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Qiu Z, Pang X, Xiang Q, Cui Y. The Crosstalk between Nephropathy and Coagulation Disorder: Pathogenesis, Treatment, and Dilemmas. J Am Soc Nephrol 2023; 34:1793-1811. [PMID: 37487015 PMCID: PMC10631605 DOI: 10.1681/asn.0000000000000199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 07/10/2023] [Indexed: 07/26/2023] Open
Abstract
ABSTRACT The interaction between the kidney and the coagulation system greatly affects each other because of the abundant vessel distribution and blood perfusion in the kidney. Clinically, the risks of complicated thrombosis and bleeding have become important concerns in the treatment of nephropathies, especially nephrotic syndrome, CKD, ESKD, and patients with nephropathy undergoing RRTs. Adverse effects of anticoagulant or procoagulant therapies in patients with nephropathy, especially anticoagulation-related nephropathy, heparin-induced thrombocytopenia, and bleeding, seriously worsen the prognosis of patients, which have become challenges for clinicians. Over the decades, the interaction between the kidney and the coagulation system has been widely studied. However, the effects of the kidney on the coagulation system have not been systematically investigated. Although some coagulation-related proteins and signaling pathways have been shown to improve coagulation abnormalities while avoiding additional kidney damage in certain kidney diseases, their potential as anticoagulation targets in nephropathy requires further investigation. Here, we review the progression of research on the crosstalk between the coagulation system and kidney diseases and systematically analyze the significance and shortcomings of previous studies to provide new sight into future research. In addition, we highlight the status of clinical treatment for coagulation disorder and nephropathy caused by each other, indicating guidance for the formulation of therapeutic strategies or drug development.
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Affiliation(s)
- Zhiwei Qiu
- Department of Pharmacy, Peking University First Hospital, Beijing, China
- Institute of Clinical Pharmacology, Peking University First Hospital, Beijing, China
| | - Xiaocong Pang
- Department of Pharmacy, Peking University First Hospital, Beijing, China
- Institute of Clinical Pharmacology, Peking University First Hospital, Beijing, China
| | - Qian Xiang
- Department of Pharmacy, Peking University First Hospital, Beijing, China
- Institute of Clinical Pharmacology, Peking University First Hospital, Beijing, China
| | - Yimin Cui
- Department of Pharmacy, Peking University First Hospital, Beijing, China
- Institute of Clinical Pharmacology, Peking University First Hospital, Beijing, China
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Liu Y, Chen H, Li H, Wang F, Jia J, Yan T. Circulating platelets supply ST6Gal-1 in patients with IgA nephropathy. Postgrad Med 2023; 135:161-168. [PMID: 36533382 DOI: 10.1080/00325481.2022.2159206] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Our previous study showed ST6 β-galactoside α2,6-sialyltransferase 1 (ST6Gal-1) levels in plasma were associated with a slower progression of IgA nephropathy (IgAN). Platelets are the crucial regulator of cell surface glycosylation events in circulation by supplying glycosyltransferases. METHODS A total of 180 patients with IgAN were included in this study. ST6Gal-1 levels were analyzed before and after activation of platelets by flow cytometry. RESULTS We found that IgAN patients in the higher platelet counts group exhibited higher levels of ST6Gal-1 compared with the lower platelet counts group. There was a positive correlation between platelet counts and ST6Gal-1 levels in plasma. Patients with higher platelet counts had higher levels of IgA, serum C3, serum C4 and proteinuria, higher percentages of platelet crits, S1 and T1/2, lower levels of platelet distribution width and the mean platelet volume, as well as a lower percentage of platelet large cell ratio compared with those patients with lower platelet counts. No differences were found in terms of the eGFR decline and composite kidney endpoints between two groups. Furthermore, we investigated whether platelets were activated and released ST6Gal-1 in patients with IgAN. The expression of CD62P in platelets in patients with IgAN was higher than those of healthy controls. There were no obvious changes in ST6Gal-1 levels between the rest and the activated platelets within 1 to 2-hour, however, the difference in ST6Gal-1 levels became more pronounced after 4-hour of incubation. CONCLUSIONS In conclusion, human circulating platelets contain ST6Gal-1, which may be released by the activation of platelets in IgAN.
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Affiliation(s)
- Youxia Liu
- Department of Nephrology, Tianjin Medical University General Hospital, Tianjin, PR China
| | - Hongshan Chen
- Department of Nephrology, Tianjin Medical University General Hospital, Tianjin, PR China
| | - Hongfen Li
- Department of Nephrology, Tianjin Medical University General Hospital, Tianjin, PR China
| | - Fanghao Wang
- Department of Nephrology, Tianjin Medical University General Hospital, Tianjin, PR China
| | - Junya Jia
- Department of Nephrology, Tianjin Medical University General Hospital, Tianjin, PR China
| | - Tiekun Yan
- Department of Nephrology, Tianjin Medical University General Hospital, Tianjin, PR China
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Omae T, Ishikawa T, Nakajima Y, Nogami K. Coagulation potential in pediatric patients with immunoglobulin A nephropathy. Pediatr Int 2022; 64:e15042. [PMID: 34699659 DOI: 10.1111/ped.15042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/29/2021] [Accepted: 10/25/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Immunoglobulin A nephropathy (IgAN) is the most prevalent primary chronic glomerular disease in children. Understanding the changes in coagulability caused by IgAN is important for clarifying pathophysiology and choice of treatment. The coagulation potential in patients with IgAN remains to be investigated, however. We aimed to assess comprehensive coagulation potential in pediatric patients with IgAN and explore its relationship with pathological disease severity. METHODS Fourteen children with IgAN diagnosed by renal biopsy, who were admitted at Nara Medical University Hospital between 2015 and 2020, were analyzed. Rotational thromboelastometry was used to evaluate coagulation potential. Values of rotational thromboelastometry parameters in patients with IgAN were compared with those in control children. RESULTS In patients with IgAN (aged median 9.5 year), clotting time plus clot formation time (CT + CFT) was shortened (P = 0.003) and α angle was greater (P < 0.001) than those in controls, indicating a hypercoagulable state. The rate of mesangial hypercellularity of glomeruli correlated with CT + CFT, α, and maximum clot firmness (MCF) (rs = -0.79, 0.56, and 0.37). The rate of cellular/fibrocellular crescent of glomeruli correlated with CT + CFT, α, and MCF (rs = -0.41, 0.60, and 0.50). Patients with mesangial hypercellularity ≥80% of glomeruli showed reduced CT + CFT and increased α angle (P = 0.007 and 0.03). Patients with cellular/fibrocellular crescent ≥10% of glomeruli showed decreased CT + CFT and increased α angle (both P = 0.02). CONCLUSIONS The hypercoagulable state in pediatric patients with IgAN may be associated with the pathological severity of their disease.
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Affiliation(s)
- Takashi Omae
- Department of Pediatrics, Nara Medical University, Kashihara, Nara, Japan
| | - Tomoaki Ishikawa
- Department of Pediatrics, Nara Medical University, Kashihara, Nara, Japan
| | - Yuto Nakajima
- Department of Pediatrics, Nara Medical University, Kashihara, Nara, Japan
| | - Keiji Nogami
- Department of Pediatrics, Nara Medical University, Kashihara, Nara, Japan
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Yan Q, Ina K, Chiba S, Wei H, Tatsukawa S, Fujikura Y. The signal pathway for the repressive effect of dipyridamole on myofibroblast transdifferentiation. J Cell Mol Med 2018; 23:1608-1612. [PMID: 30451359 PMCID: PMC6349209 DOI: 10.1111/jcmm.14006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 10/10/2018] [Accepted: 10/11/2018] [Indexed: 12/27/2022] Open
Affiliation(s)
- Qiong Yan
- Department of Molecular Anatomy, Faculty of Medicine, Oita University, Yufu, Oita, Japan
| | - Keisuke Ina
- Department of Molecular Anatomy, Faculty of Medicine, Oita University, Yufu, Oita, Japan
| | - Seiichi Chiba
- Department of Molecular Anatomy, Faculty of Medicine, Oita University, Yufu, Oita, Japan
| | - Huixing Wei
- Department of Molecular Anatomy, Faculty of Medicine, Oita University, Yufu, Oita, Japan
| | - Shuji Tatsukawa
- Department of Molecular Anatomy, Faculty of Medicine, Oita University, Yufu, Oita, Japan
| | - Yoshihisa Fujikura
- Department of Molecular Anatomy, Faculty of Medicine, Oita University, Yufu, Oita, Japan
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Dipyridamole decreases dialysis risk and improves survival in patients with pre-dialysis advanced chronic kidney disease. Oncotarget 2017; 9:5368-5377. [PMID: 29435184 PMCID: PMC5797055 DOI: 10.18632/oncotarget.19850] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 07/25/2017] [Indexed: 01/13/2023] Open
Abstract
Introduction Dipyridamole decreases proteinuria and improves renal function progression in patients with glomerular disease through its inhibition of platelet activation and enhanced nitric oxide expression. Few studies have evaluated the effects of dipyridamole on renal outcome or survival in CKD stage 5 patients who have not yet received dialysis (CKD 5 ND). Materials and Methods A prospective cohort study was conducted based on the Taiwan National Health Insurance Research Database. From January 1, 2000 to June 30, 2009, we enrolled 28,497 patients who had a serum creatinine > 6 mg/dL and a hematocrit < 28% and who were treated with erythropoiesis-stimulating agents (ESAs). All patients were further divided into two groups with or without dipyridamole use within 90 days after starting ESA therapy. Patient followed-up took place until dialysis, death before initiation of dialysis or December 31, 2009. The primary outcomes were long-term dialysis and death before initiating dialysis. Results The dipyridamole users and nonusers groups included 7,746 and 20,751 patients, respectively. We found that 20,152 patients (70.7%) required long-term dialysis and 5,697 patients (20.0%) died before a progression to end-stage renal disease required dialysis. After propensity score-matching, dipyridamole users were associated with lower risks for long-term dialysis (adjusted HR, 0.96; 95% CI, 0.93–0.99) and death (adjusted HR, 0.91; 95% CI, 0.85–0.97) compared with nonusers. Conclusions Dipyridamole exhibited a protective effect in reducing the risk for long-term dialysis and death among CKD 5 ND patients. Randomized studies are needed to validate this association.
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Wu J, Duan SW, Sun XF, Li WG, Wang YP, Liu WH, Zhang JR, Lun LD, Li XM, Zhou CH, Li JJ, Liu SW, Xie YS, Cai GY, Ma L, Huang W, Wu H, Jia Q, Chen XM. Efficacy of Leflunomide, Telmisartan, and Clopidogrel for Immunoglobulin A Nephropathy: A Randomized Controlled Trial. Chin Med J (Engl) 2017; 129:1894-903. [PMID: 27503012 PMCID: PMC4989418 DOI: 10.4103/0366-6999.187848] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: The efficacy and safety of telmisartan combined with clopidogrel, leflunomide, or both drugs for immunoglobulin A nephropathy (IgAN) are unclear. This study was designed to evaluate the efficacy and safety of telmisartan combined with clopidogrel, leflunomide, or both drugs for IgAN. Methods: It is a multicenter, prospective, double-dummy randomized controlled trial. Primary IgAN patients were recruited in 13 renal units across Beijing, China, from July 2010 to June 2012. After a 4-week telmisartan (80 mg/d) wash-in, 400 patients continuing on 80 mg/d telmisartan were randomly assigned to additionally receive placebo (Group A), 50 mg/d clopidogrel (Group B), 20 mg/d leflunomide (Group C), or 50 mg/d clopidogrel and 20 mg/d leflunomide (Group D). The 24-week intervention was completed by 360 patients. The primary endpoint was change in 24-h proteinuria at 24 weeks. A linear mixed-effect model was used to analyze the changes at 4, 12, and 24 weeks. Generalized estimating equations were used to evaluate changes in hematuria grade. This trial was registered at the Chinese Clinical Trial Registry. Results: The effects of telmisartan combined with leflunomide on changes in proteinuria (0.36 [95% confidence interval (CI) 0.18–0.55] g/d, P < 0.001), in serum uric acid (76.96 [95% CI 57.44–96.49] μmol/L, P < 0.001), in serum creatinine (9.49 [95% CI 6.54–12.44] μmol/L, P < 0.001), and in estimated glomerular filtration rate (−6.72 [95% CI −9.46 to −3.98] ml∙min−1∙1.73 m−2, P < 0.001) were statistically significant, whereas they were not statistically significant on changes in systolic and diastolic blood pressure and weight (P > 0.05). Telmisartan combined with clopidogrel had no statistical effect on any outcome, and there was no interaction between the interventions. No obvious adverse reactions were observed. Conclusions: Telmisartan combined with leflunomide, not clopidogrel, is safe and effective for decreasing proteinuria in certain IgAN patients. Trial Registration: chictr.org.cn, ChiCTR-TRC-10000776; http://www.chictr.org.cn/showproj.aspx?proj=8760.
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Affiliation(s)
- Jie Wu
- Department of Nephrology, Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing 100853, China
| | - Shu-Wei Duan
- Department of Nephrology, Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing 100853, China
| | - Xue-Feng Sun
- Department of Nephrology, Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing 100853, China
| | - Wen-Ge Li
- Department of Nephrology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Ya-Ping Wang
- Department of Nephrology, PLA Army General Hospital, Beijing 100700, China
| | - Wen-Hu Liu
- Department of Nephrology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Jian-Rong Zhang
- Department of Nephrology, General Hospital of Chinese People's Armed Police Forces, Beijing 100039, China
| | - Li-De Lun
- Department of Nephrology, Air Force General Hospital of People's Liberation Army, Beijing 100142, China
| | - Xue-Mei Li
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Chun-Hua Zhou
- Department of Nephrology, Navy General Hospital, Beijing 100048, China
| | - Ji-Jun Li
- Department of Nephrology, First Affiliated Hospital of General Hospital of People's Liberation Army, Beijing 100048, China
| | - Shu-Wen Liu
- Department of Nephrology, Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing 100853, China
| | - Yuan-Sheng Xie
- Department of Nephrology, Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing 100853, China
| | - Guang-Yan Cai
- Department of Nephrology, Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing 100853, China
| | - Lu Ma
- Treatment Center for Kidney Disease, No. 281 Hospital of Beijing Military Region, Qinhuangdao, Hebei 066100, China
| | - Wen Huang
- Department of Nephrology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Hua Wu
- Department of Nephrology, Beijing Hospital, Beijing 100730, China
| | - Qiang Jia
- Department of Nephrology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Xiang-Mei Chen
- Department of Nephrology, Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing 100853, China
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He Z, Zhang Y, Cao M, Ma R, Meng H, Yao Z, Zhao L, Liu Y, Wu X, Deng R, Dong Z, Bi Y, Kou J, Novakovic V, Shi J, Hao L. Increased phosphatidylserine-exposing microparticles and their originating cells are associated with the coagulation process in patients with IgA nephropathy. Nephrol Dial Transplant 2015; 31:747-59. [PMID: 26673909 DOI: 10.1093/ndt/gfv403] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 11/01/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Relatively little information is available about phosphatidylserine positive (PS(+)) microparticles (MPs) and their originating cells in IgA nephropathy (IgAN) despite well-established intraglomerular coagulation. Our objectives were to detect PS exposure on MP membranes and MP-origin cells and to evaluate its role in procoagulant activity (PCA) and fibrin formation and their association with pathological lesions in the disease. METHODS Patients with IgAN and healthy controls were studied. Lactadherin was used to quantify PS exposure on MPs and MP-origin cells. PCA of MPs and MP-origin cells was evaluated by clotting time and purified coagulation complex assays. Fibrin production was determined by turbidity. PS exposure, fibrin strands and FVa/Xa binding were observed on MPs/cells using confocal microscopy. RESULTS Using flow cytometry, we found that IgAN patients had high levels of PS(+) MPs derived from lymphocytes, monocytes, neutrophils, platelets, erythrocytes and endothelial cells (ECs). The PS exposure on MP-origin cells also increased in these patients. MPs and MP-origin cells (leukocytes, platelets and erythrocytes) isolated from IgAN patients and ECs cultured with IgAN serum had a significantly shorter median coagulation time (P < 0.001), higher median intrinsic FXa (P < 0.001) and higher thrombin (P < 0.001) generation than controls. These coagulation functional assays were associated with the glomerular lesions. The lesions were also correlated with glomerular fibrin deposition (all P < 0.05). In the presence of patient MPs or their related cells, fibrin formation peaked faster with a higher maximum turbidity when compared with healthy controls. Blocking PS with lactadherin in the IgAN group prolonged coagulation time to control levels, inhibited the PCA up to 80% and markedly reduced fibrin formation. More importantly, we observed that fibrin strands formed on MPs and ECs in the same regions that bound lactadherin, similar to the FVa/Xa costaining. CONCLUSIONS We find that high levels of PS(+) MPs and the MP-origin cells are associated with the coagulation process in IgAN, and this may provide a previously unrecognized contribution to intraglomerular coagulation.
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Affiliation(s)
- Zhangxiu He
- Department of Nephropathy and Hemodialysis, First Hospital, Harbin Medical University, Harbin, China
| | - Yan Zhang
- Department of Hematology, First Hospital, Harbin Medical University, Harbin, China
| | - Muhua Cao
- Department of Hematology, First Hospital, Harbin Medical University, Harbin, China
| | - Ruishuang Ma
- Department of Hematology, First Hospital, Harbin Medical University, Harbin, China
| | - Huan Meng
- Department of Cardiology, Second Hospital, Harbin Medical University, Harbin, China
| | - Zhipeng Yao
- Department of Hematology, First Hospital, Harbin Medical University, Harbin, China
| | - Lu Zhao
- Department of Hematology, First Hospital, Harbin Medical University, Harbin, China
| | - Yan Liu
- Department of Hematology, First Hospital, Harbin Medical University, Harbin, China
| | - Xiaoming Wu
- Department of Hematology, First Hospital, Harbin Medical University, Harbin, China
| | - Ruijuan Deng
- Department of Hematology, First Hospital, Harbin Medical University, Harbin, China
| | - Zengxiang Dong
- Department of Cardiology, First Hospital, Harbin Medical University, Harbin, China
| | - Yayan Bi
- Department of Cardiology, First Hospital, Harbin Medical University, Harbin, China
| | - Junjie Kou
- Department of Cardiology, Second Hospital, Harbin Medical University, Harbin, China
| | | | - Jialan Shi
- Department of Hematology, First Hospital, Harbin Medical University, Harbin, China
| | - Lirong Hao
- Department of Nephropathy and Hemodialysis, First Hospital, Harbin Medical University, Harbin, China
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Association between B-group vitamins and venous thrombosis: systematic review and meta-analysis of epidemiological studies. J Thromb Thrombolysis 2013; 34:459-67. [PMID: 22743781 DOI: 10.1007/s11239-012-0759-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A homocysteine-independent role for B-group vitamins on venous thrombosis (VT) development has been reported. However, related research findings remain inconsistent. PUBMED, EMBASE, and COCHRANE databases were searched to collect information on all eligible studies to make a meta-analysis about the relationship between B-group vitamins and VT. Literature search results did not suggest a correlation between thiamin, pantothenic acid, niacin, or riboflavin with VT. Based on their correlations in the literature, folic acid, vitamin B12, B6 were considered in the meta-analysis and systematic review. Significant standardized mean differences were obtained for plasma folic acid (-0.55; 95% CI, -0.75 to -0.36) and vitamin B12 (-0.34; 95% CI, -0.55 to -0.13). Reduced levels of folic acid and vitamin B12 may be independent risk factors of VT. Moreover, a qualitative systematic review indicated that low level of vitamin B6 was an independent risk factor of VT. Randomized clinical studies of B-group vitamins supplementation showed varying results on VT prevention. Multivitamin supplementation for VT prevention, regardless of homocysteine level, would be of interest. Further prospective clinical studies are needed to provide additional evidence on the clinical benefits of B-group vitamin supplementation for VT.
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