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Wang X, Luo L, Wang Y, An Z. Effect of Platelet Function Testing Guidance on Clinical Outcomes for Patients with Intracranial Aneurysms Undergoing Endovascular Treatment. AJNR Am J Neuroradiol 2023; 44:928-933. [PMID: 37414457 PMCID: PMC10411848 DOI: 10.3174/ajnr.a7923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/01/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Platelet function testing has been proposed to better adjust individualized antiplatelet treatment for patients undergoing endovascular treatment for intracranial aneurysms. Its clinical significance needs to be comprehensively evaluated. PURPOSE Our aim was to evaluate the impact of platelet function testing-guided versus standard antiplatelet treatment in patients receiving endovascular treatment for intracranial aneurysms. DATA SOURCES PubMed, EMBASE, and the Cochrane Library of clinical trials were searched from inception until March 2023. STUDY SELECTION Eleven studies comprising 6199 patients were included. DATA ANALYSIS ORs with 95% CIs were calculated using random effects models. DATA SYNTHESIS The platelet function testing-guided group was associated with a decreased rate of symptomatic thromboembolic events (OR = 0.57; 95% CI, 0.42-0.76; I2 = 26%). No significant difference was found in asymptomatic thromboembolic events (OR = 1.07; 95% CI, 0.39-2.94; I2 = 48%), hemorrhagic events (OR = 0.71; 95% CI, 0.42-1.19; I2 = 34%), intracranial hemorrhagic events (OR = 0.61; 95% CI, 0.03-10.79; I2 = 62%), morbidity (OR = 0.53; 95% CI, 0.05-5.72; I2 = 86%), and mortality (OR = 1.96; 95% CI, 0.64-5.97; I2 = 0%) between the 2 groups. Subgroup analysis suggested that platelet function testing-guided therapy may contribute to fewer symptomatic thromboembolic events in patients who received stent-assisted coiling (OR = 0.43; 95% CI, 0.18-1.02; I2 = 43%) or a combination of stent-assisted and flow-diverter stent placement (OR = 0.61; 95% CI, 0.36-1.02; I2 = 0%) or who changed from clopidogrel to other thienopyridines (OR = 0.64; 95% CI, 0.40-1.02; I2 = 18%), though the difference did not reach statistical significance. LIMITATIONS Heterogeneous endovascular treatment methods and adjusted antiplatelet regimens were limitations. CONCLUSIONS Platelet function testing-guided antiplatelet strategy significantly reduced the incidence of symptomatic thromboembolic events without any increase in the hemorrhagic events for patients undergoing endovascular treatment for intracranial aneurysms.
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Affiliation(s)
- X Wang
- From the Departments of Pharmacy (X.W., Z.A.)
| | - L Luo
- Department of Pharmacy (L.L.), Beijing Huairou Hospital, Beijing, China
| | - Y Wang
- Neurosurgery (Y.W.), Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Z An
- From the Departments of Pharmacy (X.W., Z.A.)
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Favaloro EJ, Gosselin RC, Pasalic L, Lippi G. Hemostasis and Thrombosis: An Overview Focusing on Associated Laboratory Testing to Diagnose and Help Manage Related Disorders. Methods Mol Biol 2023; 2663:3-38. [PMID: 37204701 DOI: 10.1007/978-1-0716-3175-1_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Hemostasis is a complex but balanced process that permit normal blood flow, without adverse events. Disruption of the balance may lead to bleeding or thrombotic events, and clinical interventions may be required. Hemostasis laboratories typically offer an array of tests, including routine coagulation and specialized hemostasis assays used to guide clinicians for diagnosing and managing patients. Routine assays may be used to screen patients for hemostasis-related disturbances but may also be used for drug monitoring, measuring efficacy of replacement or adjunctive therapy, and other indications, which may then be used to guide further patient management. Similarly, "specialized" assays are used for diagnostic purposes or may be used to monitor or measure efficacy of a given therapy. This chapter provides an overview of hemostasis and thrombosis, with a focus on laboratory testing that may be used to diagnose and help manage patients suspected of hemostasis- and thrombosis-related disorders.
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Affiliation(s)
- Emmanuel J Favaloro
- School of Medical Sciences, Faculty of Medicine and Health University of Sydney, Westmead Hospital, Westmead, NSW, Australia.
- School of Dentistry and Medical Sciences, Faculty of Science and Health, Charles Sturt University, Wagga, Wagga, NSW, Australia.
| | - Robert C Gosselin
- Hemostasis & Thrombosis Center, Davis Health System, University of California, Sacramento, CA, USA
| | - Leonardo Pasalic
- Department of Haematology, Sydney Centres for Thrombosis and Haemostasis, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Westmead, NSW, Australia
- Westmead Clinical School, University of Sydney, Westmead, NSW, Australia
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
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Favaloro EJ, Pasalic L, Lippi G. Towards 50 years of platelet function analyser (PFA) testing. Clin Chem Lab Med 2022; 61:851-860. [PMID: 35859143 DOI: 10.1515/cclm-2022-0666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 07/11/2022] [Indexed: 11/15/2022]
Abstract
The platelet function analyser (PFA) is a prevalent platelet function screening instrument, and comes in two models-the original PFA-100 and the contemporary PFA-200. The instruments have 'identical' output, being a 'closure time' (CT). Moreover, normal reference ranges provided by the manufacturer, for the specific test cartridges, are the same for both models. There are three different types of test cartridge: collagen/epinephrine (C/Epi), collagen/adenosine diphosphate (C/ADP), and "Innovance PFA P2Y" (only available in certain geographical locations). The PFA-100 was released in the mid 1990s, and so is approaching 50 years of age. The PFA-200, released in some locations in the mid 2010s, is destined to eventually replace the PFA-100, but is not yet available in the USA. The test system is highly sensitive to von Willebrand disease (VWD; C/Epi and C/ADP) and to aspirin therapy (C/Epi only), but only has moderate sensitivity to defects in platelet function and/or deficiencies in platelet number. Accordingly, recommendations for use for screening platelet function vary according to user experience. Some workers have alternatively used the PFA to assess thrombosis risk or pre-operative bleeding risk. In this review, we provide an overview of the history of PFA, and summarise its current clinical utility.
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Affiliation(s)
- Emmanuel J Favaloro
- Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Westmead, NSW, Australia.,Sydney Centres for Thrombosis and Haemostasis, Westmead, NSW, Australia.,Faculty of Science and Health, Charles Sturt University, Wagga Wagga, NSW, Australia
| | - Leonardo Pasalic
- Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Westmead, NSW, Australia.,Sydney Centres for Thrombosis and Haemostasis, Westmead, NSW, Australia.,Westmead Clinical School, University of Sydney, Westmead, NSW, Australia
| | - Giuseppe Lippi
- Section of Clinical Biochemistry and School of Medicine, University of Verona, Verona, Italy
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Krüger-Genge A, Tondera C, Hauser S, Braune S, Görs J, Roch T, Klopfleisch R, Neffe AT, Lendlein A, Pietzsch J, Jung F. Immunocompatibility and non-thrombogenicity of gelatin-based hydrogels. Clin Hemorheol Microcirc 2021; 77:335-350. [PMID: 33337355 DOI: 10.3233/ch-201028] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Immunocompatibility and non-thrombogenicity are important requirements for biomedical applications such as vascular grafts. Here, gelatin-based hydrogels formed by reaction of porcine gelatin with increasing amounts of lysine diisocyanate ethyl ester were investigated in vitro in this regard. In addition, potential adverse effects of the hydrogels were determined using the "Hen's egg test on chorioallantoic membrane" (HET-CAM) test and a mouse model.The study revealed that the hydrogels were immunocompatible, since complement activation was absent and a substantial induction of reactive oxygen species generating monocytes and neutrophils could not be observed in whole human blood. The density as well as the activation state of adherent thrombocytes was comparable to medical grade polydimethylsiloxane, which was used as reference material. The HET-CAM test confirmed the compatibility of the hydrogels with vessel functionality since no bleedings, thrombotic events, or vessel destructions were observed. Only for the samples synthesized with the highest LDI amount the number of growing blood vessels in the CAM was comparable to controls and significantly higher than for the softer materials. Implantation into mice showed the absence of adverse or toxic effects in spleen, liver, or kidney, and only a mild lymphocytic activation in the form of a follicular hyperplasia in draining lymph nodes (slightly increased after the implantation of the material prepared with the lowest LDI content). These results imply that candidate materials prepared with mid to high amounts of LDI are suitable for the coating of the blood contacting surface of cardiovascular implants.
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Affiliation(s)
- A Krüger-Genge
- Institute of Biomaterial Science and Berlin-Brandenburg Centre for Regenerative Therapies (BCRT), Helmholtz Zentrum Geesthacht, Teltow, Germany
| | - C Tondera
- Department of Radiopharmaceutical and Chemical Biology, Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany.,School of Science, Faculty of Chemistry and Food Chemistry, Technical University Dresden, Dresden, Germany
| | - S Hauser
- Department of Radiopharmaceutical and Chemical Biology, Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
| | - S Braune
- Institute of Biomaterial Science and Berlin-Brandenburg Centre for Regenerative Therapies (BCRT), Helmholtz Zentrum Geesthacht, Teltow, Germany
| | - J Görs
- Institute of Biomaterial Science and Berlin-Brandenburg Centre for Regenerative Therapies (BCRT), Helmholtz Zentrum Geesthacht, Teltow, Germany
| | - T Roch
- Institute of Biomaterial Science and Berlin-Brandenburg Centre for Regenerative Therapies (BCRT), Helmholtz Zentrum Geesthacht, Teltow, Germany.,Helmholtz Virtual Institute - Multifunctional Biomaterials for Medicine, Teltow and Berlin, Germany
| | - R Klopfleisch
- Institute of Veterinary Pathology, Freie Universität Berlin, Berlin, Germany
| | - A T Neffe
- Institute of Biomaterial Science and Berlin-Brandenburg Centre for Regenerative Therapies (BCRT), Helmholtz Zentrum Geesthacht, Teltow, Germany.,Helmholtz Virtual Institute - Multifunctional Biomaterials for Medicine, Teltow and Berlin, Germany
| | - A Lendlein
- Institute of Biomaterial Science and Berlin-Brandenburg Centre for Regenerative Therapies (BCRT), Helmholtz Zentrum Geesthacht, Teltow, Germany.,Helmholtz Virtual Institute - Multifunctional Biomaterials for Medicine, Teltow and Berlin, Germany.,Institute of Chemistry, University of Potsdam, Potsdam, Germany
| | - J Pietzsch
- Department of Radiopharmaceutical and Chemical Biology, Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany.,School of Science, Faculty of Chemistry and Food Chemistry, Technical University Dresden, Dresden, Germany
| | - F Jung
- Institute of Biomaterial Science and Berlin-Brandenburg Centre for Regenerative Therapies (BCRT), Helmholtz Zentrum Geesthacht, Teltow, Germany.,Helmholtz Virtual Institute - Multifunctional Biomaterials for Medicine, Teltow and Berlin, Germany
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Charpy J, Chaghouri PE, Benattar N, Castet SM, Huguenin Y, James C, Fiore M. Evaluation of the potential utility of the total thrombus-formation analysis system in comparison to the platelet function analyser in subjects with primary haemostatic defects. Br J Haematol 2020; 191:e7-e10. [PMID: 32609384 DOI: 10.1111/bjh.16925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | | | | | - Sabine-Marie Castet
- Centre de Ressources et de Compétence des Maladies Hémorragiques Constitutionnelles, CHU de Bordeaux, Bordeaux, France
| | - Yoann Huguenin
- Centre de Ressources et de Compétence des Maladies Hémorragiques Constitutionnelles, CHU de Bordeaux, Bordeaux, France
| | - Chloé James
- Laboratoire d'hématologie, CHU de Bordeaux, Pessac, France.,Inserm U1034, Biology of Cardiovascular Disease, Pessac, France
| | - Mathieu Fiore
- Laboratoire d'hématologie, CHU de Bordeaux, Pessac, France.,Centre de Référence des Pathologies Plaquettaires Constitutionnelles, CHU de Bordeaux, Pessac, France
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Motum P, Just S, Zebeljan D, Nicholls C, Kershaw G, Oliver S, Mohammed S, Favaloro EJ. A diagnosis of von Willebrand disease despite normal test results for factor VIII and von Willebrand factor antigen and activity. Am J Hematol 2019; 94:1425-1432. [PMID: 31423628 DOI: 10.1002/ajh.25618] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 08/08/2019] [Accepted: 08/13/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Penelope Motum
- Haematology, NSW Health Pathology Liverpool Hospital New South Wales Australia
| | - Sarah Just
- Haematology, NSW Health Pathology Liverpool Hospital New South Wales Australia
| | - Diane Zebeljan
- Haematology, NSW Health Pathology Liverpool Hospital New South Wales Australia
| | - Catherine Nicholls
- Department of Genetic Pathology SA Pathology Adelaide South Australia Australia
| | - Geoffrey Kershaw
- Haematology, NSW Health Pathology Royal Prince Alfred Hospital New South Wales Australia
| | - Susan Oliver
- Department of Haematology Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital Westmead New South Wales Australia
| | - Soma Mohammed
- Department of Haematology Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital Westmead New South Wales Australia
| | - Emmanuel J. Favaloro
- Department of Haematology Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital Westmead New South Wales Australia
- Department of Haematology Sydney Centres for Thrombosis and Haemostasis Westmead New South Wales Australia
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Braune S, Latour RA, Reinthaler M, Landmesser U, Lendlein A, Jung F. In Vitro Thrombogenicity Testing of Biomaterials. Adv Healthc Mater 2019; 8:e1900527. [PMID: 31612646 DOI: 10.1002/adhm.201900527] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 08/15/2019] [Indexed: 12/29/2022]
Abstract
The short- and long-term thrombogenicity of implant materials is still unpredictable, which is a significant challenge for the treatment of cardiovascular diseases. A knowledge-based approach for implementing biofunctions in materials requires a detailed understanding of the medical device in the biological system. In particular, the interplay between material and blood components/cells as well as standardized and commonly acknowledged in vitro test methods allowing a reproducible categorization of the material thrombogenicity requires further attention. Here, the status of in vitro thrombogenicity testing methods for biomaterials is reviewed, particularly taking in view the preparation of test materials and references, the selection and characterization of donors and blood samples, the prerequisites for reproducible approaches and applied test systems. Recent joint approaches in finding common standards for a reproducible testing are summarized and perspectives for a more disease oriented in vitro thrombogenicity testing are discussed.
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Affiliation(s)
- Steffen Braune
- Institute of Biomaterial Science and Berlin‐Brandenburg Centre for Regenerative Therapies (BCRT)Helmholtz‐Zentrum Geesthacht Kantstrasse 55 14513 Teltow Germany
| | - Robert A. Latour
- Rhodes Engineering Research CenterDepartment of BioengineeringClemson University Clemson SC 29634 USA
| | - Markus Reinthaler
- Institute of Biomaterial Science and Berlin‐Brandenburg Centre for Regenerative Therapies (BCRT)Helmholtz‐Zentrum Geesthacht Kantstrasse 55 14513 Teltow Germany
- Department for CardiologyCharité UniversitätsmedizinCampus Benjamin Franklin Hindenburgdamm 30 12203 Berlin Germany
| | - Ulf Landmesser
- Department for CardiologyCharité UniversitätsmedizinCampus Benjamin Franklin Hindenburgdamm 30 12203 Berlin Germany
| | - Andreas Lendlein
- Institute of Biomaterial Science and Berlin‐Brandenburg Centre for Regenerative Therapies (BCRT)Helmholtz‐Zentrum Geesthacht Kantstrasse 55 14513 Teltow Germany
- Institute of ChemistryUniversity of Potsdam Karl‐Liebknecht‐Strasse 24‐25 14476 Potsdam Germany
- Helmholtz Virtual Institute “Multifunctional Biomaterials for Medicine”Helmholtz‐Zentrum Geesthacht Kantstrasse 55 14513 Teltow Germany
| | - Friedrich Jung
- Institute of Biomaterial Science and Berlin‐Brandenburg Centre for Regenerative Therapies (BCRT)Helmholtz‐Zentrum Geesthacht Kantstrasse 55 14513 Teltow Germany
- Helmholtz Virtual Institute “Multifunctional Biomaterials for Medicine”Helmholtz‐Zentrum Geesthacht Kantstrasse 55 14513 Teltow Germany
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Rand ML, Reddy EC, Israels SJ. Laboratory diagnosis of inherited platelet function disorders. Transfus Apher Sci 2018; 57:485-493. [DOI: 10.1016/j.transci.2018.07.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Favaloro EJ, Mohammed S, Lippi G. Postanalytical considerations that may improve the diagnosis or exclusion of haemophilia and von Willebrand disease. Haemophilia 2018; 24:849-861. [PMID: 30024638 DOI: 10.1111/hae.13587] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 06/17/2018] [Indexed: 01/07/2023]
Abstract
von Willebrand disease (VWD) and haemophilia represent the most common inherited or acquired bleeding disorders. However, many laboratories and clinicians may be challenged by their accurate diagnosis or exclusion. Difficulties in diagnosis/exclusion may include analytical issues, where assays occasionally generate an incorrect result (ie representing an analytical error) or have limitations in their measurement range of and/or low analytical sensitivity. Also increasingly recognized is the influence of preanalytical issues on the diagnosis of VWD or haemophilia. Unfortunately, postanalytical considerations are often not well considered in the diagnostic process. Therefore, this narrative review aims to provide an overview of some important postanalytical considerations that may help improve the diagnosis of VWD and haemophilia. This review primarily discusses aspects around reporting of test results. However, we also discuss other less well-recognized postanalytical considerations, including the use of assay ratios to help identify differential diagnoses and then guide further investigation.
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Affiliation(s)
- Emmanuel J Favaloro
- Diagnostic Haemostasis Laboratory, Department of Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Westmead, NSW, Australia.,Sydney Centres for Thrombosis and Haemostasis, Westmead, NSW, Australia
| | - Soma Mohammed
- Diagnostic Haemostasis Laboratory, Department of Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Westmead, NSW, Australia
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
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Abstract
Testing of platelet function comprises a crucial element of hemostasis assessment, particularly for investigations into bleeding and/or bruising. The Platelet Function Analyzer (PFA)-100 is the most utilized primary hemostasis-screening test system available, as recently remodeled/upgraded to the PFA-200. Internal quality control (IQC) and external quality assessment (EQA) (including proficiency testing) represent critical elements of ensuring test practice quality. Although true for all tests, IQC and EQA are logistically challenging for platelet function testing, inclusive of the PFA-100/200. We accordingly update our experience with novel yet feasible approaches to both IQC and EQA of PFA-100/200. Over the past 10 years, a total of 43 challenges have been tested, with most challenges designed to mimic moderate or severe primary hemostasis defects. The current report is restricted to the last four years and has also differentially assessed PFA-100 vs. PFA-200 EQA results to identify potential variance. Numerical results for closure times (CTs) and participant-supplied interpretive comments were analyzed. Reported CTs for each challenge were within limits of expectation, and good reproducibility was evidenced by repeated challenges. Coefficients of variation (CVs) for challenges, generally ranging from 15% to 25%, were similar or better than those obtained using native whole blood and consistent with past reports. Participant interpretations were generally consistent with test data and expectations. There was no evident difference in PFA-100 vs. PFA-200 EQA test results. The EQA material has also been successfully evaluated from the perspective of potential IQC. To conclude, IQC and EQA processes for the PFA-100/200 have been established that are highly reproducible, supporting the concept of EQA/IQC for platelet function testing, and also facilitating monitoring and improvement in its performance. In terms of EQA, PFA-100 and PFA-200 instruments appear to behave similarly.
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Affiliation(s)
- Emmanuel J Favaloro
- a Department of Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology , Westmead Hospital , Westmead , NSW , Australia.,b Sydney Centres for Thrombosis and Haemostasis , Westmead , Australia
| | - Roslyn Bonar
- c RCPAQAP Haematology , St Leonards , New South Wales , Australia
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Spiezia L, Al Mamary A, Campello E, Piazza D, Maggiolo S, Dalla Valle F, Napodano M, Simioni P. On-treatment platelet reactivity in peripheral and coronary blood in patients undergoing primary PCI for ST-segment elevation myocardial infarction (STEMI). Scandinavian Journal of Clinical and Laboratory Investigation 2018; 78:281-286. [PMID: 29575927 DOI: 10.1080/00365513.2018.1455220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Dual antiplatelet therapy is recommended in patients undergoing primary percutaneous coronary intervention (p-PCI) for ST-segment elevation myocardial infarction (STEMI). Pre-analytical variables may influence platelet function analysis results. Our aim was to evaluate the on-treatment platelet reactivity in peripheral artery vs coronary blood in patients with STEMI. We enrolled one hundred and nine patients who consecutively underwent p-PCI at Cardiology Unit of Padua University Hospital between June 2014 and June 2015. Before the procedure, all patients received intravenous aspirin 250 mg and either of the thienopyridines; clopidogrel 600 mg, prasugrel 60 mg or ticagrelor 180 mg. ASPI-test and ADP-test using multiple electrode aggregometry (MEA) were performed in samples collected from both a peripheral artery and the culprit coronary artery. 'Low responders' were patients with an ASPI-test or ADP-test value greater than or equal to a pre-established normal range. No significant differences were observed in ASPI-test values between peripheral (19 (median) [3-49 (10-90 percentiles)] U) vs coronary (12 [1-40] U, p = .06) blood and in ADP-test (40 [14-82] U vs 33 [7-79] U, p =.68) blood. In peripheral blood, fifteen (14%) patients were 'low aspirin' and forty-one (38%) 'low thienopyridines' responders. The prevalence of 'low clopidogrel' responders was higher (45%) than prasugrel (36%) and ticagrelor (33%). Similar results were observed in coronary blood. In patients undergoing p-PCI for STEMI, MEA platelet function observed in coronary arteries was consistent with peripheral artery blood's independently of the antiplatelet drug used. The clinical significance of peripheral and coronary on-aspirin/thienopyridines platelet reactivity needs further clarification.
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Affiliation(s)
- Luca Spiezia
- a Department of Medicine, Thrombotic and Haemorrhagic Diseases Unit , University of Padua , Padua , Italy
| | - Ahmed Al Mamary
- b Department of Cardiac, Thoracic and Vascular Sciences, Cardiology Unit , University of Padua , Padua , Italy
| | - Elena Campello
- a Department of Medicine, Thrombotic and Haemorrhagic Diseases Unit , University of Padua , Padua , Italy
| | - Daniele Piazza
- a Department of Medicine, Thrombotic and Haemorrhagic Diseases Unit , University of Padua , Padua , Italy
| | - Sara Maggiolo
- a Department of Medicine, Thrombotic and Haemorrhagic Diseases Unit , University of Padua , Padua , Italy
| | - Fabio Dalla Valle
- a Department of Medicine, Thrombotic and Haemorrhagic Diseases Unit , University of Padua , Padua , Italy
| | - Massimo Napodano
- b Department of Cardiac, Thoracic and Vascular Sciences, Cardiology Unit , University of Padua , Padua , Italy
| | - Paolo Simioni
- a Department of Medicine, Thrombotic and Haemorrhagic Diseases Unit , University of Padua , Padua , Italy
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Enko D, Mangge H, Münch A, Niedrist T, Mahla E, Metzler H, Prüller F. Pneumatic tube system transport does not alter platelet function in optical and whole blood aggregometry, prothrombin time, activated partial thromboplastin time, platelet count and fibrinogen in patients on anti-platelet drug therapy. Biochem Med (Zagreb) 2017; 27:217-224. [PMID: 28392742 PMCID: PMC5382865 DOI: 10.11613/bm.2017.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 01/14/2017] [Indexed: 01/09/2023] Open
Abstract
Introduction The aim of this study was to assess pneumatic tube system (PTS) alteration on platelet function by the light transmission aggregometry (LTA) and whole blood aggregometry (WBA) method, and on the results of platelet count, prothrombin time (PT), activated partial thromboplastin time (APTT), and fibrinogen. Materials and methods Venous blood was collected into six 4.5 mL VACUETTE® 9NC coagulation sodium citrate 3.8% tubes (Greiner Bio-One International GmbH, Kremsmünster, Austria) from 49 intensive care unit (ICU) patients on dual anti-platelet therapy and immediately hand carried to the central laboratory. Blood samples were divided into 2 Groups: Group 1 samples (N = 49) underwent PTS (4 m/s) transport from the central laboratory to the distant laboratory and back to the central laboratory, whereas Group 2 samples (N = 49) were excluded from PTS forces. In both groups, LTA and WBA stimulated with collagen, adenosine-5’-diphosphate (ADP), arachidonic acid (AA) and thrombin-receptor-activated-peptide 6 (TRAP-6) as well as platelet count, PT, APTT, and fibrinogen were performed. Results No statistically significant differences were observed between blood samples with (Group 1) and without (Group 2) PTS transport (P values from 0.064 – 0.968). The AA-induced LTA (bias: 68.57%) exceeded the bias acceptance limit of ≤ 25%. Conclusions Blood sample transportation with computer controlled PTS in our hospital had no statistically significant effects on platelet aggregation determined in patients with anti-platelet therapy. Although AA induced LTA showed a significant bias, the diagnostic accuracy was not influenced.
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Affiliation(s)
- Dietmar Enko
- Institute of Clinical Chemistry and Laboratory Medicine, General Hospital Steyr, Steyr, Austria; Clinical Institute of Medical and Laboratory Diagnostics, Medical University Graz, Graz, Austria
| | - Harald Mangge
- Clinical Institute of Medical and Laboratory Diagnostics, Medical University Graz, Graz, Austria
| | - Andreas Münch
- Department of Anesthesiology and Intensive Care Medicine, Medical University Graz, Graz, Austria
| | - Tobias Niedrist
- Clinical Institute of Medical and Laboratory Diagnostics, Medical University Graz, Graz, Austria
| | - Elisabeth Mahla
- Department of Anesthesiology and Intensive Care Medicine, Medical University Graz, Graz, Austria; Research Unit "Perioperative Platelet Function", Medical University of Graz, Graz, Austria
| | - Helfried Metzler
- Department of Anesthesiology and Intensive Care Medicine, Medical University Graz, Graz, Austria
| | - Florian Prüller
- Clinical Institute of Medical and Laboratory Diagnostics, Medical University Graz, Graz, Austria; Research Unit "Perioperative Platelet Function", Medical University of Graz, Graz, Austria
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Favaloro EJ. Clinical utility of closure times using the platelet function analyzer-100/200. Am J Hematol 2017; 92:398-404. [PMID: 27935090 DOI: 10.1002/ajh.24620] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 11/21/2016] [Accepted: 11/28/2016] [Indexed: 01/02/2023]
Abstract
The "platelet function analyzer" (PFA)-100 was first introduced to us in 1995. Since then, the instrument has appeared in over 50 reviews and almost 1000 publications. Recently, the PFA-100 has been "upgraded" to the PFA-200, which has transformed the user interface and electronic management, but retained the fundamental mechanics, and essentially provides the same results. The PFA-100/200 has conceivable clinical utility to screen for von Willebrand Disease (VWD) and platelet disorders, and in monitoring desmopressin (DDAVP) therapy in both, and possibly anti-platelet therapy. Its great strengths are its usage simplicity and sensitivity to conditions affecting primary hemostasis. However, as a "global" test, its limitation is that closure time (CT) test results are neither predictive of, nor specific for, any individual disorder. However, utilized properly, the PFA-100/200 reflects a valuable addition to hemostasis laboratories involved in identification or therapeutic-monitoring of disorders of primary hemostasis.
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Affiliation(s)
- Emmanuel J. Favaloro
- Department of Haematology; Institute of Clinical Pathology and Medical Research (ICPMR), Sydney Centres for Thrombosis and Haemostasis, NSW Health Pathology, Westmead Hospital; NSW Australia
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15
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Abstract
INTRODUCTION Platelets play a key role in primary hemostasis and are also intricately linked to secondary hemostasis. Investigation of platelet function in children, especially in neonates, is seriously challenged by the volumes required to perform the majority of platelet function tests and due to the lack of standardization of these tests for use in children. Areas covered: The present review summarizes developmental hemostasis with a focus on the differences in platelet adhesion, activation and aggregation, between preterm neonates, full-term neonates, during childhood and in adults. Some of the most widely used platelet function tests are presented, including novel tests requiring only a small blood volume. Expert commentary: Currently available platelet function tests are limited as regards to investigation of neonates due to difficulties in obtaining adequate blood volume, poor standardization, lack of reference intervals for neonates and children, and an incomplete understanding of the functional phenotype of neonatal platelets, especially preterm neonatal platelets.
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Affiliation(s)
- Anne-Mette Hvas
- a Centre for Haemophilia and Thrombosis, Department of Clinical Biochemistry , Aarhus University Hospital , Aarhus , Denmark
| | - Emmanuel J Favaloro
- b Department of Haematology , Sydney Centres for Thrombosis and Haemostasis, Institute of Clinical Pathology and Medical Research (ICPMR), Westmead Hospital , Westmead , Australia
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16
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Braune S, Fröhlich GM, Lendlein A, Jung F. Effect of temperature on platelet adherence. Clin Hemorheol Microcirc 2017; 61:681-8. [PMID: 26639771 DOI: 10.3233/ch-152028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Thrombogenicity is one of the main parameters tested in vitro to evaluate the hemocompatibility of artificial surfaces. While the influence of the temperature on platelet aggregation has been addressed by several studies, the temperature influence on the adherence of platelets to body foreign surfaces as an important aspect of biomedical device handling has not yet been explored. Therefore, we analyzed the influence of two typically applied incubation-temperatures (22°C and 37°C) on the adhesion of platelets to biomaterials. MATERIAL AND METHODS Thrombogenicity of three different polymers - medical grade poly(dimethyl siloxane) (PDMS), polytetrafluoroethylene (PTFE) and polyethylene terephthalate (PET) - were studied in an in vitro static test. Platelet adhesion was studied with stringently characterized blood from apparently healthy subjects. Collection of whole blood and preparation of platelet rich plasma (PRP) was carried out at room temperature (22°C). PRP was incubated with the polymers either at 22°C or 37°C. Surface adherent platelets were fixed, fluorescently labelled and assessed by an image-based approach. RESULTS AND DISCUSSION Differences in the density of adherent platelets after incubation at 22°C and 37°C occurred on PDMS and PET. Similar levels of adherent platelets were observed on the very thrombogenic PTFE. The covered surface areas per single platelet were analyzed to measure the state of platelet activation and revealed no differences between the two incubation temperatures for any of the analyzed polymers. Irrespective of the observed differences between the low and medium thrombogenic PDMS and PET and the higher variability at 22°C, the thrombogenicity of the three investigated polymers was evaluated being comparable at both incubation temperatures.
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Affiliation(s)
- S Braune
- Institute of Biomaterial Science, Helmholtz-Zentrum Geesthacht, Teltow, Germany.,Berlin-Brandenburg Center for Regenerative Therapies, Teltow and Berlin, Germany
| | | | - A Lendlein
- Institute of Biomaterial Science, Helmholtz-Zentrum Geesthacht, Teltow, Germany.,Berlin-Brandenburg Center for Regenerative Therapies, Teltow and Berlin, Germany.,Institute of Chemistry, University of Potsdam, Potsdam, Germany
| | - F Jung
- Institute of Biomaterial Science, Helmholtz-Zentrum Geesthacht, Teltow, Germany.,Berlin-Brandenburg Center for Regenerative Therapies, Teltow and Berlin, Germany
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17
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Aoun SG, Welch BG, Pride LG, White J, Novakovic R, Hoes K, Sarode R. Contribution of whole platelet aggregometry to the endovascular management of unruptured aneurysms: an institutional experience. J Neurointerv Surg 2016; 9:974-977. [PMID: 27651476 DOI: 10.1136/neurintsurg-2016-012623] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 08/22/2016] [Accepted: 08/29/2016] [Indexed: 01/21/2023]
Abstract
BACKGROUND Stent-assisted coiling of intracranial aneurysms is an efficient alternative treatment to surgical clipping but requires prolonged antiplatelet therapy. Some patients are non-responsive to aspirin and/or clopidogrel. OBJECTIVE To analyze the implications of this assessment using the 'whole blood aggregometry (WBA) by impedance' technique. MATERIALS AND METHODS The Southwestern Tertiary Aneurysm Registry was reviewed between 2002 and 2012 for patients with unruptured aneurysms treated with stent-assisted coiling. The study population was divided into patients who were tested preoperatively for platelet responsiveness to aspirin and clopidogrel ('tested' patients) and those who were not ('non-tested'). Where necessary, tested patients received additional doses of antiplatelet drugs to achieve adequate platelet inhibition. Endpoints included the incidence of non-responsiveness, the rates of thrombotic and hemorrhagic complications, and the rates of permanent morbidity and mortality. RESULTS A total of 266 patients fulfilled our selection criteria: 114 non-tested patients who underwent 121 procedures, and 152 tested patients who underwent 171 procedures. The two groups did not vary significantly in patient age, gender, and aneurysms location. Aspirin non-responsiveness was detected in 3 patients (1.75%) and clopidogrel non-responsiveness in 21 patients (12.3%). Non-tested patients had an 11.6% rate of thrombotic complications with a 4.1% permanent morbidity or mortality rate versus 2.3% and 0.6% in tested patients (p=0.0013). The incidence of hemorrhagic complications was similar between the two groups. CONCLUSIONS Preoperative platelet inhibition testing using WBA can be useful to assess and correct antiaggregant non-responsiveness, and may reduce postoperative mortality and permanent morbidity.
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Affiliation(s)
- S G Aoun
- Departments of Neurosurgery, Radiology, and Pathology, The University of Texas Southwestern, Dallas, Texas, USA
| | - B G Welch
- Departments of Neurosurgery, Radiology, and Pathology, The University of Texas Southwestern, Dallas, Texas, USA
| | - L G Pride
- Departments of Neurosurgery, Radiology, and Pathology, The University of Texas Southwestern, Dallas, Texas, USA
| | - J White
- Departments of Neurosurgery, Radiology, and Pathology, The University of Texas Southwestern, Dallas, Texas, USA
| | - R Novakovic
- Departments of Neurosurgery, Radiology, and Pathology, The University of Texas Southwestern, Dallas, Texas, USA
| | - K Hoes
- Departments of Neurosurgery, Radiology, and Pathology, The University of Texas Southwestern, Dallas, Texas, USA
| | - R Sarode
- Departments of Neurosurgery, Radiology, and Pathology, The University of Texas Southwestern, Dallas, Texas, USA
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18
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Braune S, Zhou S, Groth B, Jung F. Quantification of adherent platelets on polymer-based biomaterials. Comparison of colorimetric and microscopic assessment. Clin Hemorheol Microcirc 2016; 61:225-36. [PMID: 26410874 DOI: 10.3233/ch-151995] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Platelet adhesion to artificial surfaces is one of the most important indicators for the thrombogenicity of implant materials. Currently, a variety of enzyme activity-based colorimetric assays or microscopy-based techniques are commonly in use to assess this characteristic. Studies about how data of colorimetric assays correlate with the image-based quantification of adherent platelets are scarce. To address this question, the present study compared two colorimetric assays (lactate dehydrogenase (LDH) and acid phosphatase (ACP)) with an image-based quantification of the density of platelets adhering on polymer-based biomaterial surfaces. MATERIALS AND METHODS Tri-sodium citrated whole blood was collected from apparently healthy subjects and platelet rich plasma (PRP) was prepared according to a standardized protocol. An in vitro static thrombogenicity test was applied to study platelet adhesion from PRP adjusted to 50,000 platelets per μL on three different polymers: medical grade polytetrafluoroethylene (PTFE), silicone and polyethylene terephthalate (PET). For the direct image-based approach, surface adherent platelets were fixed, fluorescently labelled and microscopically visualized. The image-based determination of platelet densities provided reference values for the comparison with data of the colorimetric assays. Correlation between standard platelet concentrations and ACP/LDH absorbance measurements were analysed to estimate accuracy and association of both parameters. ACP and LDH release from resting and ADP-stimulated platelets was studied to estimate how platelet activation influences colorimetric assay results. RESULTS The density of adherent platelets ranged from 15,693 ± 2,487 platelets·mm-2 (PTFE) to 423 ± 99 platelets·mm-2 (silicone) and 4,621 ± 1,427 platelets·mm-2 (PET) and differed significantly between the three polymers (ANOVA: p < 0.05). Correlation coefficients between microscopic and colorimetric determination of platelet densities ranged between r = 0.93 (LDH, p < 0.001) and r = 0.94 (ACP, p < 0.001). ACP absorbance measurements of platelet standards with different concentrations corresponded well to an ideal linear regression, while LDH data either deceeded or exceeded the expected values. The LDH release during ADP-induced platelet activation was significantly higher compared to the release of ACP. CONCLUSION For an adjusted platelet concentration of 50,000 platelets·μL-1, both colorimetric assays (ACP and LDH) allowed a similar accurate quantification of the mean platelet density compared to the microscopic evaluation. Better linearity of the assay standards, less variability of the results and a lower influence of platelet activation on the measurements mark the ACP assay as more suitable for the assessment of material surface adherent platelets compared to the LDH assay, particularly, if near physiological platelet concentrations are applied.
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Affiliation(s)
- S Braune
- Institute of Biomaterial Science and Berlin-Brandenburg Center for Regenerative Therapies, Helmholtz-Zentrum Geesthacht, Teltow, Germany
| | - S Zhou
- Institute of Biomaterial Science and Berlin-Brandenburg Center for Regenerative Therapies, Helmholtz-Zentrum Geesthacht, Teltow, Germany.,Tianjin University, Helmholtz-Zentrum Geesthacht, Joint Laboratory for Biomaterials and Regenerative Medicine, Teltow, Germany
| | - B Groth
- Institute of Biomaterial Science and Berlin-Brandenburg Center for Regenerative Therapies, Helmholtz-Zentrum Geesthacht, Teltow, Germany
| | - F Jung
- Institute of Biomaterial Science and Berlin-Brandenburg Center for Regenerative Therapies, Helmholtz-Zentrum Geesthacht, Teltow, Germany
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19
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Israels SJ. Laboratory testing for platelet function disorders. Int J Lab Hematol 2016; 37 Suppl 1:18-24. [PMID: 25976956 DOI: 10.1111/ijlh.12346] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 03/06/2015] [Indexed: 12/27/2022]
Abstract
Platelet function testing is both complex and labor intensive. A stepwise approach to the evaluation of patients with suspected platelet disorders will optimize the use of laboratory resources, beginning with an appropriate clinical evaluation to determine whether the bleeding is consistent with a defect of primary hemostasis. Bleeding assessment tools, evaluation of platelet counts, and review of peripheral blood cell morphology can aid the initial assessment. For patients requiring further laboratory testing, platelet aggregometry, secretion assays, and von Willebrand factor assays are the most useful next steps and will direct further specialized testing including flow cytometry, electron microscopy, and molecular diagnostics. Guidelines and recommendations for standardizing platelet function testing, with a particular focus on light transmission aggregometry, are available and can provide a template for clinical laboratories in establishing procedures that will optimize diagnosis and assure quality results. This review outlines an approach to platelet function testing and reviews testing methods available to clinical laboratories.
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Affiliation(s)
- S J Israels
- Department of Pediatrics and Child Health, Manitoba Institute of Cell Biology, University of Manitoba, Winnipeg, Manitoba, Canada
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20
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Platelet aggregation, secretion, and coagulation changes in children with asthma. Blood Coagul Fibrinolysis 2015; 25:738-44. [PMID: 24842314 DOI: 10.1097/mbc.0000000000000136] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The chronic inflammation in asthma evolves by cells including eosinophils, mast cells and lymphocytes. Despite their principal function in hemostasis, platelets contribute to pathogenesis of asthma that activation of platelets occurs following antigen provocation and during asthma attack. Our aim was to evaluate the platelet functions and other hemostatic features of children with asthma, both during symptom-free period and asthma attack. We enrolled patients with asthma attack (n = 33), mild intermittent asthma (n = 18), mild persistent asthma (n = 15) and healthy children (n = 20). Demographic characteristics and disease-related features were noted. Platelet aggregation and secretion tests (expressed as ATP release) were performed by lumiaggregometer method by stimulation with collagen, epinephrine, ADP, thrombin, ristocetin and arachidonic acid. Plasma levels of D-dimer, factor VIII (FVIII) and von Willebrand factor (vWF) were assessed. There were no differences in platelet aggregation induced by agonists between study groups. ATP release from platelets of patients with asthma exacerbation induced by ADP was lower compared with mild intermittent asthma (P < 0.001). Epinephrine-stimulated ATP secretion was also lower in patients with asthma attack than mild intermittent (P = 0.039) and mild persistent asthma (P = 0.011) and controls (P = 0.018). vWF measurements were higher in children with asthma attack than other study groups (P = 0.001). However, FVIII was increased in patients with severe asthma attack. Asthma is a disease in which many immune cells play a role, one of which is the platelet. Distinctions in platelet secretion profiles and plasma levels of vWF and FVIII provide evidence that coagulation mechanisms might be critical for asthma pathogenesis.
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21
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Alis R, Sanchis-Gomar F, Risso-Ballester J, Blesa JR, Romagnoli M. Effect of training status on the changes in platelet parameters induced by short-duration exhaustive exercise. Platelets 2015; 27:117-22. [PMID: 26023745 DOI: 10.3109/09537104.2015.1047334] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
It is now well known that hemostasis is directly involved in the benefits induced by physical activity. It has recently been shown that the baseline mean platelet volume (MPV) may be a predictor of endurance performance. We aimed to explore whether platelet parameters are associated with VO2max as well as running duration and speed in a short-duration exhaustive exercise test. Thirty healthy male subjects (10 sedentary and 20 trained) performed an incremental running test until exhaustion. MPV, platelet distribution width (PDW), platelet (Plt) count, and plateletcrit (Pct) were determined before exercise, immediately after exercise and after 30' recovery. Training status did not produce any difference in the baseline levels or in the post-exercise increases found in all the parameters tested. VO2max, test duration, and running speed were not correlated with any baseline parameter. Although MPV was found to be a predictor of endurance performance in long-duration exercise, the results of the present study are consistent with the hypothesis that MPV may not be a significant marker of performance in short-duration exhaustive exercise. Likewise, more research is needed to ascertain whether platelet activation is a reliable performance predictor in other exercise settings.
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Affiliation(s)
- Rafael Alis
- a Research Institute "Dr. Viña Giner", Molecular and Mitochondrial Medicine, Catholic University of Valencia San Vicente Mártir , Valencia , Spain .,b School of Medicine, Catholic University of Valencia San Vicente Mártir , Valencia , Spain
| | - Fabian Sanchis-Gomar
- c Research Institute of the Hospital 12 de Octubre ("i+12") , Madrid , Spain , and
| | - Jennifer Risso-Ballester
- a Research Institute "Dr. Viña Giner", Molecular and Mitochondrial Medicine, Catholic University of Valencia San Vicente Mártir , Valencia , Spain
| | - Jose R Blesa
- a Research Institute "Dr. Viña Giner", Molecular and Mitochondrial Medicine, Catholic University of Valencia San Vicente Mártir , Valencia , Spain .,b School of Medicine, Catholic University of Valencia San Vicente Mártir , Valencia , Spain
| | - Marco Romagnoli
- a Research Institute "Dr. Viña Giner", Molecular and Mitochondrial Medicine, Catholic University of Valencia San Vicente Mártir , Valencia , Spain .,d Department of Physical Education and Sports , University of Valencia , Valencia , Spain
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22
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Connolly-Andersen AM, Sundberg E, Ahlm C, Hultdin J, Baudin M, Larsson J, Dunne E, Kenny D, Lindahl TL, Ramström S, Nilsson S. Increased Thrombopoiesis and Platelet Activation in Hantavirus-Infected Patients. J Infect Dis 2015; 212:1061-9. [PMID: 25762786 DOI: 10.1093/infdis/jiv161] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 03/06/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Thrombocytopenia is a common finding during viral hemorrhagic fever, which includes hemorrhagic fever with renal syndrome (HFRS). The 2 main causes for thrombocytopenia are impaired thrombopoiesis and/or increased peripheral destruction of platelets. In addition, there is an increased intravascular coagulation risk during HFRS, which could be due to platelet activation. METHODS Thrombopoiesis was determined by quantification of platelet counts, thrombopoietin, immature platelet fraction, and mean platelet volume during HFRS. The in vivo platelet activation was determined by quantification of soluble P-selectin (sP-selectin) and glycoprotein VI (sGPVI). The function of circulating platelets was determined by ex vivo stimulation followed by flow cytometry analysis of platelet surface-bound fibrinogen and P-selectin exposure. Intravascular coagulation during disease was determined by scoring for disseminated intravascular coagulation (DIC) and recording thromboembolic complications. RESULTS The levels of thrombopoietin, immature platelet fraction, and mean platelet volume all indicate increased thrombopoiesis during HFRS. Circulating platelets had reduced ex vivo function during disease compared to follow-up. Most interestingly, we observed significantly increased in vivo platelet activation in HFRS patients with intravascular coagulation (DIC and thromboembolic complications) as shown by sP-selectin and sGPVI levels. CONCLUSIONS HFRS patients have increased thrombopoiesis and platelet activation, which contributes to intravascular coagulation.
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Affiliation(s)
| | - Erik Sundberg
- Infectious Diseases, Department of Clinical Microbiology Clinical Chemistry, Department of Medical Biosciences, Umeå University, Sweden
| | - Clas Ahlm
- Infectious Diseases, Department of Clinical Microbiology
| | - Johan Hultdin
- Clinical Chemistry, Department of Medical Biosciences, Umeå University, Sweden
| | - Maria Baudin
- Infectious Diseases, Department of Clinical Microbiology
| | - Johanna Larsson
- Clinical Chemistry, Department of Medical Biosciences, Umeå University, Sweden
| | - Eimear Dunne
- Clinical Research Centre, Royal College of Surgeons in Ireland, Dublin
| | - Dermot Kenny
- Clinical Research Centre, Royal College of Surgeons in Ireland, Dublin
| | - Tomas L Lindahl
- Department of Clinical and Experimental Medicine, Linköping University, Sweden
| | - Sofia Ramström
- Department of Clinical and Experimental Medicine, Linköping University, Sweden
| | - Sofie Nilsson
- Clinical Chemistry, Department of Medical Biosciences, Umeå University, Sweden
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23
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Braune S, Groß M, Walter M, Zhou S, Dietze S, Rutschow S, Lendlein A, Tschöpe C, Jung F. Adhesion and activation of platelets from subjects with coronary artery disease and apparently healthy individuals on biomaterials. J Biomed Mater Res B Appl Biomater 2015; 104:210-7. [PMID: 25631281 DOI: 10.1002/jbm.b.33366] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 12/02/2014] [Accepted: 01/05/2015] [Indexed: 12/30/2022]
Abstract
On the basis of the clinical studies in patients with coronary artery disease (CAD) presenting an increased percentage of activated platelets, we hypothesized that hemocompatibility testing utilizing platelets from healthy individuals may result in an underestimation of the materials' thrombogenicity. Therefore, we investigated the interaction of polymer-based biomaterials with platelets from CAD patients in comparison to platelets from apparently healthy individuals. In vitro static thrombogenicity tests revealed that adherent platelet densities and total platelet covered areas were significantly increased for the low (polydimethylsiloxane, PDMS) and medium (Collagen) thrombogenic surfaces in the CAD group compared to the healthy subjects group. The area per single platelet-indicating the spreading and activation of the platelets-was markedly increased on PDMS treated with PRP from CAD subjects. This could not be observed for collagen or polytetrafluoroethylene (PTFE). For the latter material, platelet adhesion and surface coverage did not differ between the two groups. Irrespective of the substrate, the variability of these parameters was increased for CAD patients compared to healthy subjects. This indicates a higher reactivity of platelets from CAD patients compared to the healthy individuals. Our results revealed, for the first time, that utilizing platelets from apparently healthy donors bears the risk of underestimating the thrombogenicity of polymer-based biomaterials.
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Affiliation(s)
- S Braune
- Institute of Biomaterial Science, Helmholtz-Zentrum Geesthacht, Teltow, Germany
- Berlin-Brandenburg Center for Regenerative Therapies, Teltow and Berlin, Germany
- Institute of Chemistry, University of Potsdam, Potsdam, Germany
| | - M Groß
- Department of Cardiology and Pneumology, Charitè-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - M Walter
- Institute of Biomaterial Science, Helmholtz-Zentrum Geesthacht, Teltow, Germany
- Berlin-Brandenburg Center for Regenerative Therapies, Teltow and Berlin, Germany
- Institute of Chemistry, University of Potsdam, Potsdam, Germany
| | - S Zhou
- Institute of Biomaterial Science, Helmholtz-Zentrum Geesthacht, Teltow, Germany
- Berlin-Brandenburg Center for Regenerative Therapies, Teltow and Berlin, Germany
- Institute of Chemistry, University of Potsdam, Potsdam, Germany
| | - S Dietze
- Institute of Biomaterial Science, Helmholtz-Zentrum Geesthacht, Teltow, Germany
- Berlin-Brandenburg Center for Regenerative Therapies, Teltow and Berlin, Germany
- Institute of Chemistry, University of Potsdam, Potsdam, Germany
| | - S Rutschow
- Department of Cardiology and Pneumology, Charitè-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - A Lendlein
- Institute of Biomaterial Science, Helmholtz-Zentrum Geesthacht, Teltow, Germany
- Berlin-Brandenburg Center for Regenerative Therapies, Teltow and Berlin, Germany
- Institute of Chemistry, University of Potsdam, Potsdam, Germany
| | - C Tschöpe
- Berlin-Brandenburg Center for Regenerative Therapies, Teltow and Berlin, Germany
- Department of Cardiology, Charitè-Universitätsmedizin Berlin, Campus Virchow, Berlin, Germany
| | - F Jung
- Institute of Biomaterial Science, Helmholtz-Zentrum Geesthacht, Teltow, Germany
- Berlin-Brandenburg Center for Regenerative Therapies, Teltow and Berlin, Germany
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24
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Favaloro EJ, Bodó I, Israels SJ, Brown SA. von Willebrand disease and platelet disorders. Haemophilia 2014; 20 Suppl 4:59-64. [PMID: 24762277 DOI: 10.1111/hae.12414] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2014] [Indexed: 01/24/2023]
Abstract
The diagnosis and management of bleeding disorders is made difficult by the complexity and variety of disorders, clinical symptoms and bleeding type and severity. von Willebrand disease (VWD) and platelet disorders are disorders of primary haemostasis and together represent the most common inherited bleeding disorders. In this article, we describe the diagnosis of VWD and platelet disorders and the treatment options for VWD.
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Affiliation(s)
- E J Favaloro
- Diagnostic Haemostasis, Haematology Department, Institute of Clinical Pathology and Medical Research (ICPMR), Pathology West, Westmead Hospital, Westmead, NSW, Australia
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25
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Choi JL, Li S, Han JY. Platelet function tests: a review of progresses in clinical application. BIOMED RESEARCH INTERNATIONAL 2014; 2014:456569. [PMID: 24895576 PMCID: PMC4034486 DOI: 10.1155/2014/456569] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Accepted: 04/25/2014] [Indexed: 01/03/2023]
Abstract
The major goal of traditional platelet function tests has been to screen and diagnose patients who present with bleeding problems. However, as the central role of platelets implicated in the etiology of arterial thrombotic diseases such as myocardial infarction and stroke became widely known, platelet function tests are now being promoted to monitor the efficacy of antiplatelet drugs and also to potentially identify patients at increased risk of thrombosis. Beyond hemostasis and thrombosis, an increasing number of studies indicate that platelets play an integral role in intercellular communication, are mediators of inflammation, and have immunomodulatory activity. As new potential biomarkers and technologies arrive at the horizon, platelet functions testing appears to take on a new aspect. This review article discusses currently available clinical application of platelet function tests, placing emphasis on essential characteristics.
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Affiliation(s)
- Jae-Lim Choi
- Department of Laboratory Medicine, Dong-A University College of Medicine, 1,3-Ga, Dongdaesin-dong, Seo-gu, Busan 602-715, Republic of Korea
| | - Shuhua Li
- Department of Laboratory Medicine, Dong-A University College of Medicine, 1,3-Ga, Dongdaesin-dong, Seo-gu, Busan 602-715, Republic of Korea
| | - Jin-Yeong Han
- Department of Laboratory Medicine, Dong-A University College of Medicine, 1,3-Ga, Dongdaesin-dong, Seo-gu, Busan 602-715, Republic of Korea
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27
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Watson SP, Lowe GC, Lordkipanidzé M, Morgan NV. Genotyping and phenotyping of platelet function disorders. J Thromb Haemost 2013; 11 Suppl 1:351-63. [PMID: 23516995 DOI: 10.1111/jth.12199] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The majority of patients with platelet function disorders (PFDs) have normal platelet counts and mild day-to-day bleeding symptoms, but are at risk of major hemorrhage at times of trauma, surgery, or childbirth. This group is challenging to investigate, because the assays are often time-intensive and labour-intensive, and interpretation is difficult, especially in patients with mild disorders. In addition, interuser variability in performance of the assays, including the currently accepted gold standard, light transmission aggregometry, makes the results difficult to compare between laboratories. Furthermore, a similar pattern of mucocutaneous bleeding is seen in disorders in other components of the hemostatic pathway, including type 1 von Willebrand disease (VWD). We have undertaken an extensive investigation of patients with clinically diagnosed excessive bleeding, using a genotyping and platelet phenotyping approach based on lumi-aggregometry, and other specialist tests of platelet function, in combination with Sanger and next-generation sequencing (NGS). We found a functional defect in ~ 60% of patients, the majority being associated with feedback pathways of platelet activation. Function-disrupting mutations were identified in known and novel genes, and coinheritance with other genetic disorders of hemostasis, including type 1 VWD, was shown. A significant number of mutations are heterozygous and unlikely to cause extensive bleeding in isolation, consistent with incomplete penetrance of inheritance of bleeding disorders and a multifactorial etiology for excessive bleeding in many patients. Mucocutaneous bleeding is a complex trait, and this has important implications for NGS in the assessment of a PFD.
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Affiliation(s)
- S P Watson
- Centre for Cardiovascular Sciences, Institute of Biomedical Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
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Abstract
Introduction Bleeding is one of the most feared risks from a renal biopsy. To determine this risk, a clotting screen is performed prior to the biopsy to identify any coagulation abnormalities. In addition, concerns exist with respect to bleeding from platelet dysfunction and the special cases of paraprotenemia. Method Literature search of all the relevant articles in relation to bleeding risk from clotting abnormalities and platelet dysfunction in the setting of kidney biopsy was conducted. Results Bleeding risk from abnormal clotting screen is minimal in the absence of prior bleeding history in patients with renal disease. Administration of fresh frozen plasma in these cases is probably unnecessary and often causes delay in the procedure. In a similar way, platelet transfusions may not be appropriate in those with platelet dysfunction. Conclusions Global coagulation function tests are now available which need to be considered to determine bleeding risk before kidney biopsy, in conjunction with a good patient history.
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Affiliation(s)
- Jecko Thachil
- Department of Haematology , Central Manchester University Hospitals NHS Foundation Trust , Manchester M13 9WL , UK
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29
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Laboratory hemostasis: milestones in Clinical Chemistry and Laboratory Medicine. Clin Chem Lab Med 2013; 51:91-7. [DOI: 10.1515/cclm-2012-0387] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Accepted: 06/20/2012] [Indexed: 11/15/2022]
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30
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Hoffmann JJ. Laboratory hematology in the history of Clinical Chemistry and Laboratory Medicine. Clin Chem Lab Med 2013; 51:119-27. [DOI: 10.1515/cclm-2012-0464] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 07/26/2012] [Indexed: 11/15/2022]
Abstract
Abstract
Background: For the occasion of the 50th anniversary of the journal Clinical Chemistry and Laboratory Medicine (CCLM), an historic overview of papers that the journal has published in the field of laboratory hematology (LH) is presented.
Methods: All past volumes of CCLM were screened for papers on LH and these were categorized. Bibliographic data of these papers were also analyzed.
Results:
CCLM published in total 387 LH papers. The absolute number of LH papers published annually showed a significant increase over the years since 1985. Also the share of LH papers demonstrated a steady increase (overall mean 5%, but mean 8% over the past 4 years). The most frequent category was coagulation and fibrinolysis (23.5%). Authors from Germany contributed the most LH papers to the journal (22.7%), followed by the Netherlands and Italy (16.3 and 13.2%, respectively). Recent citation data indicated that other publications cited LH review papers much more frequently than other types of papers.
Conclusions: The history of the journal reflects the emergence and development of laboratory hematology as a separate discipline of laboratory medicine.
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Affiliation(s)
- Johannes J.M.L. Hoffmann
- Abbott Diagnostics Division, Abbott GmbH & Co. KG , Max-Planck-Ring 2, 65205 Wiesbaden-Delkenheim , Germany
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31
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Abstract
Although the appropriate quality of samples is essential for platelet function testing, information is lacking on interference from mechanical trauma of blood and hemolysis on PFA-100 analyzer. Citrated blood collected from nine healthy volunteers was divided into three aliquots. The first aliquot ('A') was processed without further manipulation, whereas the second and third were subjected to mechanical trauma by two ('aliquot B') or four passages ('aliquot C') through a very fine needle (30 gauge) to produce hemolysis and cell trauma mimicking poor sample collection. Samples were tested on PFA-100 and Advia 2120, and plasma then separated and tested for lactate dehydrogenase (LDH) and hemolysis index. Negligible hemolysis was present in aliquot A (hemolysis index 0.2 ± 0.1, cell-free hemoglobin 0-0.5 g/l), whereas an increasing amount was present in aliquots B (hemolysis index of 13.1 ± 1.8, cell-free hemoglobin 6.0-6.5 g/l) and C (hemolysis index 24.0 ± 1.1, cell-free hemoglobin 11.5-12.0 g/l). Increases in LDH, and concomitant reductions in platelet and red blood cell counts were observed in aliquots B and C. In hemolyzed aliquots B, four out of nine samples yielded 'flow obstruction' with both PFA-100 agonist cartridges, whereas the closure times were dramatically prolonged in the remaining five samples. In hemolyzed aliquots C, flow obstruction was recorded in six of nine samples for collagen and ADP and all samples for collagen and epinephrine, whereas closure times of collagen and ADP in the remaining three samples were dramatically prolonged. Mechanical trauma of blood causing hemolysis makes PFA-100 testing unreliable. When flow obstructions are observed, the potential presence of hemolysis should be investigated.
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Favaloro EJ, (Adcock) Funk DM, Lippi G. Pre-analytical Variables in Coagulation Testing Associated With Diagnostic Errors in Hemostasis. Lab Med 2012. [DOI: 10.1309/lm749bqetkypypvm] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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SLADKY JL, KLIMA J, GROOMS L, KERLIN BA, O’BRIEN SH. The PFA-100® does not predict delta-granule platelet storage pool deficiencies. Haemophilia 2012; 18:626-9. [DOI: 10.1111/j.1365-2516.2011.02733.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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36
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Valarche V, Desconclois C, Boutekedjiret T, Dreyfus M, Proulle V. Multiplate whole blood impedance aggregometry: a new tool for von Willebrand disease. J Thromb Haemost 2011; 9:1645-7. [PMID: 21679294 DOI: 10.1111/j.1538-7836.2011.04400.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Israels SJ, Kahr WHA, Blanchette VS, Luban NLC, Rivard GE, Rand ML. Platelet disorders in children: A diagnostic approach. Pediatr Blood Cancer 2011; 56:975-83. [PMID: 21294245 DOI: 10.1002/pbc.22988] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Accepted: 11/29/2010] [Indexed: 01/23/2023]
Abstract
The investigation of children with suspected inherited platelet disorders is challenging. The causes of mucocutaneous bleeding are many, and specialized testing for platelet disorders can be difficult to access or interpret. An algorithm developed for the investigation of suspected platelet disorders provides a sequential approach to evaluating both platelet function abnormalities and thrombocytopenia. Investigation begins with a clinical evaluation and laboratory testing that is generally available, including platelet counting, peripheral blood cell morphology, and aggregometry. Based on results of initial investigations, the algorithm recommends specialized testing for specific diagnoses, including flow cytometry, immunofluorescence microscopy, electron microscopy, and mutational analysis.
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Affiliation(s)
- Sara J Israels
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada.
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38
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Tello-Montoliu A, Ueno M, Angiolillo DJ. Antiplatelet drug therapy: role of pharmacodynamic and genetic testing. Future Cardiol 2011; 7:381-402. [DOI: 10.2217/fca.11.14] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Antiplatelet therapy represents the cornerstone of treatment for the short- and long-term prevention of atherothrombotic disease processes, in particular in high-risk settings such as in patients with acute coronary syndrome and those undergoing percutaneous coronary intervention. Currently, dual antiplatelet therapy with aspirin and clopidogrel represents the most commonly used treatment regimen in these settings. However, a considerable number of patients continue to experience adverse outcomes, including both bleeding and recurrent ischemic events. Numerous investigations have demonstrated that this phenomenon may be, in part, attributed to the broad variability in individual response profiles to this standard antiplatelet treatment regimen, as identified by various assays of platelet function testing. In addition, recent studies have demonstrated that genetic polymorphisms may also have an important role in determining levels of platelet inhibition and may be considered as a tool to identify patients at risk of adverse events. This article provides an overview on antiplatelet drug response variability, an update on definitions, including the role of pharmacodynamic testing, underlying mechanisms – with emphasis on recent understandings on pharmacogenetics and drug–drug interactions – and current and future perspectives on individualized antiplatelet therapy.
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Affiliation(s)
- Antonio Tello-Montoliu
- University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
- Department of Cardiology-Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Masafumi Ueno
- University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
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Brooks MB, Stokol T, Catalfamo JL. Comparative Hemostasis: Animal Models and New Hemostasis Tests. Clin Lab Med 2011; 31:139-59. [DOI: 10.1016/j.cll.2010.10.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Favaloro EJ. More on preanalytical variables affecting platelet function testing using light transmittance aggregometry. Clin Chem Lab Med 2011; 49:737-9. [PMID: 21275810 DOI: 10.1515/cclm.2011.112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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43
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Abstract
The continuing education course “Hemostasis” provided a comprehensive review of hemostasis and selected perturbations of the underlying processes as well as an assessment of hemostasis in animal models and preclinical testing environments. The session began with a review of the current state of understanding of hemostasis and how the waterfall or cascade of activation has transformed to the current cell-based, membrane-associated sequence of highly regulated events. The specific mechanisms of drug-induced thrombocytopenia were then presented, followed by a discussion of the relationships of coagulation and platelets in inflammation and cancer metastasis and platelet activity. Evaluation of hemostasis and platelet function in animals and especially in the environment of the contract research facility concluded the session.
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Affiliation(s)
- Dale C. Baker
- Portola Pharmaceuticals, Inc., South San Francisco, California, USA
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