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Chen D, Pruthi R. A Brief History of Hemostasis and Thrombosis at the Mayo Clinic. Semin Thromb Hemost 2024; 50:26-33. [PMID: 36940712 DOI: 10.1055/s-0043-1764470] [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: 03/23/2023]
Abstract
Coagulation is a crucial biological mechanism in human bodies to prevent blood loss. Abnormal coagulation can cause bleeding diathesis or thrombosis, common pathologic conditions in our clinical practice. Many individuals and organizations have dedicated their efforts in the past decades to understanding the biological and pathological mechanisms of coagulation and developing laboratory testing tools and treatment options to help patients with bleeding or thrombotic conditions. Since 1926, the Mayo Clinic coagulation group has made significant contributions to the clinical and laboratory practice, basic and translational research on various hemostatic and thrombotic disorders, and the education and collaboration to share and advance our knowledge in coagulation through a highly integrated team and practice model. We would like to use this review to share our history and inspire medical professionals and trainees to join the efforts to advance our understanding of coagulation pathophysiology and improve our care for patients with coagulation disorders.
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Affiliation(s)
- Dong Chen
- Division of Hematopathology, Mayo Clinic, Rochester, Minnesota
| | - Rajiv Pruthi
- Division of Hematopathology, Mayo Clinic, Rochester, Minnesota
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2
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Shedding of soluble glycoprotein VI is neither affected by animal-derived antibeta-2-glycoprotein 1 antibodies nor IgG fractions from patients with systemic lupus erythematosus. Blood Coagul Fibrinolysis 2020; 31:258-263. [DOI: 10.1097/mbc.0000000000000909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lenz CJ, Mankad R, Klarich K, Kurmann R, McBane RD. Antiphospholipid syndrome and the relationship between laboratory assay positivity and prevalence of non-bacterial thrombotic endocarditis: A retrospective cohort study. J Thromb Haemost 2020; 18:1408-1414. [PMID: 32180317 DOI: 10.1111/jth.14798] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 02/27/2020] [Accepted: 03/11/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Nonbacterial thrombotic endocarditis (NBTE) is a potential complication of antiphospholipid syndrome (APS) manifesting as noninfectious lesions on one or more cardiac valves. There are limited tools to inform clinicians regarding which APS patients would benefit most from echocardiographic screening for this complication. OBJECTIVES We tested the hypothesis that the risk of both prevalent and incident NBTE is directly related to the number of positive laboratory assays for APS. PATIENTS/METHODS In this single-center, retrospective, cohort study design, consecutive patients with confirmed APS seen at Mayo Clinic Rochester, MN (1/1/1993-6/26/2016), were identified by searching a centralized electronic database. Demographic data, clinical presentation, echocardiographic features, laboratory findings, and survival data were scrutinized. RESULTS During the study period, 611 patients met the diagnostic criteria for APS and 386 (63%) underwent echocardiography. Of these, 58 (15%) were found to have NBTE. NBTE was more common in those with double (19.4%) and triple-positive laboratory criteria (27.0%) compared with single-positive disease (5.7%, P < .001). Survival free of NBTE diagnosis was significantly shorter in those patients with >1 positive laboratory assay (P < .01). Cox proportional hazard analysis suggests that patients with APS are more likely to be diagnosed with NBTE if they have >1 positive laboratory assay (relative risk 20.1; 95% confidence interval 1.3-316.6; P < .03). CONCLUSION Antiphospholipid syndrome carries a high prevalence of NBTE (15%). This prevalence is particularly high for patients with either double- or triple-positive laboratory criteria.
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Affiliation(s)
- Charles J Lenz
- Gonda Vascular Center, Mayo Clinic, Rochester, MN
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Rekha Mankad
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Kyle Klarich
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Reto Kurmann
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Robert D McBane
- Gonda Vascular Center, Mayo Clinic, Rochester, MN
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
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4
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Diagnosis and Exclusion of Pulmonary Embolism. Thromb Res 2018; 163:207-220. [DOI: 10.1016/j.thromres.2017.06.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 05/30/2017] [Accepted: 06/05/2017] [Indexed: 12/21/2022]
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El-Azhary RA, Patzelt MT, McBane RD, Weaver AL, Albright RC, Bridges AD, Claus PL, Davis MDP, Dillon JJ, El-Zoghby ZM, Hickson LJ, Kumar R, McCarthy-Fruin KAM, McEvoy MT, Pittelkow MR, Wetter DA, Williams AW, McCarthy JT. Calciphylaxis: A Disease of Pannicular Thrombosis. Mayo Clin Proc 2016; 91:1395-1402. [PMID: 27712638 DOI: 10.1016/j.mayocp.2016.06.026] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 06/18/2016] [Accepted: 06/21/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To identify coagulation risk factors in patients with calciphylaxis and the relationship between anticoagulation use and overall survival. PATIENTS AND METHODS Study subjects were 101 patients with calciphylaxis seen at Mayo Clinic from 1999 to September 2014. Data including thrombophilia profiles were extracted from the medical records of each patient. Survival status was determined using patient registration data and the Social Security Death Index. Survival was estimated using the Kaplan-Meier method, and associations were evaluated using Cox proportional hazards models. RESULTS Sixty-four of the 101 patients underwent thrombophilia testing. Of these, a complete test panel was performed in 55 and a partial panel in 9. Severe thrombophilias observed in 60% (33 of 55) of the patients included antiphospholipid antibody syndrome protein C, protein S, or antithrombin deficiencies or combined thrombophilias. Of the 55 patients, severe thrombophilia (85%, 23 of 27) was noted in patients who were not on warfarin at the time of testing (27). Nonsevere thrombophilias included heterozygous factor V Leiden (n=2) and plasminogen deficiency (n=1). For the comparison of survival, patients were divided into 3 treatment categories: Warfarin (n=63), other anticoagulants (n=20), and no anticoagulants (n=18). There was no statistically significant survival difference between treatment groups. CONCLUSION Laboratory testing reveals a strikingly high prevalence of severe thrombophilias in patients with calciphylaxis, underscoring the importance of congenital and acquired thrombotic propensity potentially contributing to the pathogenesis of this disease. These findings may have therapeutic implications; however, to date, survival differences did not vary by therapeutic choice.
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Affiliation(s)
| | - Michelle T Patzelt
- Mayo Medical School, Mayo Graduate School of Medicine, Mayo Clinic, Rochester, MN
| | - Robert D McBane
- Department of Medicine, Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN
| | - Amy L Weaver
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Robert C Albright
- Department of Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | | | - Paul L Claus
- Department of Medicine, Division of Hyperbaric Medicine in Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, MN
| | | | - John J Dillon
- Department of Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Ziad M El-Zoghby
- Department of Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - LaTonya J Hickson
- Department of Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Rajiv Kumar
- Department of Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | | | | | | | | | - Amy W Williams
- Department of Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - James T McCarthy
- Department of Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
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Wysokinska EM, Wysokinski WE, Ketha S, Litin S, Daniels P, Slusser J, Hodge DO, Heit JA, McBane RD. Periprocedural Anticoagulation Management of Patients with Thrombophilia. Am J Med 2016; 129:986-92. [PMID: 27235004 DOI: 10.1016/j.amjmed.2016.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 04/29/2016] [Accepted: 05/02/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND Appropriate periprocedural management of the chronically anticoagulated patient with an inherited or acquired thrombophilia is uncertain. The objective of this study was to test "thrombophilia" as a potential predictor of the 3-month cumulative incidence of thromboembolism and major bleeding among chronically anticoagulated patients undergoing an invasive procedure. METHODS In a prospective cohort study, consecutive chronically anticoagulated patients referred to the Mayo Thrombophilia Center for standardized periprocedural anticoagulation management who had venous thromboembolism and complete thrombophilia testing were categorized as "severe," "non-severe," or "no identifiable" thrombophilia. The 3-month cumulative incidence rates of thromboembolism, bleeding, and death were estimated using the Kaplan-Meier product limit method. RESULTS Among 362 patients with complete thrombophilia testing, 165 (46%) had a defined thrombophilia; 76 patients had severe thrombophilia, mainly due to antiphospholipid syndrome (66%). Half of the patients in each of the 3 groups received pre- and postprocedure heparin. During follow-up, there were no thromboembolic events, rare major bleeding events (1% for each group), and 4 deaths. Due to the very low event rates for each of these outcomes, Cox proportional hazard modeling could not be performed. CONCLUSIONS Periprocedural event rates were low irrespective of thrombophilia status. Inherited or acquired thrombophilia was not a predictor of thromboembolism, major bleeding, or mortality after temporary interruption of chronic anticoagulation for an invasive procedure.
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Affiliation(s)
- Ewa M Wysokinska
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minn
| | - Waldemar E Wysokinski
- Mayo Clinic Thrombophilia Center, Gonda Vascular Center, Mayo Clinic, Rochester, Minn
| | - Siva Ketha
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn
| | - Scott Litin
- Mayo Clinic Thrombophilia Center, Gonda Vascular Center, Mayo Clinic, Rochester, Minn
| | - Paul Daniels
- Mayo Clinic Thrombophilia Center, Gonda Vascular Center, Mayo Clinic, Rochester, Minn
| | - Joshua Slusser
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minn
| | - David O Hodge
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minn
| | - John A Heit
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minn; Mayo Clinic Thrombophilia Center, Gonda Vascular Center, Mayo Clinic, Rochester, Minn; Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minn
| | - Robert D McBane
- Mayo Clinic Thrombophilia Center, Gonda Vascular Center, Mayo Clinic, Rochester, Minn.
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Kelchtermans H, Pelkmans L, de Laat B, Devreese KM. IgG/IgM antiphospholipid antibodies present in the classification criteria for the antiphospholipid syndrome: a critical review of their association with thrombosis. J Thromb Haemost 2016; 14:1530-48. [PMID: 27279342 DOI: 10.1111/jth.13379] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Indexed: 01/08/2023]
Abstract
UNLABELLED Essentials The clinical value of IgM antibodies in thrombotic antiphospholipid syndrome (APS) is debated. By review of literature, we reconsidered the clinical value of IgM antibodies in thrombotic APS. More significant correlations with thrombosis were found for the IgG compared to IgM isotype. Unavailability of paired IgG/IgM results hampers evaluating the added value of IgM positivity. Click to hear Dr de Groot's perspective on antiphospholipid syndrome SUMMARY Background Despite the update of the classification criteria for the antiphospholipid syndrome (APS), difficulties persist in the identification of patients at risk for thrombosis. Current guidelines include assays detecting IgG/IgM anti-β2 -glycoprotein I and anti-cardiolipin antibodies, although the relevance of IgM antibodies has been debated. Objectives Through a review of the literature from 2001 to 2014, we aimed to formally establish the thrombotic risk stratification potential of IgM as compared with IgG anti-phospholipid antibodies (aPLs). Patients/methods One thousand two hundred and twenty-eight articles were selected by a computer-assisted search of the literature. Of the 177 studies that met our inclusion criteria, the clinical value of IgG/IgM aPLs was established through analysis of odds ratios for thrombosis or percentage of positives in the thrombotic population. Results/conclusions We clearly found more significant correlations with thrombosis for the IgG than for the IgM isotype. Nonetheless, in a minority of studies, significant associations with thrombosis were found for IgM but not IgG antibodies. The unavailability of paired results of IgG and IgM for each separate patient hampers evaluation of the added value of isolated IgM positivity. To fully take advantage of results obtained by future studies, we strongly encourage scientists to provide all studied information per patient. We planned a large multicenter study to investigate clinical associations of isolated/combined positivity for criteria/non-criteria aPLs. Importantly, because of the presence of non-pathogenic aPLs, quantitative assays are characterized by a high false-positivity rate. Optimization of functional assays, such as thrombin generation measuring the whole scheme of coagulation, may help to reduce APS-related morbidity and mortality.
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Affiliation(s)
- H Kelchtermans
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands
- Synapse BV, Maastricht, the Netherlands
| | - L Pelkmans
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands
- Synapse BV, Maastricht, the Netherlands
| | - B de Laat
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands
- Synapse BV, Maastricht, the Netherlands
| | - K M Devreese
- Coagulation Laboratory, Department of Clinical Chemistry, Microbiology and Immunology, Ghent University Hospital, Ghent, Belgium
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Pengo V, Banzato A, Bison E, Denas G, Zoppellaro G, Bracco A, Padayattil Jose S, Hoxha A, Ruffatti A. Laboratory testing for antiphospholipid syndrome. Int J Lab Hematol 2016; 38 Suppl 1:27-31. [PMID: 27161602 DOI: 10.1111/ijlh.12507] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 03/21/2016] [Indexed: 11/29/2022]
Abstract
This is a practical report on laboratory tests for the diagnosis of antiphospholipid syndrome (APS). After a general definition of APS, this study deals with appropriateness and timing in requesting the determination of antiphospholipid (aPL) antibodies. Lupus anticoagulant (LAC), anticardiolipin (aCL), and anti β2-glycoprotein I (aβGPI) are the mandatory tests to be performed, while other tests are not yet validated for clinical use. Interpretation of results is an important discussed issue that implies a close liaison between clinical pathologists and clinicians. Finally, a personal definition of APS according to aPL antibody profile closes the manuscript.
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Affiliation(s)
- V Pengo
- Clinical Cardiology, Department of Cardiac, Thoracic, and Vascular Sciences and Division of Rheumatology, University of Padova, Padova, Italy
| | - A Banzato
- Clinical Cardiology, Department of Cardiac, Thoracic, and Vascular Sciences and Division of Rheumatology, University of Padova, Padova, Italy
| | - E Bison
- Clinical Cardiology, Department of Cardiac, Thoracic, and Vascular Sciences and Division of Rheumatology, University of Padova, Padova, Italy
| | - G Denas
- Clinical Cardiology, Department of Cardiac, Thoracic, and Vascular Sciences and Division of Rheumatology, University of Padova, Padova, Italy
| | - G Zoppellaro
- Clinical Cardiology, Department of Cardiac, Thoracic, and Vascular Sciences and Division of Rheumatology, University of Padova, Padova, Italy
| | - A Bracco
- Clinical Cardiology, Department of Cardiac, Thoracic, and Vascular Sciences and Division of Rheumatology, University of Padova, Padova, Italy
| | - S Padayattil Jose
- Clinical Cardiology, Department of Cardiac, Thoracic, and Vascular Sciences and Division of Rheumatology, University of Padova, Padova, Italy
| | - A Hoxha
- Department of Medicine, University of Padova, Padova, Italy
| | - A Ruffatti
- Department of Medicine, University of Padova, Padova, Italy
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Sutkowska E, McBane RD, Tafur AJ, Sutkowski K, Grill DE, Slusser JP, Wysokinski WE. Thrombophilia differences in splanchnic vein thrombosis and lower extremity deep venous thrombosis in North America. J Gastroenterol 2013; 48:1111-8. [PMID: 23247829 DOI: 10.1007/s00535-012-0728-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Accepted: 11/23/2012] [Indexed: 02/04/2023]
Abstract
BACKGROUND The utility of thrombophilia testing in patients with splanchnic vein thrombosis (SpVT) has not previously been rigorously evaluated. The purpose of this study was to characterize differences in the prevalence of thrombophilia in patients with SpVT involving portal (PVT), mesenteric (MVT), splenic (SVT), or hepatic (HVT) veins in isolation or with multisegmental (M-SpVT) involvement compared to patients with lower extremity deep vein thrombosis (DVT). METHODS An inception cohort of patients with incident SpVT was identified for whom comprehensive thrombophilia testing was performed between 1995 and 2005 and compared to DVT controls. RESULTS 341 patients with SpVT (mean age 50 ± 16 years, 53 % women) including isolated PVT (n = 112), MVT (n = 67), HVT (n = 22), SVT (n = 11), and M-SpVT (n = 129) involvement and 3621 DVT controls (mean age 55 ± 16 years, 56 % women) had comprehensive thrombophilia testing. The prevalence of abnormal results was similar for SpVT (24.6 %) and DVT (25.9 %) patients. "Strong" thrombophilias were more prevalent among SpVT patients (12.3 vs. 8.5 %, p = 0.0168). Patients with splenic (45.5 %) and mesenteric (41.8 %) thrombosis had the highest thrombophilia prevalence. Protein S deficiency was more common in SpVT patients (3.5 vs. 0.9 %, p < 0.001). In contrast, FV Leiden was more prevalent among DVT patients (15.8 vs. 10.9 %, p = 0.0497). CONCLUSION The prevalence of selected thrombophilia factors differ comparing SpVT and DVT patients. The prevalence is particularly high for patients with splenic and mesenteric vein thrombosis. Whereby the finding of strong thrombophilia impacts duration of anticoagulant therapy, such testing is warranted in the evaluation of patients with unprovoked SpVT.
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Affiliation(s)
- Edyta Sutkowska
- Division of Rehabilitation, Department and Clinic of Orthopedic and Traumatologic Surgery, Wroclaw Medical University, Wroclaw, Poland
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van Wissen S, Bastiaansen BAJ, Stroobants AK, van den Dool EJ, Idu MM, Levi M, Stroes ESG. Catastrophic antiphospholipid syndrome mimicking a malignant pancreatic tumour – a case report. Lupus 2008; 17:586-90. [DOI: 10.1177/0961203307087406] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Abstract The catastrophic antiphospholipid syndrome is characterised by rapid onset thromboses, often resistant to conventional anticoagulant treatment, and resulting in life threatening multiple organ dysfunction. The diagnosis of catastrophic antiphospholipid syndrome may be difficult, predominantly due to its frequently atypical presentation. We report a case of a 35-year-old female who presented with a pancreatic tumour and extensive thromboses. Following a storm of ischemic events due to thrombotic occlusions in spite of therapeutic heparin dose, the suspicion of catastrophic antiphospholipid syndrome emerged. The patient was successfully treated with anticoagulants, immunuglobulins, plasmapheresis and rituximab. The present report shows that the use of the diluted Russell’s viper venom time can be helpful in providing additional information on the lupus anticoagulans antibody status, allowing careful monitoring of lupus anticoagulans conversion and hence response to therapy.
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Affiliation(s)
- S van Wissen
- Department of Internal Medicine and Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - BAJ Bastiaansen
- Department of Gastroenterology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - AK Stroobants
- Department of Clinical Chemistry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - EJ van den Dool
- Department of Clinical Chemistry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - MM Idu
- Department of Vascular Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - M Levi
- Department of Internal Medicine and Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - ESG Stroes
- Department of Internal Medicine and Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Sidelmann JJ, Sjøland JA, Gram J, Bertelsen V, Mourits-Andersen T, Münster H, Münster AMB, Jespersen J. Lupus anticoagulant is significantly associated with inflammatory reactions in patients with suspected deep vein thrombosis. Scandinavian Journal of Clinical and Laboratory Investigation 2007; 67:270-9. [PMID: 17454841 DOI: 10.1080/00365510601038992] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Lupus anticoagulant (LA) and antiphospholipid antibodies (aPL) are suggested as risk factors for development of deep vein thrombosis (DVT) among patients without systemic lupus erythematosus (SLE). Other conditions, e.g. inflammation, are reported to induce LA and it is uncertain whether the association between LA and DVT is causal. In this study the associations between aPL, LA and inflammation were investigated in 170 consecutive patients without SLE, but with a tentative diagnosis of DVT. MATERIAL AND METHODS DVT was diagnosed in 64 patients. LA was determined according to the criteria of the International Society of Thrombosis and Haemostasis. The concentration of anticardiolipin (aCL) and beta(2)-glycoprotein I (anti-beta(2)-GPI) antibodies as well as C-reactive protein (CRP) was determined with sensitive and precise methods. RESULTS LA was demonstrated in 8 patients with DVT and in 10 patients without DVT, relative risk 1.33 (CI: 0.55-3.18). No significant association was observed between aCL or anti-beta(2)-GPI and DVT. Patients suffering from DVT had significantly higher concentrations of CRP than patients without DVT. However, CRP was also significantly higher in patients positive for LA than in patients without LA irrespective of the presence of DVT (p<0.001). CONCLUSIONS The present study supports a strong association between inflammatory reactions and development of LA in patients with suspected DVT, whereas no significant association was demonstrated between LA or aPL and DVT.
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Affiliation(s)
- J J Sidelmann
- Department for Thrombosis Research, University of Southern Denmark, Esbjerg, Denmark.
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Aboud MR, Roddie C, Ward CM, Coyle L. The laboratory diagnosis of lupus anticoagulant in patients on oral anticoagulation. ACTA ACUST UNITED AC 2006; 28:105-10. [PMID: 16630214 DOI: 10.1111/j.1365-2257.2006.00753.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Laboratory-specific cut-off lupus ratios (LR), above which a plasma is judged positive for lupus anticoagulant (LA), were established for both activated partial thromboplastin time-based and dilute Russell viper venom time-based methods. The validity of using these cut-off values to determine the presence of LA in patients on oral anticoagulation (OAC) was assessed. A cohort of 40 patients (23 male and 17 female), aged 22-84 years (mean 52 years) were tested for LA at the time of a thrombotic event. Repeated testing was performed after the same patients were treated with OAC (international normalized ratio 2.0-3.5). For 36 patients (90%), LA status was unchanged pre- and on-OAC. Thirteen of the 40 patients (32.5%) were positive for LA both pre- and on-OAC. Of the 27 patients negative for LA pre-OAC, 23 remained negative on-OAC. The four discordant results were interesting in that LA positivity was demonstrated only after the patient was stable on-OAC. In our cohort of 40 patients, there was a trend for LRs to decrease on-OAC, but this did not reach statistical significance. The subset (4) went against this trend and became positive after the thrombotic event.
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Affiliation(s)
- M R Aboud
- Pacific Laboratory Medicine Services, Royal North Shore Hospital, Sydney, Australia.
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13
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Endler G, Marsik C, Jilma B, Schickbauer T, Vormittag R, Wagner O, Mannhalter C, Rumpold H, Pabinger I. Anti-cardiolipin antibodies and overall survival in a large cohort: preliminary report. Clin Chem 2006; 52:1040-4. [PMID: 16574758 DOI: 10.1373/clinchem.2005.063925] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Anti-cardiolipin antibodies have been associated with both arterial and venous thrombosis, but their overall impact on all-cause or vascular mortality is unknown. In this study, we evaluated the influence of anti-cardiolipin antibodies on all-cause and vascular mortality. METHODS All individuals who fulfilled the inclusion criteria (completeness of data, no admission from an intensive care unit, unique identification with name and date of birth) and whose anti-cardiolipin antibodies were measured between October 2002 and February 2004 were included in this study (n = 4756; 64% female; median age, 46 years). Death/survival and cause of death were obtained from the Austrian Death Registry. The median observation period was 1.5 years, and the study comprised 7189 person-years. RESULTS During the study period, 184 patients (3.9%) died. There were no associations between either anti-cardiolipin IgM or IgG antibodies and both vascular death and noncancer mortality as outcome variables in a Cox regression analysis adjusted for age and sex. In contrast, the risk of cancer-related mortality was increased 2.6-fold. CONCLUSIONS Anti-cardiolipin antibodies are associated with cancer mortality, likely as an epiphenomenon of malignancy, but they are not predictive of vascular mortality or noncancer mortality. Hence, although a clear association between anti-cardiolipin antibodies and (mostly nonfatal) vascular events has been described in the literature, our data indicate that this finding is not necessarily associated with an increase in vascular mortality.
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Affiliation(s)
- Georg Endler
- Institute of Medical and Chemical Laboratory Diagnostics, Department of Clinical Pharmacology, Division of Haematology and Immunology, Medical University of Vienna, Vienna, Austria
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14
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Jang JW, Yeo CD, Kim JD, Bae SH, Choi JY, Jung ES, Rha SE, Byun JY, Yoon SK. Trousseau's syndrome in association with cholangiocarcinoma: positive tests for coagulation factors and anticardiolipin antibody. J Korean Med Sci 2006; 21:155-9. [PMID: 16479083 PMCID: PMC2733966 DOI: 10.3346/jkms.2006.21.1.155] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Thromboembolic events are reported to occur with a high frequency in the setting of malignancy. However, reports on an association between cholangiocarcinoma and pulmonary thromboembolism, thus far, are almost lacking. We present here an unusual case of a 56-yr-old patient presenting cholangiocarcinoma and unexplained pulmonary thromboembolism. The patient had been quite healthy before the diagnosis. Coagulation tests showed elevated levels of fibrinogen, fibrinogen degradation product (FDP), D-dimer, and IgM anticardiolipin antibody (aCL Ab). The thromboemboli were resolved 3 weeks after anticoagulant therapy using low molecular-weight-heparin. Then, follow-up coagulation tests showed a marked decrease to normal in aCL Ab titer as well as the normalization of FDP and D-dimer levels. In this case, we describe pulmonary thromboembolism caused by hypercoagulable state associated with cholangiocarcinoma and speculate that such a thrombotic phenomenon could be regressed by anticoagulant therapy.
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Affiliation(s)
- Jeong Won Jang
- Department of Internal Medicine, College of Medicine, WHO Collaborating Center on Viral Hepatitis, The Catholic University of Korea, Seoul, Korea
| | - Chang Dong Yeo
- Department of Internal Medicine, College of Medicine, WHO Collaborating Center on Viral Hepatitis, The Catholic University of Korea, Seoul, Korea
| | - Jin Dong Kim
- Department of Internal Medicine, College of Medicine, WHO Collaborating Center on Viral Hepatitis, The Catholic University of Korea, Seoul, Korea
| | - Si Hyun Bae
- Department of Internal Medicine, College of Medicine, WHO Collaborating Center on Viral Hepatitis, The Catholic University of Korea, Seoul, Korea
| | - Jong Young Choi
- Department of Internal Medicine, College of Medicine, WHO Collaborating Center on Viral Hepatitis, The Catholic University of Korea, Seoul, Korea
| | - Eun Sun Jung
- Department of Pathology, The Catholic University of Korea, Seoul, Korea
| | - Sung Eun Rha
- Department of Radiology, The Catholic University of Korea, Seoul, Korea
| | - Jae Young Byun
- Department of Radiology, The Catholic University of Korea, Seoul, Korea
| | - Seung Kew Yoon
- Department of Internal Medicine, College of Medicine, WHO Collaborating Center on Viral Hepatitis, The Catholic University of Korea, Seoul, Korea
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15
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Statkute L, Traynor A, Oyama Y, Yaung K, Verda L, Krosnjar N, Burt RK. Antiphospholipid syndrome in patients with systemic lupus erythematosus treated by autologous hematopoietic stem cell transplantation. Blood 2005; 106:2700-9. [PMID: 15870182 DOI: 10.1182/blood-2005-01-0330] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Systemic lupus erythematosus (SLE) is the most common disease associated with antiphospholipid syndrome (APS). We, therefore, evaluated 46 patients with refractory SLE treated by autologous hematopoietic stem cell transplantation (HSCT) for a history of APS prior to transplantation. The prevalence of SLE-related APS in our patient population was 61% (28 of 46 patients with refractory SLE). Nineteen of 28 patients with APS had lupus anticoagulant (LA) or high titers of anticardiolipin antibodies (ACLAs), either immunoglobulin (Ig)G or IgM, when evaluated at study entry. Six of 8 evaluable LA+ patients became and remained LA-; 5 of 7 initially ACLA IgG+ patients and 9 of 11 ACLA IgM+ patients demonstrated normalization of ACLA titers when followed after HSCT. Eighteen of 22 patients refractory to chronic anticoagulation discontinued anticoagulation therapy a median of 4 months after transplantation; 78% of them remained free of thrombotic events and in complete SLE remission for up to 78 months (median, 15 months) after HSCT. There was no treatment-related mortality. Autologous HSCT may be performed safely in patients with APS and appears to be effective therapy for eliminating ALPAs and preventing thrombotic complications in patients with SLE.
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Affiliation(s)
- Laisvyde Statkute
- Division of Immunotherapy, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
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Abstract
PURPOSE OF REVIEW The antiphospholipid antibody syndrome is an important cause of arterial and/or venous thrombosis. In this review the authors discuss recent trends in the clinical and laboratory diagnosis of this syndrome that are of relevance to ophthalmologists. RECENT FINDINGS The diagnostic criteria of antiphospholipid antibody syndrome have been reviewed and revalidated recently. Few prospective studies have been conducted to determine the prevalence of antiphospholipid antibodies in patients with retinal vascular occlusion and the spectrum of ophthalmologic findings in patients with established antiphospholipid syndrome. New antibody tests for antiphospholipid antibody syndrome are available with increased sensitivity and specificity, but lack of standardization, and interassay and interlaboratory variation makes it difficult to determine their clinical value. SUMMARY Ophthalmologists should be familiar with the spectrum of clinical manifestation of antiphospholipid syndrome, the diagnostic criteria of this disease, and be able to carry out a basic laboratory workup for this entity. A high index of suspicion for this disorder is also important in making the diagnosis.
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Affiliation(s)
- Raed Behbehani
- Neuroophthalmology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
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