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Szanto T, Helin T, Joutsi-Korhonen L, Lehtinen AE, El Beayni N, Lepäntalo A, Lassila R. Development of a Coagulation Disorders Unit. Semin Thromb Hemost 2024; 50:687-694. [PMID: 38373723 DOI: 10.1055/s-0044-1779633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
Our Coagulation Disorders Unit in Helsinki, Finland, provides 24/7 services for local and national hospitals and colleagues upon requests regarding bleeding and thrombosis diagnostics and management, including follow-up. The unit has a tight connection between the clinic and laboratory, and its maintenance and sharing knowledge and observations have been priorities, already for over 20 years and will continue to be of major importance. The consultation service is provided by phone during daytime and on-call hours, and in written form sent electronically to the consulting stakeholders. Thrombosis and hemostasis-targeted outpatient clinics are also available for the patients referred to the center. Writing local guidance and official guidelines, Nordic, European and international collaboration, and educational activities including social communication are critical elements for the Coagulation Disorders Unit. Alertness to acute coagulation abnormalities, such as occurred during COVID-19 and vaccine-induced thrombosis and thrombocytopenia, and development of strategies to manage cross-disciplinary problems are topics which call upon broad networking. The Nordic community has an ongoing historical meeting, which has been circulating among coagulation centers for the past 56 years. At the European level, the European Association of Haemophilia and Allied Disorders focuses on bleeding disorders and their management, including safety surveillance. The International Society of Thrombosis and Haemostasis offers excellent basic and clinical benchmarks for any Coagulation Disorders Unit. We hope that the description of the development and implementation of our Coagulation Disorders Unit in Helsinki achieves international interest and broadens international collaboration. Finally, we congratulate STH on its great contributions around the globe and for providing a vivid forum to foster the discipline of thrombosis and hemostasis.
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Affiliation(s)
- Timea Szanto
- Coagulation Disorders Unit, Department of Hematology, Comprehensive Cancer Centre, Comprehensive Care Centre of Hemophilia and Allied Disorders (EAHAD), Helsinki University Hospital, Helsinki, Finland
- Research Program Unit in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Tuukka Helin
- Department of Clinical Chemistry, HUS Diagnostic Centre, Helsinki University Hospital, Helsinki, Finland
| | - Lotta Joutsi-Korhonen
- Department of Clinical Chemistry, HUS Diagnostic Centre, Helsinki University Hospital, Helsinki, Finland
| | - Anna-Elina Lehtinen
- Coagulation Disorders Unit, Department of Hematology, Comprehensive Cancer Centre, Comprehensive Care Centre of Hemophilia and Allied Disorders (EAHAD), Helsinki University Hospital, Helsinki, Finland
| | - Nancy El Beayni
- Coagulation Disorders Unit, Department of Hematology, Comprehensive Cancer Centre, Comprehensive Care Centre of Hemophilia and Allied Disorders (EAHAD), Helsinki University Hospital, Helsinki, Finland
| | - Aino Lepäntalo
- Coagulation Disorders Unit, Department of Hematology, Comprehensive Cancer Centre, Comprehensive Care Centre of Hemophilia and Allied Disorders (EAHAD), Helsinki University Hospital, Helsinki, Finland
| | - Riitta Lassila
- Coagulation Disorders Unit, Department of Hematology, Comprehensive Cancer Centre, Comprehensive Care Centre of Hemophilia and Allied Disorders (EAHAD), Helsinki University Hospital, Helsinki, Finland
- Research Program Unit in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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2
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Cumitini L, Renda G, Giordano M, Rolla R, Shail T, Sacchetti S, Iezzi L, Giacomini L, Zanotti V, Auciello R, Angilletta I, Foglietta M, Zucchelli M, Antonucci I, Stuppia L, Gallina S, Dianzani U, Patti G. Role of CES1 and ABCB1 Genetic Polymorphisms on Functional Response to Dabigatran in Patients with Atrial Fibrillation. J Clin Med 2024; 13:2545. [PMID: 38731074 PMCID: PMC11084678 DOI: 10.3390/jcm13092545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/23/2024] [Accepted: 04/24/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Dabigatran etexilate is a pro-drug hydrolyzed into dabigatran by carboxylesterases (CES) and is a substrate of the P-Glycoprotein encoded by the adenosine-triphosphate-binding cassette sub-family B member (ABCB)1 genes. We evaluated the functional response to dabigatran according to different CES1 and ABCB1 single-nucleotide polymorphisms (SNPs) in patients with atrial fibrillation (AF). Methods: A total of 100 consecutive patients with AF taking dabigatran were enrolled by two Italian centers. A venous blood sample was drawn for genetic determinations, as well as a measurement of the diluted thrombin time (dTT) and drug plasma concentrations, at the trough and peak. The main objective was the relationship between the dTT values and CES1 rs2244613, CES1 rs8192935 and ABCB1 rs4148738 SNP while on two different dabigatran doses (110 and 150 mg BID). Results: A total of 43 patients were on a 110 mg dabigatran dose and 57 on 150 mg. The DTT values at the trough and at peak were not different among patients with different CES1 rs2244613 and CES1 rs8192935 genotypes, regardless of the dabigatran dose. In patients on 150 mg dabigatran, the dTT values at the trough were 77 (44-111) ng/mL in patients with the ABCB1 rs4148738 heterozygous CT genotype vs. 127 (85-147) ng/mL in the wild-type CC genotype vs. 110 (47-159) ng/mL in the mutant trait TT genotype (p = 0.048). In patients with the ABCB1 rs4148738 CT genotype, OR for having dTT values at a trough below the median was 3.21, 95% CI 1.04-9.88 (p = 0.042). Conclusions: ABCB1 rs4148738 CT heterozygous is associated with the reduced anticoagulant activity of dabigatran at the trough in patients receiving the higher dose regimen.
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Affiliation(s)
- Luca Cumitini
- Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy; (L.C.); (T.S.)
- Division of Cardiology, AOU Maggiore della Carità, 28100 Novara, Italy
| | - Giulia Renda
- Institute of Cardiology, Department of Neuroscience, Imaging and Clinical Sciences, G. d’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy; (G.R.); (L.I.); (I.A.); (M.F.); (S.G.)
- Center for Advanced Studies and Technology (CAST), G. d’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy; (M.Z.); (I.A.); (L.S.)
| | - Mara Giordano
- Department of Health Sciences, University of Eastern Piedmont, 28100 Novara, Italy; (M.G.); (R.R.); (S.S.); (L.G.); (V.Z.); (U.D.)
- Clinical Biochemistry, AOU Maggiore della Carità, 28100 Novara, Italy
| | - Roberta Rolla
- Department of Health Sciences, University of Eastern Piedmont, 28100 Novara, Italy; (M.G.); (R.R.); (S.S.); (L.G.); (V.Z.); (U.D.)
- Clinical Biochemistry, AOU Maggiore della Carità, 28100 Novara, Italy
| | - Tarek Shail
- Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy; (L.C.); (T.S.)
- Division of Cardiology, AOU Maggiore della Carità, 28100 Novara, Italy
| | - Sara Sacchetti
- Department of Health Sciences, University of Eastern Piedmont, 28100 Novara, Italy; (M.G.); (R.R.); (S.S.); (L.G.); (V.Z.); (U.D.)
- Clinical Biochemistry, AOU Maggiore della Carità, 28100 Novara, Italy
| | - Lorena Iezzi
- Institute of Cardiology, Department of Neuroscience, Imaging and Clinical Sciences, G. d’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy; (G.R.); (L.I.); (I.A.); (M.F.); (S.G.)
- Center for Advanced Studies and Technology (CAST), G. d’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy; (M.Z.); (I.A.); (L.S.)
| | - Luca Giacomini
- Department of Health Sciences, University of Eastern Piedmont, 28100 Novara, Italy; (M.G.); (R.R.); (S.S.); (L.G.); (V.Z.); (U.D.)
- Clinical Biochemistry, AOU Maggiore della Carità, 28100 Novara, Italy
| | - Valentina Zanotti
- Department of Health Sciences, University of Eastern Piedmont, 28100 Novara, Italy; (M.G.); (R.R.); (S.S.); (L.G.); (V.Z.); (U.D.)
- Clinical Biochemistry, AOU Maggiore della Carità, 28100 Novara, Italy
| | - Raffaella Auciello
- Department of Clinical Pathology, Renzetti Hospital, Lanciano (Chieti), 66034 Lanciano, Italy;
| | - Ilaria Angilletta
- Institute of Cardiology, Department of Neuroscience, Imaging and Clinical Sciences, G. d’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy; (G.R.); (L.I.); (I.A.); (M.F.); (S.G.)
- Center for Advanced Studies and Technology (CAST), G. d’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy; (M.Z.); (I.A.); (L.S.)
| | - Melissa Foglietta
- Institute of Cardiology, Department of Neuroscience, Imaging and Clinical Sciences, G. d’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy; (G.R.); (L.I.); (I.A.); (M.F.); (S.G.)
| | - Mirco Zucchelli
- Center for Advanced Studies and Technology (CAST), G. d’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy; (M.Z.); (I.A.); (L.S.)
- Department of Innovative Technologies in Medicine, G. d’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy
| | - Ivana Antonucci
- Center for Advanced Studies and Technology (CAST), G. d’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy; (M.Z.); (I.A.); (L.S.)
- Department of Psychological, Health and Territory Sciences, G. d’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy
| | - Liborio Stuppia
- Center for Advanced Studies and Technology (CAST), G. d’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy; (M.Z.); (I.A.); (L.S.)
- Department of Psychological, Health and Territory Sciences, G. d’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy
| | - Sabina Gallina
- Institute of Cardiology, Department of Neuroscience, Imaging and Clinical Sciences, G. d’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy; (G.R.); (L.I.); (I.A.); (M.F.); (S.G.)
- Center for Advanced Studies and Technology (CAST), G. d’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy; (M.Z.); (I.A.); (L.S.)
| | - Umberto Dianzani
- Department of Health Sciences, University of Eastern Piedmont, 28100 Novara, Italy; (M.G.); (R.R.); (S.S.); (L.G.); (V.Z.); (U.D.)
- Clinical Biochemistry, AOU Maggiore della Carità, 28100 Novara, Italy
| | - Giuseppe Patti
- Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy; (L.C.); (T.S.)
- Division of Cardiology, AOU Maggiore della Carità, 28100 Novara, Italy
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Oshima T, Fujiu K, Matsunaga H, Matsuda J, Matsubara T, Saga A, Yoshida Y, Shimizu Y, Hasumi E, Oguri G, Kojima T, Komuro I. Uninterrupted Direct Oral Anticoagulants Without a Change in Regimen for Catheter Ablation for Atrial Fibrillation Is an Acceptable Protocol. Circ Rep 2021; 3:481-487. [PMID: 34568626 PMCID: PMC8423616 DOI: 10.1253/circrep.cr-20-0139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 06/13/2021] [Accepted: 06/23/2021] [Indexed: 11/09/2022] Open
Abstract
Background:
In patients undergoing catheter ablation (CA) for atrial fibrillation (AF), the use of uninterrupted direct oral anticoagulants (DOACs) is the current protocol. This study evaluated bleeding complications following the uninterrupted use of 4 DOACs in patients undergoing CA for AF without any change in the dosing regimen. Moreover, we assessed differences between once- and twice-daily DOAC dosing in patients undergoing CA for AF who continued on DOACs without any change in the dosing regimen. Methods and Results:
This study was a retrospective single-center cohort study of consecutive patients. All patients continued DOACs without interruption or changes to the dosing schedule, even in the case of morning procedures. The primary endpoint was the incidence of major bleeding events within the first 30 days after CA. In all, 710 consecutive patients were included in the study. Bleeding complications were less frequent in the uninterrupted twice- than once-daily DOACs group. However, the incidence of cardiac tamponade across all DOACs was low (0.98%; 7/710), suggesting that uninterrupted DOACs without changes to the dosing regimen may be an acceptable strategy. The rate of total bleeding events, including minor bleeding (12/710; 1.6%), was also satisfactory. Conclusions:
Uninterrupted DOACs without any change in dosing regimen for patients undergoing CA for AF is acceptable. Bleeding complications may be less frequent in patients receiving DOACs twice rather than once daily.
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Affiliation(s)
- Tsukasa Oshima
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo Tokyo Japan
| | - Katsuhito Fujiu
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo Tokyo Japan.,Department of Advanced Cardiology, School of Medicine, The University of Tokyo Tokyo Japan
| | - Hiroshi Matsunaga
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo Tokyo Japan
| | - Jun Matsuda
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo Tokyo Japan
| | - Takumi Matsubara
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo Tokyo Japan
| | - Akiko Saga
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo Tokyo Japan
| | - Yuriko Yoshida
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo Tokyo Japan
| | - Yu Shimizu
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo Tokyo Japan
| | - Eriko Hasumi
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo Tokyo Japan
| | - Gaku Oguri
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo Tokyo Japan
| | - Toshiya Kojima
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo Tokyo Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo Tokyo Japan
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Lähteenmäki J, Vuorinen AL, Pajula J, Harno K, Lehto M, Niemi M, van Gils M. Pharmacogenetics of Bleeding and Thromboembolic Events in Direct Oral Anticoagulant Users. Clin Pharmacol Ther 2021; 110:768-776. [PMID: 34043814 DOI: 10.1002/cpt.2316] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/19/2021] [Indexed: 12/16/2022]
Abstract
This study aimed to analyze associations between genetic variants and the occurrence of clinical outcomes in dabigatran, apixaban, and rivaroxaban users. This was a retrospective real-world study linking genotype data of three Finnish biobanks with national register data on drug dispensations and healthcare encounters. We investigated several single-nucleotide variants (SNVs) in the ABCG2, ABCB1, CES1, and CYP3A5 genes potentially associated with bleeding or thromboembolic events in direct oral anticoagulant (DOAC) users based on earlier research. We used Cox regression models to compare the incidence of clinical outcomes between carriers and noncarriers of the SNVs or haplotypes. In total, 1,806 patients on apixaban, dabigatran, or rivaroxaban were studied. The ABCB1 c.3435C>T (p.Ile1145=, rs1045642) SNV (hazard ratio (HR) 0.42, 95% confidence interval (CI), 0.18-0.98, P = 0.044) and 1236T-2677T-3435T (rs1128503-rs2032582-rs1045642) haplotype (HR 0.44, 95% CI, 0.20-0.95, P = 0.036) were associated with a reduced risk for thromboembolic outcomes, and the 1236C-2677G-3435C (HR 2.55, 95% CI, 1.03-6.36, P = 0.044) and 1236T-2677G-3435C (HR 5.88, 95% CI, 2.35-14.72, P < 0.001) haplotypes with an increased risk for thromboembolic outcomes in rivaroxaban users. The ABCB1 c.2482-2236G>A (rs4148738) SNV associated with a lower risk for bleeding events (HR 0.37, 95% CI, 0.16-0.89, P = 0.025) in apixaban users. ABCB1 variants are potential factors affecting thromboembolic events in rivaroxaban users and bleeding events in apixaban users. Studies with larger numbers of patients are warranted for comprehensive assessment of the pharmacogenetic associations of DOACs and their relevance for clinical practice.
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Affiliation(s)
| | | | - Juha Pajula
- VTT Technical Research Centre of Finland Ltd., Espoo, Finland
| | - Kari Harno
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Mika Lehto
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.,University of Helsinki, Helsinki, Finland
| | - Mikko Niemi
- Department of Clinical Pharmacology and Individualized Drug Therapy Research Program, University of Helsinki, Helsinki, Finland.,Department of Clinical Pharmacology, HUS Diagnostic Center, Helsinki University Hospital, Helsinki, Finland
| | - Mark van Gils
- VTT Technical Research Centre of Finland Ltd., Espoo, Finland.,Tampere University, Tampere, Finland
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Wiesen MHJ, Fietz C, Jübner M, Iwersen-Bergmann S, Andresen-Streichert H, Müller C, Streichert T. Quantification of direct-acting oral anticoagulants: Application of a clinically validated liquid chromatography-tandem mass spectrometry method to forensic cases. Drug Test Anal 2020; 13:419-426. [PMID: 32959964 DOI: 10.1002/dta.2930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 12/23/2022]
Abstract
In certain forensic cases, a quantification of direct-acting oral anticoagulants (DOACs) can be necessary. We evaluate the applicability of a previously described liquid chromatography-tandem mass spectrometry (LC-MS/MS) methodology for the determination of DOACs in plasma to postmortem specimen. Postmortem internal quality control (PIQC) samples were prepared in pooled blank postmortem heart blood, femoral blood, cerebrospinal fluid (CSF), and urine as well in plasma. To examine the application of the clinical method to forensic cases, the main validation parameters were reinvestigated using PIQC samples. Postmortem samples of 12 forensic cases with evidence of previous rivaroxaban intake and unknown bleeding disorders were analyzed. Interday variability remained within the acceptance criterion of ±15%. Matrix effects were comparable in blank plasma and postmortem matrix extracts. After 4 weeks of storage in the refrigerator, no relevant decrease of DOACs was evident. After 96 h of storage at room temperature, a slight decrease in edoxaban concentration was observed in CSF and urine, while plasma edoxaban decreased by about 50%. Median (range) rivaroxaban concentrations determined in specimen of forensic cases were as follows: heart blood (n = 6), 17.2 ng/ml (<LOQ, 56.6 ng/ml); femoral blood (n = 12), 27.6 ng/ml (<LOQ, 110.5 ng/ml); CSF (n = 7), 11.7 ng/ml (<LOQ, 17.5 ng/ml); urine (n = 6), 275.7 ng/ml (14.5-870.9 ng/ml). The median heart/femoral blood rivaroxaban ratio was 1.2 (n = 5). Exemplary, a forensic case with detection of edoxaban in femoral blood, CSF, and urine, is presented. DOACs can be detected in postmortem heart and femoral blood, CSF, and urine specimen by LC-MS/MS. Based on limited forensic cases, no significant redistribution was evident for rivaroxaban, which was found at highest concentrations in urine.
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Affiliation(s)
- Martin H J Wiesen
- Faculty of Medicine and University Hospital Cologne, Pharmacology at the Laboratory Center, Therapeutic Drug Monitoring, University of Cologne, Cologne, Germany
| | - Cornelia Fietz
- Faculty of Medicine and University Hospital Cologne, Pharmacology at the Laboratory Center, Therapeutic Drug Monitoring, University of Cologne, Cologne, Germany
| | - Martin Jübner
- Faculty of Medicine and University Hospital Cologne, Institute of Legal Medicine, University of Cologne, Cologne, Germany
| | | | - Hilke Andresen-Streichert
- Faculty of Medicine and University Hospital Cologne, Institute of Legal Medicine, University of Cologne, Cologne, Germany
| | - Carsten Müller
- Faculty of Medicine and University Hospital Cologne, Pharmacology at the Laboratory Center, Therapeutic Drug Monitoring, University of Cologne, Cologne, Germany
| | - Thomas Streichert
- Faculty of Medicine and University Hospital Cologne, Pharmacology at the Laboratory Center, Therapeutic Drug Monitoring, University of Cologne, Cologne, Germany.,Faculty of Medicine and University Hospital Cologne, Institute for Clinical Chemistry, University of Cologne, Cologne, Germany
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