quality control, it is equally important to integrate all aspects of the patient's clinical and objective data to detect unusual disease entities.
Collapse
Affiliation(s)
- Auras R Atreya
- Department of Internal Medicine, Baystate Medical Center/Tufts University School of Medicine, Massachusetts, USA
| | | | | | | |
Collapse
|
15
|
Peigne V, Perez P, Resche Rigon M, Mariotte E, Canet E, Mira JP, Coppo P, Veyradier A, Azoulay E. Causes and risk factors of death in patients with thrombotic microangiopathies. Intensive Care Med 2012; 38:1810-7. [PMID: 22797353 DOI: 10.1007/s00134-012-2638-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Accepted: 06/16/2012] [Indexed: 12/11/2022]
Abstract
PURPOSE Although plasma therapy of thrombotic micro-angiopathies (TMAs) has dramatically improved survival, the outcome remains fatal in up to 15 % of patients. We investigated the causes and risk factors of death in patients with TMA. METHODS Retrospective matched case-control national-registry study of 57 patients who died within 180 days of TMA diagnosis and 48 survivors matched on age, gender, and baseline platelet count and creatinine level. The study period was 1995-2007. Factors associated with mortality were identified using a conditional logistic regression model. RESULTS Median time from TMA symptom onset to death was 7 (5-14) days. The leading causes of death were nosocomial infections, myocardial infarction, stroke, and pulmonary embolism. Cases and controls did not differ significantly regarding haemolysis parameters, ADAMTS13 activity, or neurological or gastrointestinal involvement. TMA was more frequently related to HIV or cancer in patients who died. Compared to survivors, non-survivors more often had cardiac involvement at diagnosis (38 vs. 6 %, p = 0.03) and less often received plasma exchange therapy (60 vs. 92 %, p = 0.004). Only two factors were independently associated with mortality by multivariate analysis: cardiac involvement at diagnosis (odds ratio, 5.96; 95 % confidence interval, 1.06-33.4) and plasma exchange therapy (odds ratio, 0.25; 95 % confidence interval, 0.06-0.99). CONCLUSION Our data emphasise the adverse prognostic significance of cardiac abnormalities and support routine plasma exchange in patients with TMA. Given the high risk of cardiac and neurological complications, adequate monitoring should be proposed to these patients in appropriate hospital settings.
Collapse
Affiliation(s)
- Vincent Peigne
- AP-HP, Hôpital Saint-Louis Medical ICU, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Gandhi K, Aronow WS, Desai H, Amin H, Sharma M, Lai HM, Singh P. Cardiovascular manifestations in patients with thrombotic thrombocytopenic purpura: a single-center experience. Clin Cardiol 2010; 33:213-6. [PMID: 20394041 DOI: 10.1002/clc.20731] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Cardiovascular manifestation in patients with thrombotic thrombocytopenic purpura. HYPOTHESIS The aim of this study was to investigate the incidence of acute myocardial infarction (AMI), arrhythmias, congestive heart failure, and mortality in patients hospitalized for thrombotic thrombocytopenic purpura (TTP). METHODS Thirty-eight patients (27 women and 11 men), mean age 44 years, were hospitalized with the diagnosis of TTP confirmed by a hematologist. We investigated the incidence of AMI which developed during hospitalization for TTP. AMI was diagnosed by new electrocardiographic changes, increased serum cardiac troponin I levels, and clinical symptomatology. The patients with AMI were also monitored for development of arrhythmias during hospitalization. RESULTS Of the 38 patients, 8 (21%) developed new Q-wave AMI. There was no significant difference in baseline characteristics between patients who developed AMI and those who did not develop AMI. Of the 8 patients with AMI, 2 (25%) developed atrial fibrillation, 1 (13%) developed atrial flutter, 1 (13%) developed supraventricular tachycardia, and 2 (25%) developed congestive heart failure. Death occurred in 3 of 8 patients (38%) with AMI and in 1 of 30 patients (3%) without AMI (P < 0.01). CONCLUSIONS New Q-wave AMI developed in 21% of 38 patients hospitalized with TTP. Supraventricular tachyarrhythmias developed in 50% of 8 patients with TTP who developed AMI. Patients hospitalized for TTP should be monitored for adverse cardiac events due to the high incidence of new AMI, supraventricular tachyarrhythmias, and mortality.
Collapse
Affiliation(s)
- Kaushang Gandhi
- Department of Medicine, Cardiology and Hematology Divisions, New York Medical College, Valhalla, New York, USA.
| | | | | | | | | | | | | |
Collapse
|
17
|
Zhan H, Zheng H, Moliterno AR, Streiff MB. Acute cardiomyopathy in a patient with thrombotic thrombocytopenic purpura. Am J Med 2010; 123:e3-4. [PMID: 20103008 DOI: 10.1016/j.amjmed.2009.07.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2009] [Revised: 06/27/2009] [Accepted: 07/01/2009] [Indexed: 11/16/2022]
|
18
|
Sterling JA. Recent Publications on Medications and Pharmacy. Hosp Pharm 2009. [DOI: 10.1310/hpj4404-354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Hospital Pharmacy presents this feature to keep pharmacists abreast of new publications in the medical/pharmacy literature. Articles of interest regarding a broad scope of topics are abstracted monthly.
Collapse
Affiliation(s)
- Jacyntha A. Sterling
- Saint Francis Hospital, Tulsa, Oklahoma
- Drug Information Specialist at Saint Francis Hospital, 6161 S Yale Ave, Tulsa, OK 74136
| |
Collapse
|