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Shakhmatova OO, Komarov AL, Krivosheeva EN, Dobrovolsky AB, Titaeva EV, Amelyushkina VA, Gomyranova NV, Panchenko EP. [Albuminuria as a marker of atherosclerosis burden and a possible predictor of adverse events in patients with polyvascular disease]. TERAPEVT ARKH 2023; 95:763-768. [PMID: 38158919 DOI: 10.26442/00403660.2023.09.202434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 07/21/2021] [Indexed: 01/03/2024]
Abstract
BACKGROUND The role of albuminuria as a marker of the atherosclerosis burden and a predictor of prognosis in patients with polyvascular disease (PD) has been little studied. AIM To evaluate the prevalence, association with atherosclerosis burden, and prognostic value of albuminuria in relation to cardiovascular and bleeding complications in patients with PD. MATERIALS AND METHODS The data was obtained from the prospective registry REGATA-1 (NCT04347200). Seventy four patients (75.7% males, median age 67 [61-69] years) with PD (CAD and peripheral arterial disease) were enrolled. All patients received aspirin and rivaroxaban 2.5 mg. The albumin-creatinine ratio in a single morning urine sample, estimated glomerular filtration rate (eGFR), and von Willebrand factor levels were determined. RESULTS Mild albuminuria (10-29 mg/g) was detected in 45.9% of patients, moderate and severe (≥30 mg/g) - in 29.7%; eGFR<60 ml/min - in 21.7%, chronic kidney disease (CKD) according to the full KDIGO criteria (eGFR and/or albuminuria ≥30 mg/g) - twice as often (39.2%). The frequency of nephroprotective therapy prescription was insufficient. The level of albuminuria did not correlate with von Willebrand factor (endothelial dysfunction marker), but was associated with affecting of 4-5 vascular beds (ROC AUC 0.775; p=0.011). During the follow-up (12 [8-18] months) 3 patients developed MACE, 11 - BARC 2-3 bleedings. Neither albuminuria nor eGFR were predictors of MACE, bleeding, or net clinical benefit. CKD (KDIGO) was also not associated with bleedings. CKD (KDIGO) was independent predictor of MACE (in significant multiple regression model beta - coefficient for CKD was 0.097; p=0.042), however, the small number of end points allows us to speak only of a hypothesis-generating trend. The implementation of CKD (KDIGO) has increased the predictive value of the REACH score. CONCLUSION Albuminuria is highly prevalent in patients with PD. It is a marker of atherosclerosis burden. CKD, diagnosed taking into account the level of albuminuria, can be used in a comprehensive assessment of cardiovascular risk in this category of patients.
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Affiliation(s)
| | - A L Komarov
- Chazov National Medical Research Center of Cardiology
| | | | | | - E V Titaeva
- Chazov National Medical Research Center of Cardiology
| | | | | | - E P Panchenko
- Chazov National Medical Research Center of Cardiology
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Korobkova V, Komarov AL, Shakhmatova OO, Dobrovolsky AB, Novikova ES, Guskova EV, Titaeva EV, Yarovaya EB, Shuleshova AG, Panchenko EP. High plasma D-dimer and von Willebrand factor levels are associated with risk of upper gastrointestinal bleeding in patients with chronic coronary syndromes receiving long-term antiplatelet therapy. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Purpose
Plasma von Willebrand factor (VWF) and D-dimer levels have been proposed as markers of endothelial damage, coagulation activation and subsequent cardiovascular events. Thrombotic and hemorrhagic burdens are closely related. However, the association of coagulation markers with bleeding complications in pts with atherosclerosis remains unclear.
We aimed to assess the predictive value of D-dimer and VWF levels for upper gastrointestinal bleeding (UGIB) in patients with chronic coronary syndromes (CCS) receiving long-term antithrombotic therapy.
Patients and methods
Single center prospective Registry of Long-term AnTithrombotic TherApy (REGATTA-1 NCT04347200) included 934 pts with CCS (78.6% males, age 61±10.7 yrs, 76% after elective PCI). The UGIB annual incidence was 1.9 events per 100 patient-years.
VWF was determined in 28 pts with UGIB and 141 controls, matched for age, sex and main clinical risk factors. D-dimer was determined from 28 and 380 pts respectively
Results
The median for VWF was 139 [interquartile range 107–168]%. The median for D-dimer was 443,8 [interquartile range 272.5–702.4] ng/ml. ROC analysis revealed acceptable discriminatory ability for VWF (cut off >105%; AUC=0.67, 95% CI: 0.59–0.74, p=0.001) and for D-dimer (cut off >928 ng/ml; AUC=0.63, 95% CI: 0.59–0.68, p=0.002). High levels of coagulation markers remained significant in regression model adjuster for ESC panel of UGIB risk factors. OR for D-dimer = 3.4, 95% CI: 1.09–10.66; p=0.03). OR for VWF = 11.74, 95% CI: 1.19–116.18; p=0.03).
Conclusion
VWF and D-dimer should be considered as valuable prognostic biomarkers to improve the prediction of UGIB in addition to well-known scoring systems in CCS patients receiving long-term antithrombotic therapy.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- V Korobkova
- National Medical Research Center of Cardiology, Moscow, Russian Federation
| | - A L Komarov
- National Medical Research Center of Cardiology, Moscow, Russian Federation
| | - O O Shakhmatova
- National Medical Research Center of Cardiology, Moscow, Russian Federation
| | - A B Dobrovolsky
- National Medical Research Center of Cardiology, Moscow, Russian Federation
| | - E S Novikova
- National Medical Research Center of Cardiology, Moscow, Russian Federation
| | - E V Guskova
- National Medical Research Center of Cardiology, Moscow, Russian Federation
| | - E V Titaeva
- National Medical Research Center of Cardiology, Moscow, Russian Federation
| | - E B Yarovaya
- M.V. Lomonosov Moscow State University, Moscow, Russian Federation
| | - A G Shuleshova
- National Medical Research Center of Cardiology, Moscow, Russian Federation
| | - E P Panchenko
- National Medical Research Center of Cardiology, Moscow, Russian Federation
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Krivosheeva EN, Panchenko EP, Kropacheva ES, Dobrovolsky AB, Titaeva EV, Mironov VM, Samko AN. Prediction-Determining Outcomes and Their Predictors in Atrial Fibrillation Patients Receiving Multicomponent Antithrombotic Therapy in Real Clinical Practice. ACTA ACUST UNITED AC 2020; 60:33-45. [PMID: 33155957 DOI: 10.18087/cardio.2020.8.n1123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/01/2020] [Accepted: 06/30/2020] [Indexed: 11/18/2022]
Abstract
Aim Searching for clinical, angiographic, and biochemical predictors of cardiovascular complications (CVC) and hemorrhagic complications in patients with atrial fibrillation (AF) receiving a multicomponent antithrombotic therapy (MAT) for an elective percutaneous coronary intervention (PCI). Patients with ischemic heart disease (IHD) and AF who require MAT for PCI are at a high risk of thrombotic complications (stroke, systemic embolism, coronary events) and hemorrhage. This warrants searching for new risk factors determining prediction of the outcome.Materials and methods This study included 207 patients (146 males aged 70.1±8.3 years) with IHD and AF who received direct oral anticoagulants (DOAC) as a part of their MAT therapy. Median duration of the follow-up was 12 [8.0; 12.0] months. The efficacy endpoint was a sum of CVCs combining cardiovascular death, ischemic stroke, venous thromboembolic complications, acute coronary syndrome (ACS), and requirement for an unscheduled PCI. "Coronary events", including ACS and requirement for an unscheduled PCI were analyzed separately. The safety endpoint was BARC type 2-5 bleeding. Upon admission, biomarkers (growth-differentiation factor 15 (GDF-15), D-dimer, thrombin-activated fibrinolysis inhibitor (TAFI), and plasminogen activator inhibitor-1 (PAI-1)) were measured for all patients. Searching for prognostically significant indexes was performed with the Cox proportional hazards regression.Results Incidence of all CVCs was 16.4 %. Independent predictors of CVC included the DOAC treatment at a reduced dose (odds ratio (OR) 2.5 at 95 % confidence interval (CI) 1.02-6.15; p=0.0454), GDF-15 >1191 pg /ml (OR 3.76 at 95 % CI, 1.26-11.18; p=0.0172), PAI-1 >13.2 U/ml (OR 2.67 at 95 % CI, 1.13-6,26; p=0.0245). Incidence of coronary complications was 9.2 %. Independent predictors of coronary complications included a SYNTAX index >26.5 (OR 4.5 at 95 % CI, 1.45-13.60; p=0.0090), PCI for chronic coronary occlusion (OR 3.21 at 95 % CI, 1.10-9.33; p=0.0326), a GDF-15 >1191 pg/ml (ОR 4.70 at 95 % CI, 1.32-16.81; p=0.0172). Incidence of BARC type 2-5 bleeding was 26.1 %. The only independent predictor for hemorrhage complications was the total PRECISE-DAPT score >30 (ОR 3.22; 95 % CI, 1.89-5.51; р<0.0001).Conclusion Three independent predictors of CVC were identified for patients with IHD and AF treated with MAT following an elective PCI: treatment with a reduced dose of DOAC, GDF-15 >1191 pg /ml, and PAI-1>13.2 U/ml. Independent predictors of coronary complications included a SYNTAX index >26.5, PCI for chronic coronary occlusion, and GDF-15 >1191 pg/ml. The factor associated with a risk of bleeding was the total PRECISE-DAPT score >30.
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Affiliation(s)
- E N Krivosheeva
- National medical research center of cardiology of the Ministry of healthcare of the Russian Federation, Moscow
| | - E P Panchenko
- National medical research center of cardiology of the Ministry of healthcare of the Russian Federation, Moscow
| | - E S Kropacheva
- National medical research center of cardiology of the Ministry of healthcare of the Russian Federation, Moscow
| | - A B Dobrovolsky
- National medical research center of cardiology of the Ministry of healthcare of the Russian Federation, Moscow
| | - E V Titaeva
- National medical research center of cardiology of the Ministry of healthcare of the Russian Federation, Moscow
| | - V M Mironov
- National medical research center of cardiology of the Ministry of healthcare of the Russian Federation, Moscow
| | - A N Samko
- National medical research center of cardiology of the Ministry of healthcare of the Russian Federation, Moscow
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Spiridonova VA, Novikova TM, Sizov VA, Shashkovskaya VS, Titaeva EV, Dobrovolsky AB, Zharikova EB, Mazurov AV. DNA Aptamers to Thrombin Exosite I. Structure-Function Relationships and Antithrombotic Effects. Biochemistry (Mosc) 2020; 84:1521-1528. [PMID: 31870256 DOI: 10.1134/s0006297919120113] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
DNA aptamers (oligonucleotides) interacting with thrombin exosite I contain G-quadruplex, two T-T, and one T-G-T loops in their structure. They prevent exosite I binding with fibrinogen and thrombin receptors on platelet surface, thereby suppressing thrombin-stimulated formation of fibrin from fibrinogen and platelet aggregation. Earlier, we synthesized original antithrombin aptamer RE31 (5'-GTGACGTAGGTTGGTGTGGTTGGGGCGTCAC-3') that contained (in addition to G-quadruplex) a hinge region connected to six pairs of complementary bases (duplex region). In this study, we compared properties of RE31 aptamer and its analogues containing varying number of bases in the duplex region and nucleotide insertions in the hinge region. Reduction in the number of nucleotides in the duplex region by 1 to 4 pairs (in comparison with RE31 aptamer) resulted in the decrease of the structural stability of aptamers (manifested as lower melting temperatures) and their ability to inhibit thrombin-stimulated fibrin formation in human blood plasma in tests of thrombin, prothrombin, and activated partial thromboplastin times. However, an increase in the number of bases by 1 to 2 pairs did not cause significant changes in the stability and antithrombin activity of the aptamers. Insertions into the hinge region of RE31 aptamer decreased its antithrombin activity. Investigation of RE31 antithrombotic properties demonstrated that RE31 (i) slowed down thrombin formation in human blood plasma (thrombin generation test), (ii) accelerated lysis of fibrin clot by tissue plasminogen activator in in vitro model, and (iii) suppressed arterial thrombosis in in vivo model. Based on the obtained data, RE31 aptamer can be considered as a potentially effective antithrombotic compound.
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Affiliation(s)
- V A Spiridonova
- Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, Moscow, 119992, Russia
| | - T M Novikova
- Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, Moscow, 119992, Russia
| | - V A Sizov
- Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, Moscow, 119992, Russia
| | - V S Shashkovskaya
- Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, Moscow, 119992, Russia
| | - E V Titaeva
- National Medical Research Center for Cardiology, Russian Ministry of Health, Moscow, 121552, Russia
| | - A B Dobrovolsky
- National Medical Research Center for Cardiology, Russian Ministry of Health, Moscow, 121552, Russia
| | - E B Zharikova
- National Medical Research Center for Cardiology, Russian Ministry of Health, Moscow, 121552, Russia
| | - A V Mazurov
- National Medical Research Center for Cardiology, Russian Ministry of Health, Moscow, 121552, Russia.
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Vorobyeva NM, Dobrovolsky AB, Panchenko EP, Titaeva EV, Karabasheva MB, Yarovoy SY, Danilov NM, Kirienko AI. P5587Elevated D-dimer level after 1 month anticoagulant therapy as a predictor for adverse outcomes in patients with venous thromboembolism: 10-year follow-up results. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Our previous study showed that elevated D-dimer (D-D) level after 1 month of the anticoagulant therapy was an independent predictor of deep vein thrombosis (DVT) recurrences and combined endpoint (DVT recurrence and/or death from any causes) during 18 months. Prognostic value of elevated D-D level after 1 month of the anticoagulant therapy for the long-term venous thromboembolism (VTE) outcomes is unknown.
Purpose
To estimate the elevated D-D level influence after 1 month of the anticoagulant therapy on the 10-year prognosis in VTE pts.
Methods
One hundred and twelve pts (77 men) aged 18–76 (mean 54±14) years with DVT and/or pulmonary embolism were included in the study. Pts received unfractionated or low molecular weight heparin for at least 5 days followed by the long-term warfarin therapy (target international normalized ratio 2,0–3,0). D-D level was measured after 1 month from the start of the anticoagulant therapy by a quantitative assay with an estimated cut-off level of 0,5 ug/ml. The follow-up period was 10 years. Endpoints were VTE recurrence and combined endpoint (VTE recurrence and/or death from any causes).
Results
In all pts, median of follow-up was 2,77 years (min 2 weeks, max 11,61 years, IQR 1,44 to 10,31 years). Seventy seven (69%) pts had ended the 10-year follow-up period completely or achieved the endpoint. In these pts, median of follow-up was 9,23 years (IQR 1,70 to 10,53 years). Thirty-five cases were censored. During 10 years, the VTE recurrences rate was 27,7%, 14 pts died, the combined endpoint rate was 36,6%. Kaplan-Meier analysis showed that pts with elevated D-D level after 1 month of the anticoagulant therapy had higher 10-year cumulative risk for adverse outcomes (chi-square=6,0, p=0,014 for VTE recurrence; chi-square=13,7, p<0,001 for combined endpoint). Cox regression confirmed that elevated D-D level after 1 month of the anticoagulant therapy was associated with a 2,5-fold increase in the 10-year VTE recurrences risk (HR 2,52; 95% CI 1,18–5,42; p=0,018) and a 3,2-fold increase in the 10-year combined endpoint risk (HR 3,21; 95% CI 1,68–6,15; p<0,001) compared pts with normal D-D level after 1 month of the anticoagulant therapy.
Conclusions
During 10 years, the VTE recurrences rate was 27,7%, combined endpoint rate (VTE recurrence and/or death from any causes) was 36,6%. Elevated (>0,5 ug/ml) D-D level after 1 month of the anticoagulant therapy had a prognostic value and was associated with the 2,5-fold increase in the 10-year VTE recurrences risk and the 3,2-fold increase in the 10-year adverse outcomes risk.
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Affiliation(s)
- N M Vorobyeva
- Pirogov Russian National Research Medical University, Russian Clinical and Research Center of Gerontology, Moscow, Russian Federation
| | - A B Dobrovolsky
- Russian Cardiology Research & Production Center, Moscow, Russian Federation
| | - E P Panchenko
- Russian Cardiology Research & Production Center, Moscow, Russian Federation
| | - E V Titaeva
- Russian Cardiology Research & Production Center, Moscow, Russian Federation
| | - M B Karabasheva
- Russian Cardiology Research & Production Center, Moscow, Russian Federation
| | - S Y Yarovoy
- Russian Cardiology Research & Production Center, Moscow, Russian Federation
| | - N M Danilov
- Russian Cardiology Research & Production Center, Moscow, Russian Federation
| | - A I Kirienko
- Pirogov Russian National Research Medical University, Moscow, Russian Federation
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Kropacheva ES, Vorobyeva NM, Moreva OV, Panchenko EP, Dobrovolsky AB, Zemlyanskaya OA, Titaeva EV. 351TAFI level dynamics during long-term warfarin therapy as a predictor of recurrent bleedings in a target INR. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- E S Kropacheva
- Russian Cardiology Research and Production Complex, Clinical Problems of Atherothrombosis, Moscow, Russian Federation
| | - N M Vorobyeva
- Pirogov Russian National Research Medical University, Moscow, Russian Federation
| | - O V Moreva
- Russian Cardiology Research and Production Complex, Clinical Problems of Atherothrombosis, Moscow, Russian Federation
| | - E P Panchenko
- Russian Cardiology Research and Production Complex, Clinical Problems of Atherothrombosis, Moscow, Russian Federation
| | - A B Dobrovolsky
- Russian Cardiology Research and Production Complex, Clinical Problems of Atherothrombosis, Moscow, Russian Federation
| | - O A Zemlyanskaya
- Russian Cardiology Research and Production Complex, Clinical Problems of Atherothrombosis, Moscow, Russian Federation
| | - E V Titaeva
- Russian Cardiology Research and Production Complex, Clinical Problems of Atherothrombosis, Moscow, Russian Federation
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Zemlyanskaya OA, Kropacheva ES, Dobrovolsky AB, Panchenko EP. Renal function in patients receiving long-term warfarin therapy: A five-year prospective follow-up. TERAPEVT ARKH 2017; 89:78-86. [DOI: 10.17116/terarkh201789978-86] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Aim. To investigate the prognostic value of renal function and to estimate glomerular filtration rate (GFR) changes during a 5-year follow-up of patients receiving warfarin therapy. Subjects and methods. 200 patients (124 men, 76 women) mainly from a group at high risk for thromboembolic events (mean CHA2DS2-VASc scores, 3.25±1.89) were examined. The patients’ mean age was 62.3±9.4 years; the follow-up period was 5 years. 74% of the patients received warfarin monotherapy (international normalized ratio (INR) 2.0 to 3.0); 36% took vitamin K antagonists in combination with one or two antiplatelet agents. The CKD-EPI formula was used to estimate GFR in all the patients at baseline and throughout the investigation once a year. Results. GFR less than 70.9 ml/min/1.73 m2 was found to be a predictor of fatal and nonfatal thrombotic events. The decreased GFR was unassociated with the development of major and clinically relevant hemorrhagic complications within 5 years of warfarin therapy. The initial decline in renal function (GFR
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Dobrovolsky AB, Laguta PS, Guskova EV, Yarovaya EB, Titaeva EV, Storozhilova AN, Panchenko EP. Effect of Fibrinogen on Platelet Reactivity Measured by the VerifyNow P2Y12 Assay. Biochemistry (Mosc) 2016; 81:439-44. [PMID: 27297894 DOI: 10.1134/s0006297916050011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The VerifyNow assay is based upon the ability of activated platelets to cross-link beads coated with fibrinogen. However, fibrinogen is an abundant protein of blood, and therefore it may affect test results by competing with fibrinogen of beads for binding to platelets. To test this assumption, we assessed the influence of artificial alteration of fibrinogen level in blood samples obtained from donors (n = 9) and patients on clopidogrel therapy (n = 8) on the results of the VerifyNow P2Y12 assay. Fibrinogen level was altered by adding to blood samples 1/10 volume of fibrinogen solution (10.56 g/liter) or corresponding buffer. Relative to baseline, addition of buffer significantly increased platelet reactivity, whereas addition of fibrinogen decreased it. Analysis of the relationship between change in platelet reactivity values (dBase and dPRU) and change in fibrinogen concentration (dFg) revealed strong negative correlations: dBase = -63.3 × dFg - 27.1 (r = -0.924, p < 0.0005) and dPRU = -54.4 × dFg - 21.8 (r = -0.764, p < 0.0005). Thus, the results of our experiments suggest that: (i) blood fibrinogen strongly influences results of the VerifyNow P2Y12 assay, and (ii) correcting for fibrinogen effect may be needed to improve the accuracy of the test in the measuring of antiplatelet effect of clopidogrel therapy.
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Affiliation(s)
- A B Dobrovolsky
- Russian Cardiology Research and Production Complex, Ministry of Healthcare, Moscow, 121552, Russia.
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Khaspekova SG, Antonova OA, Shustova ON, Yakushkin VV, Golubeva NV, Titaeva EV, Dobrovolsky AB, Mazurov AV. Activity of tissue factor in microparticles produced in vitro by endothelial cells, monocytes, granulocytes, and platelets. Biochemistry Moscow 2016; 81:114-21. [DOI: 10.1134/s000629791602005x] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Moreva OV, Kropacheva ES, Dobrovolsky AB, Titaeva EV, Panchenko EP. [Risk Factors of Recurrent Bleedings at Therapeutic International Normalized Ratio in Patients on Long-Term Warfarin Therapy]. Kardiologiia 2016; 56:40-46. [PMID: 28294748 DOI: 10.18565/cardio.2016.2.40-46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
AIM to investigate parameters of fibrinolysis in patients on long-term warfarin (W) therapy, and assess their relation to the risk of recurrent bleeding occurring at therapeutic international normalized ratio (INR). MATERIALS AND METHODS Our prospective study involved 78 W-naive patients (40 men, age 64.3+/-12.2 years). Follow up period was 5.6+/-3.4 months. INR was measured monthly; determination of coagulation parameters (D-dimer, fibrinogen, complex plasmin-2-antiplasmin [PAP] and thrombin-activatable fibrinolysis inhibitor [TAFI] was performed before and after at least 3 months of W therapy. RESULTS During follow-up bleedings occurred in 47 (60.3%) patients, 26 patients (33.3%) had recurrent bleedings at therapeutic INR and 21 patients (26.9%) had single bleeding. Mean time in therapeutic range (TTR) was >70.
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Affiliation(s)
- O V Moreva
- Institute of Cardiology of Russian Cardiology Scientific and Production Complex, Moscow, Russia
| | - E S Kropacheva
- Institute of Cardiology of Russian Cardiology Scientific and Production Complex, Moscow, Russia
| | - A B Dobrovolsky
- Institute of Cardiology of Russian Cardiology Scientific and Production Complex, Moscow, Russia
| | - E V Titaeva
- Institute of Cardiology of Russian Cardiology Scientific and Production Complex, Moscow, Russia
| | - E P Panchenko
- Institute of Cardiology of Russian Cardiology Scientific and Production Complex, Moscow, Russia
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Moreva OV, Kropacheva ES, Panchenko EP, Dobrovolsky AB, Zemlyanskaya OA, Donnikov AE, Titaeva EV, Guskov IA. [HAS-BLED and HEMORR2HAGES Scales in Assessment of Bleeding Risk in Patients on Long-Term Warfarin Therapy]. Kardiologiia 2015; 55:50-56. [PMID: 28294923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
UNLABELLED Aim of the study was to elucidate value of HAS-BLED and HEMORR2HAGES scales for prediction bleedings in patients receiving long-term warfarin (W) therapy. MATERIAL AND METHODS The study involved 119 patients (72 men) aged 60.9+/-9.6 years with atrial fibrillation or venous thromboembolic complications. Follow up period was 5.6 +/-3.4 years. All bleedings were categorized as 1) single bleeding with INR>4.0 during the 1st month of W therapy; 2) any single bleeding after 1st month of W therapy; 3) recurrent bleedings. CYP29 and VKORC1 (G3673A) genotypic variants were determined by PCR. Patients were divided into low (<3 points of HAS-BLED scale, n=58; <4 points.
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Affiliation(s)
- O V Moreva
- Institute of Cardiology of Russian Cardiology Scientific and Production Complex, Moscow, Russia
| | - E S Kropacheva
- Institute of Cardiology of Russian Cardiology Scientific and Production Complex, Moscow, Russia
| | - E P Panchenko
- Institute of Cardiology of Russian Cardiology Scientific and Production Complex, Moscow, Russia
| | - A B Dobrovolsky
- Institute of Cardiology of Russian Cardiology Scientific and Production Complex, Moscow, Russia
| | - O A Zemlyanskaya
- Institute of Cardiology of Russian Cardiology Scientific and Production Complex, Moscow, Russia
| | - A E Donnikov
- Institute of Cardiology of Russian Cardiology Scientific and Production Complex, Moscow, Russia
| | - E V Titaeva
- Institute of Cardiology of Russian Cardiology Scientific and Production Complex, Moscow, Russia
| | - I A Guskov
- Institute of Cardiology of Russian Cardiology Scientific and Production Complex, Moscow, Russia
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Moreva OV, Kropacheva ES, Panchenko EP, Dobrovolsky AB, Zemlyanskaya OA, Donnikov AE, Titaeva EV, Guskova IA. [HAS-BLED and HEMORR2HAGES Scales in Assessment of Bleeding Risk in Patients on Long-Term Warfarin Therapy]. Kardiologiia 2015; 55:50-56. [PMID: 26898095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
UNLABELLED Aim of the study was to elucidate value of HAS-BLED and HEMORR2HAGES scales for prediction bleedings in patients receiving long-term warfarin (W) therapy. MATERIAL AND METHODS The study involved 119 patients (72 men) aged 60.9 ± 9.6 years with atrial fibrillation or venous thromboembolic complications. Follow up period was 5.6 ± 3.4 years. All bleedings were categorized as 1) single bleeding with INR > 4.0 during the 1st month of W therapy; 2) any single bleeding after 1st month of W therapy; 3) recurrent bleedings. CYP2C9 and VKORC1 (G3673A) genotypic variants were determined by PCR. Patients were divided into low (< 3 points of HAS-BLED scale, n = 58; < 4 points of HEMORR2HAGES scale, n = 109) and high (3 points of HAS-BLED scale, n = 61, ≥ 4 points of HEMORR2HAGES scale, n = 10) bleeding risk groups. RESULTS There was no relationship between total HAS-BLED, HEMORR2HAGES scores and numbers of all as well as category 1 and 2 bleedings. The difference in bleeding frequency between high and low risk groups was significant only for recurrent bleedings. There were 22 (36.1%) and 5 (8.6%) recurrent bleedings among 61 and 58 patients with high and low-risk HAS-BLED score, respectively (p = 0.0048). Recurrent bleedings also occurred more frequently among patients with high risk (7/10, 70%) compared with low risk (20/109, 18.35%) HEMORR2HAGES score (p = 0.018). Subgroups of high and low bleeding risk according to HAS-BLED and HEMORR2HAGES scores differed only by proportion of patients with recurrent bleedings. High W sensitivity represented by 2*/2*, 2*/3*, 3*/3* CYP2C9 and/or AA VKORC1 homozygosis was detected in 25 of 119 patients. Six of 8 patients (75%) with category 1 bleedings were carriers of any polymorpism. CONCLUSION HAS-BLED and HEMORR2HAGES scales performed best in predicting recurrent bleedings in patients on long term W therapy. Single bleedings with INR > 4.0 during 1st month of W therapy were associated with reduced W metabolism (AA VKORC1 or/and CYP2C9 allelic variants 2*/2*, 2*/3*, 3*/3*).
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Vorobyeva NM, Dobrovolsky AB, Titaeva EV, Kirienko AI, Panchenko EP. D-dimer testing during anticoagulant therapy should be used to indicate patients who need extended anticoagulant therapy. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.1080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Dobrovolsky AB, Titaeva EV. The fibrinolysis system: regulation of activity and physiologic functions of its main components. Biochemistry (Mosc) 2002; 67:99-108. [PMID: 11841345 DOI: 10.1023/a:1013960416302] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This review summarizes basic properties and mechanisms of activation and inhibition of main components of the fibrinolytic system that, acting in accord with the system of blood coagulation, provides temporal formation of fibrin clots at sites of vascular injury for the time required for the regeneration of vascular wall. Impairments in the fibrinolytic system may cause bleedings or thrombotic complications in patients. The predictive value of some components of the fibrinolytic system with respect to the development of complications of atherothrombosis is considered.
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Affiliation(s)
- A B Dobrovolsky
- Russian Cardiology Research Center, 3-ya Cherepovskaya ul. 15a, Moscow, 121552, Russia.
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Krasnikova TL, Parfyonova Y, Alekseeva IA, Arefieva TI, Mukhina SA, Dobrovolsky AB, Titaeva Y, Lyakishev AA, Resink TJ, Erne P, Tkachuk VA. Urokinase plasminogen activator system in humans with stable coronary artery disease. Clin Exp Pharmacol Physiol 1999; 26:354-7. [PMID: 10225148 DOI: 10.1046/j.1440-1681.1999.03043.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
1. The present study compares plasma urokinase plasminogen activator (uPA) peptide levels, plasma plasminogen inhibitor (PAI-1) activity and urokinase receptors (uPAR) on peripheral blood monocytes of patients with stable coronary artery disease (SCAD) and healthy volunteers. 2. Urokinase plasminogen activator levels were analysed by ELISA and PAI-1 activity was determined by a plasmin generation method using the chromogenic substrate S2390. Relative uPAR numbers and the adhesion molecules CD11b/CD18 on peripheral blood monocytes were estimated using specific antibodies and flow cytometry. 3. Patients with SCAD were found to have higher plasma uPA peptide levels than age-matched healthy subjects (10.40 +/- 0.99 vs 8.25 +/- 0.53 pmol/L, respectively; P < 0.05). 4. Plasma PAI-1 activity was also higher in patients with SCAD than in healthy subjects (13.6 +/- 2.5 vs 5.2 +/- 1.0 IU/mL, respectively; P < 0.05). 5. Relative uPAR and CD11b/CD18 adhesion molecules were similar on peripheral blood monocytes of patients with SCAD and in healthy subjects. 6. The data indicate a pattern of expression/activity of uPA and PAI-1 in patients with SCAD suggestive of an impaired fibrinolytic ability.
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Affiliation(s)
- T L Krasnikova
- Cardiology Research Centre of Ministry of Health, Moscow, Russia
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Smirnov MD, Pyzh MV, Borovikov DV, Atorozhilova AN, Dobrovolsky AB, Golubych VL, Gratsiansky NA. Low doses of activated protein C delay arterial thrombosis in rats. Thromb Res 1990; 57:645-50. [PMID: 2326778 DOI: 10.1016/0049-3848(90)90082-n] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- M D Smirnov
- National Cardiology Research Centre, Moscow, USSR
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