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Nilius H, Hamzeh-Cognasse H, Hastings J, Studt JD, Tsakiris DA, Greinacher A, Mendez A, Schmidt AE, Wuillemin WA, Gerber B, Vishnu P, Graf L, Kremer Hovinga JA, Bakchoul T, Cognasse F, Nagler M. Proteomic profiling for biomarker discovery in heparin-induced thrombocytopenia. Blood Adv 2024:bloodadvances.2024012782. [PMID: 38588487 DOI: 10.1182/bloodadvances.2024012782] [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] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/19/2024] [Accepted: 03/19/2024] [Indexed: 04/10/2024] Open
Abstract
New analytical techniques can assess hundreds of proteins simultaneously with high sensitivity, facilitating the observation of their complex interplay and role in disease mechanisms. We hypothesized that proteomic profiling targeting proteins involved in thrombus formation, inflammation, and the immune response would identify potentially new biomarkers for heparin-induced thrombocytopenia (HIT). Four existing panels of the Olink proximity extension assay covering 356 proteins involved in thrombus formation, inflammation, and immune response were applied to randomly selected patients with suspected HIT (confirmed HIT, n=32; HIT ruled-out, n=38; positive heparin/PF4 [H/PF4] antibodies, n=28). The relative difference in protein concentration was analyzed using a linear regression model adjusted for sex and age. To confirm the test results, soluble P-selectin was determined using ELISA in above mentioned patients and an additional second dataset (n=49). HIT was defined as a positive heparin-induced platelet aggregation test (HIPA; washed platelet assay). Among 98 patients of the primary dataset, the median 4Ts score was 5 in patients with HIT, 4 in patients with positive heparin/PF4 antibodies, and 3 in patients without HIT. The median OD of a polyspecific heparin/PF4 ELISA was 3.0, 0.9, and 0.3, respectively. Soluble P-selectin remained statistically significant after multiple test adjustments. The area under the receiver-operating-characteristics-curve was 0.81 for Olink and 0.8 for ELISA. Future studies shall assess the diagnostic and prognostic value of soluble P-selectin in the management of HIT.
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Affiliation(s)
- Henning Nilius
- Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | | | | | | | | | | | | | | | - Walter A Wuillemin
- Division of Hematology and Laboratory of Hematology, Luzern 16, Switzerland
| | - Bernhard Gerber
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Prakash Vishnu
- St. Michael Medical Center, Virginia Mason Franciscan Health, United States
| | - Lukas Graf
- Centre for Laboratory Medicine St. Gallen, St. Gallen, Switzerland
| | | | - Tamam Bakchoul
- Institute for Clinical and Experimental Transfusion Medicine, Medical Faculty of Tuebingen, University Hospital of Tuebingen, Tübingen, Germany
| | | | - Michael Nagler
- Inselspital University Hospital, Center for Laboratory Medicine, Switzerland
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Larsen EL, Nilius H, Studt JD, Tsakiris DA, Greinacher A, Mendez A, Schmidt A, Wuillemin WA, Gerber B, Vishnu P, Graf L, Kremer Hovinga JA, Goetze JP, Bakchoul T, Nagler M. Accuracy of Diagnosing Heparin-Induced Thrombocytopenia. JAMA Netw Open 2024; 7:e243786. [PMID: 38530310 DOI: 10.1001/jamanetworkopen.2024.3786] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/27/2024] Open
Abstract
Importance Heparin-induced thrombocytopenia (HIT) is a life-threatening condition that requires urgent diagnostic clarification. However, knowledge of the diagnostic utility of the recommended diagnostic tests is limited in clinical practice. Objective To evaluate the current diagnostic practice for managing the suspicion of HIT. Design, Setting, and Participants This prospective diagnostic study was conducted from January 2018 to May 2021 among consecutive patients with suspected HIT from 11 study centers in Switzerland, Germany, and the United States. Detailed clinical data and laboratory information were recorded. Platelet factor 4/heparin antibodies were quantified using an automated chemiluminescent immunoassay (CLIA). A washed-platelet heparin-induced platelet activation (HIPA) test was used as a reference standard to define HIT. Exposures Suspicion of HIT. Main Outcomes and Measures The primary outcome was the diagnostic accuracy of the 4Ts score, the CLIA, and the recommended algorithm serially combining both tests. Results Of 1448 patients included between 2018 and 2021, 1318 were available for the current analysis (median [IQR] age, 67 [57-75] years; 849 [64.6%] male). HIPA was positive in 111 patients (prevalence, 8.4%). The most frequent setting was intensive care unit (487 [37.0%]) or cardiovascular surgery (434 [33.0%]). The 4Ts score was low risk in 625 patients (46.8%). By 2 × 2 table, the numbers of patients with false-negative results were 10 (9.0%; 4Ts score), 5 (4.5%; CLIA), and 15 (13.5%; recommended diagnostic algorithm). The numbers of patients with false-positive results were 592 (49.0%; 4Ts score), 73 (6.0%; CLIA), and 50 (4.1%; recommended diagnostic algorithm), respectively. Conclusions and Relevance In this diagnostic study of patients suspected of having HIT, when the recommended diagnostic algorithm was used in clinical practice, antibody testing was required in half the patients. A substantial number of patients were, however, still misclassified, which could lead to delayed diagnosis or overtreatment. Development of improved diagnostic algorithms for HIT diagnosis should be pursued.
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Affiliation(s)
- Emil List Larsen
- Department of Clinical Biochemistry, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Henning Nilius
- Department of Clinical Chemistry, Inselspital, Bern University Hospital, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Jan-Dirk Studt
- Division of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | | | - Andreas Greinacher
- Department of Transfusion Medicine, Institute of Transfusion Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Adriana Mendez
- Department of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Adrian Schmidt
- Institute of Laboratory Medicine and Clinic of Medical Oncology and Hematology, Municipal Hospital Zurich Triemli, Zurich, Switzerland
| | - Walter A Wuillemin
- Division of Hematology and Central Hematology Laboratory, Cantonal Hospital of Lucerne and University of Bern, Switzerland
| | - Bernhard Gerber
- Clinic of Hematology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Prakash Vishnu
- Fred Hutchinson Cancer Center, University of Washington, Seattle
| | - Lukas Graf
- Cantonal Hospital of St Gallen, St Gallen, Switzerland
| | - Johanna A Kremer Hovinga
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Jens P Goetze
- Department of Clinical Biochemistry, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Biomedical Sciences, Faculty of Health, Copenhagen University, Copenhagen, Denmark
| | - Tamam Bakchoul
- Centre for Clinical Transfusion Medicine, University Hospital of Tübingen, Tübingen, Germany
| | - Michael Nagler
- Department of Clinical Chemistry, Inselspital, Bern University Hospital, Bern, Switzerland
- University of Bern, Bern, Switzerland
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Polymeris AA, Karwacki GM, Siepen BM, Schaedelin S, Tsakiris DA, Stippich C, Guzman R, Nickel CH, Sprigg N, Kägi G, Vehoff J, Barinka F, Thilemann S, Maurer M, Wagner B, Traenka C, Gensicke H, De Marchis GM, Bonati LH, Fischer U, Z’Graggen WJ, Nedeltchev K, Wegener S, Baumgartner P, Engelter ST, Seiffge DJ, Peters N, Lyrer PA. Tranexamic Acid for Intracerebral Hemorrhage in Patients on Non-Vitamin K Antagonist Oral Anticoagulants (TICH-NOAC): A Multicenter, Randomized, Placebo-Controlled, Phase 2 Trial. Stroke 2023; 54:2223-2234. [PMID: 37466000 PMCID: PMC10453353 DOI: 10.1161/strokeaha.123.042866] [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: 02/12/2023] [Revised: 06/12/2023] [Accepted: 06/20/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Evidence-based hemostatic treatment for intracerebral hemorrhage (ICH) associated with non-vitamin K antagonist oral anticoagulants (NOACs) is lacking. Tranexamic acid (TXA) is an antifibrinolytic drug potentially limiting hematoma expansion. We aimed to assess the efficacy and safety of TXA in NOAC-ICH. METHODS We performed a double-blind, randomized, placebo-controlled trial at 6 Swiss stroke centers. Patients with NOAC-ICH within 12 hours of symptom onset and 48 hours of last NOAC intake were randomized (1:1) to receive either intravenous TXA (1 g over 10 minutes followed by 1 g over 8 hours) or matching placebo in addition to standard medical care via a centralized Web-based procedure with minimization on key prognostic factors. All participants and investigators were masked to treatment allocation. Primary outcome was hematoma expansion, defined as ≥33% relative or ≥6 mL absolute volume increase at 24 hours and analyzed using logistic regression adjusted for baseline hematoma volume on an intention-to-treat basis. RESULTS Between December 12, 2016, and September 30, 2021, we randomized 63 patients (median age, 82 years [interquartile range, 76-86]; 40% women; median hematoma volume, 11.5 [4.8-27.4] mL) of the 109 intended sample size before premature trial discontinuation due to exhausted funding. The primary outcome did not differ between TXA (n=32) and placebo (n=31) arms (12 [38%] versus 14 [45%]; adjusted odds ratio, 0.63 [95% CI, 0.22-1.82]; P=0.40). There was a signal for interaction with onset-to-treatment time (Pinteraction=0.024), favoring TXA when administered within 6 hours of symptom onset. Between the TXA and placebo arms, the proportion of participants who died (15 [47%] versus 13 [42%]; adjusted odds ratio, 1.07 [0.37-3.04]; P=0.91) or had major thromboembolic complications within 90 days (4 [13%] versus 2 [6%]; odds ratio, 1.86 [0.37-9.50]; P=0.45) did not differ. All thromboembolic events occurred at least 2 weeks after study treatment, exclusively in participants not restarted on oral anticoagulation. CONCLUSIONS In a smaller-than-intended NOAC-ICH patient sample, we found no evidence that TXA prevents hematoma expansion, but there were no major safety concerns. Larger trials on hemostatic treatments targeting an early treatment window are needed for NOAC-ICH. REGISTRATION URL: https://clinicaltrials.gov; Unique identifier: NCT02866838.
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Affiliation(s)
- Alexandros A. Polymeris
- Department of Neurology and Stroke Center (A.A.P., S.T., M.M., B.W., C.T., H.G., G.M.D.M., L.H.B., U.F., S.T.E., D.J.S., N.P., P.A.L.), University Hospital Basel and University of Basel, Switzerland
| | - Grzegorz M. Karwacki
- Department of Radiology and Nuclear Medicine, Luzerner Kantonsspital, Switzerland (G.M.K.)
| | - Bernhard M. Siepen
- Department of Neurology, Inselspital, University Hospital and University of Bern, Switzerland (B.M.S., G.K., U.F., W.J.Z., D.J.S.)
- Graduate School of Health Sciences, University of Bern, Switzerland (B.M.S.)
| | - Sabine Schaedelin
- Department of Clinical Research (S.S.), University Hospital Basel and University of Basel, Switzerland
| | | | - Christoph Stippich
- Department of Neuroradiology and Radiology, Kliniken Schmieder, Allensbach, Germany (C.S.)
| | - Raphael Guzman
- Department of Neurosurgery (R.G.), University Hospital Basel and University of Basel, Switzerland
| | - Christian H. Nickel
- Department of Emergency Medicine (C.H.N.), University Hospital Basel and University of Basel, Switzerland
| | - Nikola Sprigg
- Nottingham Stroke Trials Unit, University of Nottingham, United Kingdom (N.S.)
- Stroke Center, Klinik Hirslanden Zurich, Switzerland (F.B., N.P.)
| | - Georg Kägi
- Department of Neurology, Inselspital, University Hospital and University of Bern, Switzerland (B.M.S., G.K., U.F., W.J.Z., D.J.S.)
- Department of Neurology and Stroke Center, Cantonal Hospital St. Gallen, Switzerland (G.K., J.V.)
| | - Jochen Vehoff
- Department of Neurology and Stroke Center, Cantonal Hospital St. Gallen, Switzerland (G.K., J.V.)
| | - Filip Barinka
- Stroke Center, Klinik Hirslanden Zurich, Switzerland (F.B., N.P.)
| | - Sebastian Thilemann
- Department of Neurology and Stroke Center (A.A.P., S.T., M.M., B.W., C.T., H.G., G.M.D.M., L.H.B., U.F., S.T.E., D.J.S., N.P., P.A.L.), University Hospital Basel and University of Basel, Switzerland
| | - Marina Maurer
- Department of Neurology and Stroke Center (A.A.P., S.T., M.M., B.W., C.T., H.G., G.M.D.M., L.H.B., U.F., S.T.E., D.J.S., N.P., P.A.L.), University Hospital Basel and University of Basel, Switzerland
| | - Benjamin Wagner
- Department of Neurology and Stroke Center (A.A.P., S.T., M.M., B.W., C.T., H.G., G.M.D.M., L.H.B., U.F., S.T.E., D.J.S., N.P., P.A.L.), University Hospital Basel and University of Basel, Switzerland
| | - Christopher Traenka
- Department of Neurology and Stroke Center (A.A.P., S.T., M.M., B.W., C.T., H.G., G.M.D.M., L.H.B., U.F., S.T.E., D.J.S., N.P., P.A.L.), University Hospital Basel and University of Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine Felix Platter, University of Basel, Switzerland (C.T., H.G., S.T.E., N.P.)
| | - Henrik Gensicke
- Department of Neurology and Stroke Center (A.A.P., S.T., M.M., B.W., C.T., H.G., G.M.D.M., L.H.B., U.F., S.T.E., D.J.S., N.P., P.A.L.), University Hospital Basel and University of Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine Felix Platter, University of Basel, Switzerland (C.T., H.G., S.T.E., N.P.)
| | - Gian Marco De Marchis
- Department of Neurology and Stroke Center (A.A.P., S.T., M.M., B.W., C.T., H.G., G.M.D.M., L.H.B., U.F., S.T.E., D.J.S., N.P., P.A.L.), University Hospital Basel and University of Basel, Switzerland
| | - Leo H. Bonati
- Department of Neurology and Stroke Center (A.A.P., S.T., M.M., B.W., C.T., H.G., G.M.D.M., L.H.B., U.F., S.T.E., D.J.S., N.P., P.A.L.), University Hospital Basel and University of Basel, Switzerland
- Reha Rheinfelden, Switzerland (L.H.B.)
| | - Urs Fischer
- Department of Neurology and Stroke Center (A.A.P., S.T., M.M., B.W., C.T., H.G., G.M.D.M., L.H.B., U.F., S.T.E., D.J.S., N.P., P.A.L.), University Hospital Basel and University of Basel, Switzerland
- Department of Neurology, Inselspital, University Hospital and University of Bern, Switzerland (B.M.S., G.K., U.F., W.J.Z., D.J.S.)
| | - Werner J. Z’Graggen
- Department of Neurology, Inselspital, University Hospital and University of Bern, Switzerland (B.M.S., G.K., U.F., W.J.Z., D.J.S.)
| | - Krassen Nedeltchev
- Department of Neurology and Stroke Center, Cantonal Hospital Aarau, Switzerland (K.N.)
| | - Susanne Wegener
- Department of Neurology, University Hospital and University of Zurich, Switzerland (S.W., P.B.)
| | - Philipp Baumgartner
- Department of Neurology, University Hospital and University of Zurich, Switzerland (S.W., P.B.)
| | - Stefan T. Engelter
- Department of Neurology and Stroke Center (A.A.P., S.T., M.M., B.W., C.T., H.G., G.M.D.M., L.H.B., U.F., S.T.E., D.J.S., N.P., P.A.L.), University Hospital Basel and University of Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine Felix Platter, University of Basel, Switzerland (C.T., H.G., S.T.E., N.P.)
| | - David J. Seiffge
- Department of Neurology and Stroke Center (A.A.P., S.T., M.M., B.W., C.T., H.G., G.M.D.M., L.H.B., U.F., S.T.E., D.J.S., N.P., P.A.L.), University Hospital Basel and University of Basel, Switzerland
- Department of Neurology, Inselspital, University Hospital and University of Bern, Switzerland (B.M.S., G.K., U.F., W.J.Z., D.J.S.)
| | - Nils Peters
- Department of Neurology and Stroke Center (A.A.P., S.T., M.M., B.W., C.T., H.G., G.M.D.M., L.H.B., U.F., S.T.E., D.J.S., N.P., P.A.L.), University Hospital Basel and University of Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine Felix Platter, University of Basel, Switzerland (C.T., H.G., S.T.E., N.P.)
| | - Philippe A. Lyrer
- Department of Neurology and Stroke Center (A.A.P., S.T., M.M., B.W., C.T., H.G., G.M.D.M., L.H.B., U.F., S.T.E., D.J.S., N.P., P.A.L.), University Hospital Basel and University of Basel, Switzerland
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Hammerer-Lercher A, Nilius H, Studt JD, Tsakiris DA, Greinacher A, Mendez A, Schmidt A, Wuillemin WA, Gerber B, Kremer Hovinga JA, Vishnu P, Graf L, Bakchoul T, Nagler M. Limited concordance of heparin/platelet factor 4 antibody assays for the diagnosis of heparin-induced thrombocytopenia: an analysis of the TORADI-HIT study. J Thromb Haemost 2023; 21:2559-2568. [PMID: 37247669 DOI: 10.1016/j.jtha.2023.05.016] [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: 01/28/2023] [Revised: 04/26/2023] [Accepted: 05/17/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND Anecdotal reports suggest that the correlation between heparin/platelet factor 4 (PF4) antibody assays for the diagnosis of heparin-induced thrombocytopenia (HIT) is limited. OBJECTIVES To investigate the correlation between widely used assays and examine possible factors contributing to variability. METHODS This is a large, prospective cohort study with 10 participating tertiary care hospitals including 1393 patients with suspected HIT in clinical practice. HIT was defined by a positive heparin-induced platelet activation (HIPA) assay (washed platelet reference standard test). Three different immunoassays were used to measure heparin/PF4 antibodies: chemiluminescent immunoassay, enzyme-linked immunosorbent assay, and particle gel immunoassay. Various factors that could influence the assays were examined: sex (male or female), age (<65 years or ≥65 years), unfractionated heparin exposure, presence of thrombosis, cardiovascular surgery, and intensive care unit. Spearman's correlation coefficients were calculated. Z-scores and diagnostic odds ratios were determined in the aforementioned subgroups of patients. RESULTS Among 1393 patients, 119 were classified as HIT-positive (prevalence, 8.5%). The median 4Ts score was 5 (IQR, 4-6) in patients with HIT compared with 3 (IQR, 2-4) in patients without HIT. Correlations (rs) between immunoassays were weak (0.53-0.65). Inconsistencies between immunoassays could not be explained by further analyses of z-scored test results and diagnostic odds ratios in subgroups of patients. CONCLUSION The correlation between widely used heparin/PF4 antibody assays was weak, and key factors could not explain this variability. Standardization of immunoassays is requested to improve comparability.
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Affiliation(s)
- Angelika Hammerer-Lercher
- Department of Clinical Chemistry, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Institute of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Henning Nilius
- Department of Clinical Chemistry, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Jan-Dirk Studt
- Division of Medical Oncology and Hematology, University and University Hospital Zurich, Zurich, Switzerland
| | | | - Andreas Greinacher
- Institut für Transfusionsmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Adriana Mendez
- Institute of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Adrian Schmidt
- Clinic of Medical Oncology and Hematology, Municipal Hospital Zurich Triemli, Zurich, Switzerland
| | - Walter A Wuillemin
- Division of Hematology and Central Hematology Laboratory, Cantonal Hospital of Lucerne, University of Bern, Bern, Switzerland
| | - Bernhard Gerber
- Clinic of Hematology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Johanna A Kremer Hovinga
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Prakash Vishnu
- Division of Hematology, CHI Franciscan Medical Group, Seattle, USA
| | - Lukas Graf
- Cantonal Hospital of St. Gallen, St. Gallen, Switzerland
| | - Tamam Bakchoul
- Centre for Clinical Transfusion Medicine, University Hospital of Tübingen, Tübingen, Germany
| | - Michael Nagler
- Department of Clinical Chemistry, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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5
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Picker J, Schwenke J, Neuenschwander L, Nisslé S, Maurer C, Egli R, Périard D, Staub D, Tsakiris DA, Aujesky D, Tarr P. [Folie à deux - Thrombosis and Infections]. Praxis (Bern 1994) 2023; 112:419-425. [PMID: 37282520 DOI: 10.1024/1661-8157/a004004] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Folie à deux - Thrombosis and Infections Abstract: Although infections are not represented in the Revised Geneva or Wells score, they increase the risk of venous thromboembolism (VTE) similarly to the known risk factors (immobilization, major surgery, active neoplasia). This increased risk of VTE can persist for six to twelve months after infection; moreover, the more severe the infection, the higher the risk of VTE may be. In addition to VTEs, infections can promote arterial thromboembolism. For example, 20% of pneumonias are accompanied by an acute cardiovascular event (acute coronary syndrome, heart failure, atrial fibrillation). In the case of infection-associated atrial fibrillation, the CHA2DS2 VASc score remains an appropriate guide for the indication of anticoagulation.
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Affiliation(s)
- Julia Picker
- Medizinische Universitätsklinik, Infektiologie und Spitalhygiene, Kantonsspital Baselland, Bruderholz, Universität Basel, Basel, Schweiz
- Diese Autor_innen haben zu gleichen Teilen zum Manuskript beigetragen
| | - Johannes Schwenke
- Medizinische Universitätsklinik, Infektiologie und Spitalhygiene, Kantonsspital Baselland, Bruderholz, Universität Basel, Basel, Schweiz
- Diese Autor_innen haben zu gleichen Teilen zum Manuskript beigetragen
| | - Lorenz Neuenschwander
- Medizinische Universitätsklinik, Infektiologie und Spitalhygiene, Kantonsspital Baselland, Bruderholz, Universität Basel, Basel, Schweiz
| | - Sonja Nisslé
- Medizinische Universitätsklinik, Notfallzentrum, Kantonsspital Baselland, Bruderholz, Universität Basel, Basel, Schweiz
| | - Christian Maurer
- Medizinische Universitätsklinik, Kardiologie, Kantonsspital Baselland, Bruderholz, Universität Basel, Basel, Schweiz
| | - Rolf Egli
- FMH Innere Medizin, Allschwil, Schweiz
| | - Daniel Périard
- Klinik für allgemeine Innere Medizin und Angiologie, Kantonsspital Fribourg, Fribourg, Schweiz
| | - Daniel Staub
- Medizinische Universitätsklinik, Klinik für Angiologie, Universitätsspital Basel, Universität Basel, Basel, Schweiz
| | | | - Drahomir Aujesky
- Universitätsklinik für Allgemeine Innere Medizin, Inselspital, Universitätsspital Bern, Universität Bern, Bern, Schweiz
| | - Philip Tarr
- Medizinische Universitätsklinik, Infektiologie und Spitalhygiene, Kantonsspital Baselland, Bruderholz, Universität Basel, Basel, Schweiz
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6
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Herrmann G, Blum A, Bolliger D, Achermann R, Estermann A, Gebhard CE, Henn A, Huber J, Singh J, Todorov A, Zehnder T, Zellweger N, Buser A, Tsakiris DA, Hollinger A, Siegemund M. Enhancement of the haemostatic effect of platelets in the presence of high normal concentrations of von Willebrand factor for critically ill patients needing platelet transfusion-a protocol for the will-plate randomised controlled trial. Trials 2023; 24:47. [PMID: 36670471 PMCID: PMC9854010 DOI: 10.1186/s13063-022-06876-8] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/22/2022] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION von Willebrand Factor (vWF) is a key protein mediating platelet adhesion on the surface of damaged endothelia. To the best of our knowledge, no trial exists that investigated the effect of platelet transfusion in combination with the administration of balanced vWF in severe blood loss, despite being widely used in clinical practice. The Basel Will-Plate study will investigate the impact of the timely administration of balanced vWF (1:1 vWF and FVIII) in addition to platelet transfusion on the need for blood and coagulation factor transfusion in patients admitted to the intensive care unit (ICU) who suffer from severe bleeding. The study hypothesis is based on the assumption that adding balanced vWF to platelets will reduce the overall need for transfusion of blood products compared to the transfusion of platelets alone. METHODS AND ANALYSIS The Will-Plate study is an investigator-initiated, single-centre, double-blinded randomised controlled clinical trial in 120 critically ill patients needing platelet transfusion. The primary outcome measure will be the number of fresh frozen plasma (FFP) and red blood cell (RBC) transfusions according to groups. Secondary outcome measures include the number of platelet concentrates transfused within the first 48 h after treatment of study medication, quantity of blood loss in the first 48 h after treatment with the study medication, length of stay in ICU and hospital, number of revision surgeries for haemorrhage control, ICU mortality, hospital mortality, 30-day mortality and 1-year mortality. Patients will be followed after 30 days and 1 year for activities of daily living and mortality assessment. The sample size was calculated to detect a 50% reduction in the number of blood products subsequently transfused within 2 days in patients with Wilate® compared to placebo. ETHICS AND DISSEMINATION This study has been approved by the Ethics Committee of Northwestern and Central Switzerland and will be conducted in compliance with the protocol, the current version of the Declaration of Helsinki, the ICH-GCP or ISO EN 14155 (as far as applicable) and all national legal and regulatory requirements. The study results will be presented at international conferences and published in a peer-reviewed journal. TRIALS REGISTRATION ClinicalTrials.gov NCT04555785. PROTOCOL VERSION Clinical Study Protocol Version 2, 01.11.2020. Registered on Sept. 21, 2020.
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Affiliation(s)
- Goetz Herrmann
- grid.410567.1Department for Anesthesia, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Andrea Blum
- grid.410567.1Intensive Care Unit, University Hospital Basel, Spitalstrasse 21, CH-4031 Basel, Switzerland
| | - Daniel Bolliger
- grid.410567.1Department for Anesthesia, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland ,grid.6612.30000 0004 1937 0642Medical Faculty of the University of Basel, Klingelbergstrasse 61, 4056 Basel, Switzerland
| | - Rita Achermann
- grid.410567.1Intensive Care Unit, University Hospital Basel, Spitalstrasse 21, CH-4031 Basel, Switzerland
| | - Anna Estermann
- grid.410567.1Intensive Care Unit, University Hospital Basel, Spitalstrasse 21, CH-4031 Basel, Switzerland
| | - Caroline Eva Gebhard
- grid.410567.1Intensive Care Unit, University Hospital Basel, Spitalstrasse 21, CH-4031 Basel, Switzerland
| | - Anne Henn
- grid.410567.1Hospital Pharmacy, University Hospital Basel, Spitalstrasse 26, 4031 Basel, Switzerland
| | - Jan Huber
- grid.410567.1Intensive Care Unit, University Hospital Basel, Spitalstrasse 21, CH-4031 Basel, Switzerland
| | - Jasprit Singh
- grid.410567.1Intensive Care Unit, University Hospital Basel, Spitalstrasse 21, CH-4031 Basel, Switzerland
| | - Atanas Todorov
- grid.412004.30000 0004 0478 9977Department of Nuclear Medicine, Cardiovascular Gender Medicine, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Tatjana Zehnder
- grid.410567.1Intensive Care Unit, University Hospital Basel, Spitalstrasse 21, CH-4031 Basel, Switzerland
| | - Núria Zellweger
- grid.410567.1Intensive Care Unit, University Hospital Basel, Spitalstrasse 21, CH-4031 Basel, Switzerland
| | - Andreas Buser
- grid.6612.30000 0004 1937 0642Medical Faculty of the University of Basel, Klingelbergstrasse 61, 4056 Basel, Switzerland ,grid.410567.1Transfusion Medicine and Regional Blood Transfusion Service Swiss Red Cross, Department of Hematology, University Hospital of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Dimitrios A. Tsakiris
- grid.6612.30000 0004 1937 0642Medical Faculty of the University of Basel, Klingelbergstrasse 61, 4056 Basel, Switzerland ,grid.410567.1Department for Diagnostic Haematology, University Hospital of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Alexa Hollinger
- grid.410567.1Intensive Care Unit, University Hospital Basel, Spitalstrasse 21, CH-4031 Basel, Switzerland ,grid.6612.30000 0004 1937 0642Medical Faculty of the University of Basel, Klingelbergstrasse 61, 4056 Basel, Switzerland
| | - Martin Siegemund
- grid.410567.1Intensive Care Unit, University Hospital Basel, Spitalstrasse 21, CH-4031 Basel, Switzerland ,grid.6612.30000 0004 1937 0642Medical Faculty of the University of Basel, Klingelbergstrasse 61, 4056 Basel, Switzerland
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7
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Nilius H, Cuker A, Haug S, Nakas C, Studt JD, Tsakiris DA, Greinacher A, Mendez A, Schmidt A, Wuillemin WA, Gerber B, Kremer Hovinga JA, Vishnu P, Graf L, Kashev A, Sznitman R, Bakchoul T, Nagler M. A machine-learning model for reducing misdiagnosis in heparin-induced thrombocytopenia: A prospective, multicenter, observational study. EClinicalMedicine 2023; 55:101745. [PMID: 36457646 PMCID: PMC9706528 DOI: 10.1016/j.eclinm.2022.101745] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 10/26/2022] [Accepted: 10/27/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Diagnosing heparin-induced thrombocytopenia (HIT) at the bedside remains challenging, exposing a significant number of patients at risk of delayed diagnosis or overtreatment. We hypothesized that machine-learning algorithms could be utilized to develop a more accurate and user-friendly diagnostic tool that integrates diverse clinical and laboratory information and accounts for complex interactions. METHODS We conducted a prospective cohort study including 1393 patients with suspected HIT between 2018 and 2021 from 10 study centers. Detailed clinical information and laboratory data were collected, and various immunoassays were conducted. The washed platelet heparin-induced platelet activation assay (HIPA) served as the reference standard. FINDINGS HIPA diagnosed HIT in 119 patients (prevalence 8.5%). The feature selection process in the training dataset (75% of patients) yielded the following predictor variables: (1) immunoassay test result, (2) platelet nadir, (3) unfractionated heparin use, (4) CRP, (5) timing of thrombocytopenia, and (6) other causes of thrombocytopenia. The best performing models were a support vector machine in case of the chemiluminescent immunoassay (CLIA) and the ELISA, as well as a gradient boosting machine in particle-gel immunoassay (PaGIA). In the validation dataset (25% of patients), the AUROC of all models was 0.99 (95% CI: 0.97, 1.00). Compared to the currently recommended diagnostic algorithm (4Ts score, immunoassay), the numbers of false-negative patients were reduced from 12 to 6 (-50.0%; ELISA), 9 to 3 (-66.7%, PaGIA) and 14 to 5 (-64.3%; CLIA). The numbers of false-positive individuals were reduced from 87 to 61 (-29.8%; ELISA), 200 to 63 (-68.5%; PaGIA) and increased from 50 to 63 (+29.0%) for the CLIA. INTERPRETATION Our user-friendly machine-learning algorithm for the diagnosis of HIT (https://toradi-hit.org) was substantially more accurate than the currently recommended diagnostic algorithm. It has the potential to reduce delayed diagnosis and overtreatment in clinical practice. Future studies shall validate this model in wider settings. FUNDING Swiss National Science Foundation (SNSF), and International Society on Thrombosis and Haemostasis (ISTH).
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Affiliation(s)
- Henning Nilius
- Department of Clinical Chemistry, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Adam Cuker
- Department of Medicine and Department of Pathology and Laboratory Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Sigve Haug
- Mathematical Institute, University of Bern, Bern, Switzerland
- Albert Einstein Center for Fundamental Physics and Laboratory for High Energy Physics, University of Bern, Bern, Switzerland
| | - Christos Nakas
- Department of Clinical Chemistry, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Laboratory of Biometry, School of Agriculture, University of Thessaly, Volos, Greece
| | - Jan-Dirk Studt
- Division of Medical Oncology and Hematology, University and University Hospital Zurich, Zurich, Switzerland
| | | | - Andreas Greinacher
- Institut für Immunologie und Transfusionsmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Adriana Mendez
- Department of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Adrian Schmidt
- Clinic of Medical Oncology and Hematology, Municipal Hospital Zurich Triemli, Zurich, Switzerland
| | - Walter A. Wuillemin
- Division of Hematology and Central Hematology Laboratory, Cantonal Hospital of Lucerne and University of Bern, Switzerland
| | - Bernhard Gerber
- Clinic of Hematology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Johanna A. Kremer Hovinga
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Prakash Vishnu
- Division of Hematology, CHI Franciscan Medical Group, Seattle, United States
| | - Lukas Graf
- Cantonal Hospital of St Gallen, Switzerland
| | | | - Raphael Sznitman
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Tamam Bakchoul
- Centre for Clinical Transfusion Medicine, University Hospital of Tübingen, Tübingen, Germany
| | - Michael Nagler
- Department of Clinical Chemistry, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Corresponding author. Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland.
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8
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Hirsiger JR, Martinez M, Tsakiris DA, Cittone MG, Graf L, Oldenburg J, Pezeshkpoor B, Recher M, Mueller J, Gerber B, Berger CT. Investigating potential mechanisms underlying FVIII inhibition in acquired hemophilia A associated with mRNA COVID-19 vaccines. J Thromb Haemost 2022; 20:1015-1018. [PMID: 35108443 PMCID: PMC9303467 DOI: 10.1111/jth.15665] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/22/2022] [Accepted: 01/31/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Julia R Hirsiger
- Translational Immunology, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Maria Martinez
- Division of Hematology, University Hospital Basel, Basel, Switzerland
| | | | - Micol G Cittone
- Clinic of Hematology, Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland
| | - Lukas Graf
- Hemophilia and Hemostasis Center, Centre for Laboratory Medicine, St. Gallen, Switzerland
| | - Johannes Oldenburg
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Medical Faculty, University of Bonn, Bonn, Germany
| | - Behnaz Pezeshkpoor
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Medical Faculty, University of Bonn, Bonn, Germany
| | - Mike Recher
- Immunodeficiency, Department of Biomedicine, University of Basel, Basel, Switzerland
- University Center for Immunology, University Hospital Basel, Basel, Switzerland
| | - Jens Mueller
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Medical Faculty, University of Bonn, Bonn, Germany
| | - Bernhard Gerber
- Clinic of Hematology, Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Christoph T Berger
- Translational Immunology, Department of Biomedicine, University of Basel, Basel, Switzerland
- University Center for Immunology, University Hospital Basel, Basel, Switzerland
- Immunization Clinic, Medical Outpatient Clinic, University Hospital Basel, Basel, Switzerland
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9
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Perifanis V, Neokleous N, Tsakiris DA. Update on laboratory testing and hemostasis assessment in patients receiving direct oral anticoagulants (DOACs). Thrombosis Update 2021. [DOI: 10.1016/j.tru.2021.100084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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10
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Farina-Eckhardt P, Granado C, Mueller-Borer D, Schötzau A, Tsakiris DA, Hösli I, Manegold-Brauer G. [Harvest of Stem Cells from Umbilical Cord Blood: Relevance of Perinatal Factors for the Quality of Umbilical Cord Transplant Units]. Z Geburtshilfe Neonatol 2021; 226:129-135. [PMID: 34571542 PMCID: PMC9270104 DOI: 10.1055/a-1642-1234] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Einleitung
Nabelschnurblut (NSB) enthält hämatopoetische
Stammzellen mit therapeutischem Potenzial und einzigartigen zellulären
Eigenschaften. Aufgrund der begrenzten Anzahl an Stammzellen im NSB
(Surrogatmarker total nucleated cells, TNC) eignet sich nur jede fünfte
Spende für eine Transplantation. Ziel dieser Studie war es, zu
untersuchen, ob prädiktive Faktoren für eine TNC-Zahl
über der 99. Perzentile existieren.
Material und Methodik
Retrospektive Datenanalyse der 100
größten NSB-Spenden (Top100-Kohorte) aus 2299 registrierten
Einheiten. Unterschiede zwischen maternalen, fetalen und geburtshilflichen
Faktoren wurden analysiert und mit einer standardisierten Kohorte von 731
NSB-Spenden verglichen.
Ergebnisse
Das mütterliche Alter und der BMI in der Top100-Kohorte
waren höher als in der Vergleichskohorte (32 vs. 31 Jahre,
p=0,007; 30 kg/m2 vs. 29 kg/m2,
p=0,024). Es gab mehr Erstgebärende (76,0 vs. 62,8%,
p=0,013) und Gestationsdiabetikerinnen (5,00 vs. 1,65%,
p=0,044). Die Schwangerschaftswoche, das Geburtsgewicht, der Anteil
vaginal-operativer Geburten und sekundärer Sectiones war in der
Top100-Kohorte höher (40+4 vs. 40+1 SSW,
p=0,002), (3700 vs. 3450 g, p<0,001), (53,0 vs.
22,7%, p<0,001) (10 vs. 6,2%, p=0,014).
Fazit
Für eine erfolgreiche Transplantation ist die Höhe
der TNC-Zahl entscheidend. Vaginal-operative Entbindungen, sekundäre
Sectiones und ein Geburtsgewicht über 3700 g sind
günstige Faktoren. Gerade bei Geburten mit einem pathologischen Verlauf
sollte nach sicherer Versorgung von Mutter und Kind nicht auf eine Entnahme
verzichtet werden.
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Affiliation(s)
- Patricia Farina-Eckhardt
- Klinik für Geburtshilfe und Schwangerschaftsmedizin, Frauenklinik, Universitätsspital Basel, Basel, Schweiz
| | - Cristina Granado
- Klinik für Geburtshilfe und Schwangerschaftsmedizin, Frauenklinik, Universitätsspital Basel, Basel, Schweiz
| | - Doris Mueller-Borer
- Klinik für Geburtshilfe und Schwangerschaftsmedizin, Frauenklinik, Universitätsspital Basel, Basel, Schweiz
| | | | | | - Irene Hösli
- Klinik für Geburtshilfe und Schwangerschaftsmedizin, Frauenklinik, Universitätsspital Basel, Basel, Schweiz
| | - Gwendolin Manegold-Brauer
- Klinik für Geburtshilfe und Schwangerschaftsmedizin, Frauenklinik, Universitätsspital Basel, Basel, Schweiz
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11
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Cittone MG, Battegay R, Condoluci A, Terzi di Bergamo L, Fernandes E, Galfetti E, Noseda R, Leuppi-Taegtmeyer A, Drexler B, Ceschi A, Tsakiris DA, Berger CT, Favre G, Martin T, Korte W, Graf L, Martinez M, Gerber B. The statistical risk of diagnosing coincidental acquired hemophilia A following anti-SARS-CoV-2 vaccination. J Thromb Haemost 2021; 19:2360-2362. [PMID: 34101973 PMCID: PMC9771119 DOI: 10.1111/jth.15421] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 05/29/2021] [Indexed: 12/25/2022]
Affiliation(s)
- Micol G Cittone
- Clinic of Hematology, Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland
- Institute of Oncology Research (IOR), Bellinzona, Switzerland
| | - Raphael Battegay
- Division of Hematology, University Hospital Basel, Basel, Switzerland
| | - Adalgisa Condoluci
- Clinic of Hematology, Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland
- Institute of Oncology Research (IOR), Bellinzona, Switzerland
| | | | - Eliana Fernandes
- Clinic of Hematology, Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland
| | - Elena Galfetti
- Clinic of Hematology, Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland
| | - Roberta Noseda
- Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, EOC, Lugano, Switzerland
| | - Anne Leuppi-Taegtmeyer
- Regional Pharmacovigilance Centre, Department of Clinical Pharmacology and Toxicology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Beatrice Drexler
- Division of Hematology, University Hospital Basel, Basel, Switzerland
| | - Alessandro Ceschi
- Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | | | - Christoph T Berger
- Translational Immunology, Department of Biomedicine, University of Basel, Basel, Switzerland
- Clinical Immunology, Medical Outpatient Unit, Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Genevieve Favre
- Division of Hematology, Cantonal Hospital Liestal, Liestal, Switzerland
| | - Thomas Martin
- Hemophilia and Hemostasis Center, Centre for Laboratory Medicine, St. Gallen, Switzerland
| | - Wolfgang Korte
- Hemophilia and Hemostasis Center, Centre for Laboratory Medicine, St. Gallen, Switzerland
| | - Lukas Graf
- Hemophilia and Hemostasis Center, Centre for Laboratory Medicine, St. Gallen, Switzerland
| | - Maria Martinez
- Department of Diagnostic Hematology, University of Basel, Basel, Switzerland
| | - Bernhard Gerber
- Clinic of Hematology, Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland
- University of Zurich, Zurich, Switzerland
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12
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Rothen JP, Walter PN, Tsakiris DA, Infanti L, Hersberger KE, Arnet I. Identification of Patients with Cobalamin Deficiency Crucially Depends on the Diagnostic Strategy. Clin Lab 2021; 67. [PMID: 33978377 DOI: 10.7754/clin.lab.2020.200912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Our goal was to determine vitamin B12 (cobalamin) deficiency with different diagnostic strategies, to propose the best possible laboratory strategy, and to synthesize the relevance of biomarkers in the diagnosis of a cobalamin deficiency. METHODS We performed a secondary data analysis. The testing strategies were (i) vitamin B12 solely, (ii) holotranscobolamin solely, (iii) vitamin B12 and holotranscobolamin, and (iv) reflex testing of holotranscobalamin in samples with vitamin B12 < 300 pmol. A set of 3,044 laboratory samples with vitamin B12 and holotranscobalamin serum values from unselected in- and outpatients from a secondary care hospital. A sample was classified as cobalamin deficient when low values of vitamin B12 < 137 pmol/L or holotranscobalamin ≤ 37 pmol/L were measured. RESULTS Low cobalamin values were identified in 591 (19.4%) samples either according to low vitamin B12 values (305; 10.0%) or low holotranscobalamin values (436; 14.3%). For 2,404 values with vitamin B12 < 300 pmol/L, the additional measurement of holotranscobalamin (reflex-testing) enabled the detection of an additional 278 (9.1%) deficiencies. When the grey zone was decreased to 138 - 219 pmol/L, the reflex testing of an additional 1,240 samples identified a total of 511 (16.8%) samples as cobalamin deficient. CONCLUSIONS The identification of cobalamin deficiency or sufficiency highly depends on the diagnostic strategy. A reflex testing with a grey zone for vitamin B12 < 220 pmol/L identifies cobalamin deficiency cost efficiently in 86.5% cases (511 out of 591). Physicians should apply a uniform strategy on how to address the diagnosis of cobalamin deficiency and indication for treatment. In-hospital guidelines, which describe methodology and sensitivity of the locally used assays for vitamin B12 and holotranscobalamin could guide them.
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13
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Drexler B, Tzankov A, Martinez M, Baerlocher S, Passweg JR, Dirnhofer S, Tsakiris DA, Dirks J. Blast counts are lower in the aspirate as compared to trephine biopsy in acute myeloid leukemia and myelodysplastic syndrome expressing CD56. Int J Lab Hematol 2021; 43:1078-1084. [PMID: 33709561 DOI: 10.1111/ijlh.13508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/22/2020] [Accepted: 09/30/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION CD56 is aberrantly expressed in myeloid neoplasms including myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML). Considering the adhesion effects of CD56, blast quantification in bone marrow might depend on the technique used to obtain respective diagnostic specimens. Therefore, the objective of our study was to investigate the impact of CD56-expression on blast counts in myeloid neoplasms comparing bone marrow aspirates to biopsies. METHODS We retrospectively analyzed 75 patients diagnosed with MDS and AML. We compared patients with (n = 36) and without (n = 39) CD56-expression by flow cytometry with respect to their blast quantities assessed on bone marrow aspirates versus biopsies. RESULTS The frequency of CD56-expression on blasts correlated with higher blast counts on biopsies vs. aspirate smears (rs = 0.52; P = .001). This difference in blast counts was only significant in the CD56 high expressing subgroup (median 68%, 5.5%-95% in biopsy compared to median 32.5%, 1.5%-90% in aspirate; P < .01). The percentage of CD56-positive blasts among the total blast population was lower in the peripheral blood compared to bone marrow (median 31%, 6%-88% vs. 55%, 14%-98%; P = .016). The discrepancy in the blast count between the aspirate and trephine biopsy would have led to misclassification of four cases as MDS instead of AML, if diagnosis had based on the bone marrow aspirate blast count alone. CONCLUSION Counting blasts in bone marrow aspirates of CD56-positive AML and MDS may be linked to underestimation, potentially leading to misclassification of these myeloid neoplasms, and should therefore be adjusted considering the results obtained on trephine biopsies for reliable diagnosis.
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Affiliation(s)
- Beatrice Drexler
- Division of Hematology, University Hospital Basel, Basel, Switzerland
| | - Alexandar Tzankov
- Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Switzerland
| | - Maria Martinez
- Division of Hematology, University Hospital Basel, Basel, Switzerland
| | | | - Jakob R Passweg
- Division of Hematology, University Hospital Basel, Basel, Switzerland
| | - Stefan Dirnhofer
- Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Switzerland
| | | | - Jan Dirks
- Division of Hematology, University Hospital Basel, Basel, Switzerland
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14
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Abstract
Clinical thrombophilia is the consequence of multiple gene and/or environment interactions. Thrombophilia screening requires a targeted patient with specific indication, in which a finding would have implications. Carrying out a thrombophilia examination in the physician's practice is often a cause of uncertainty and concern. The concerns begin in choosing the right patient to be examined, are associated with the time of investigation, with the choice of analysis, the test-material and with the correct interpretation of the results. Difficulties, which can influence the results, can occur with both organization and blood sampling. As common for any analysis, pre-analytical, analytical and post-analytical factors should be considered, as well as the possibility of false positive or false negative results. Finally, recommendation of correct therapeutic and prophylactic measures for the patient and his relatives is an additional focus. In this article we want to provide-on the basis of the evidence and personal experience-the theory of thrombophilia-investigation, the indications for testing, as well as practical recommendations for treatment options.
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Affiliation(s)
- Giuseppe Colucci
- Faculty of Medicine, University of Basel, Basel, Switzerland. .,Service of Hematology, Clinica Luganese Moncucco, Via Moncucco 10, 6900, Lugano, Switzerland.
| | - Dimitrios A Tsakiris
- Faculty of Medicine, University of Basel, Basel, Switzerland.,Diagnostic Hematology, Department of Hematology, University Hospital Basel, Basel, Switzerland
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15
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Dewarrat N, Gavillet M, Angelillo-Scherrer A, Naveiras O, Grandoni F, Tsakiris DA, Alberio L, Blum S. Acquired haemophilia A in the postpartum and risk of relapse in subsequent pregnancies: A systematic literature review. Haemophilia 2021; 27:199-210. [PMID: 33550699 DOI: 10.1111/hae.14233] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 12/05/2020] [Accepted: 12/09/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND About 1%-5% of acquired haemophilia A cases affect mothers in the postpartum setting. AIMS This study delineates the characteristics of this disease, specific to the postpartum setting, notably relapse in subsequent pregnancies. METHODS Report of two cases and literature study (1946-2019), yielding 73 articles describing 174 cases (total 176 cases). RESULTS Patients were aged 29.9 years (17-41) and 69% primigravidae. Diagnosis was made at a median of 60 days after delivery (range 0-308). Bleeding types were obstetrical (43.4%), cutaneous (41.3%), and muscular (36.7%). In >90% of the cases, FVIII at diagnosis was <1% (range 0%-8%). FVIII inhibitor was documented in 75.4% cases (median titre of 20 BU/ml, range 1-621). Haemostatic treatment was necessary in 57.1% using fresh frozen plasma (16%), factor concentrate (27.6%) and/or bypassing agents (37.4%). Immunosuppressive treatment was administered in 90.8%, mostly steroids (85.3%), alone or combined with immunosuppressants (27%). Rituximab was used mostly as a second line treatment. Only 24 patients (13.6%) had documented subsequent pregnancies and 6 (22.2%) suffered haemophilia recurrence during pregnancy. CONCLUSION This study allows better definition of: (1) clinical and laboratory characteristics of postpartum acquired haemophilia, (2) response to therapy, and (3) the risk of relapse for subsequent pregnancies.
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Affiliation(s)
- Natacha Dewarrat
- Service and Central Laboratory of Haematology, Department of Oncology and Department of Laboratories and Pathology, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Mathilde Gavillet
- Service and Central Laboratory of Haematology, Department of Oncology and Department of Laboratories and Pathology, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Anne Angelillo-Scherrer
- Department of Haematology and Central Haematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Olaia Naveiras
- Service and Central Laboratory of Haematology, Department of Oncology and Department of Laboratories and Pathology, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Francesco Grandoni
- Service and Central Laboratory of Haematology, Department of Oncology and Department of Laboratories and Pathology, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | | | - Lorenzo Alberio
- Service and Central Laboratory of Haematology, Department of Oncology and Department of Laboratories and Pathology, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Sabine Blum
- Service and Central Laboratory of Haematology, Department of Oncology and Department of Laboratories and Pathology, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
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16
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Zellweger NM, Huber J, Tsakiris DA, Tzankov A, Gebhard CE, Siegemund M. Haemophagocytic lymphohistiocytosis and liver failure-induced massive hyperferritinaemia in a male COVID-19 patient. Swiss Med Wkly 2021; 151:w20420. [PMID: 33516166 DOI: 10.4414/smw.2021.20420] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The authors present the case of a 58-year-old man with the unique combination of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and, later on, haemophagocytic lymphohistiocytosis admitted to the intensive care unit. During his ICU stay the patient developed a variety of complications including acute respiratory distress syndrome, pulmonary embolism, right heart failure and suspected HLH leading to multiorgan failure and death. Despite the proven diagnosis of haemophagocytic lymphohistiocytosis, the excessively high ferritin levels of the patient did not seem fully explained by this diagnosis. Therefore, the authors want to highlight different causes of hyperferritinaemia in critically ill patients and underline the importance of differential diagnoses when interpreting continuously rising ferritin levels.
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Affiliation(s)
| | - Jan Huber
- Intensive Care Unit, University Hospital Basel, Switzerland
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17
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Fontana P, Alberio L, Albisetti M, Angelillo-Scherrer A, Asmis LM, Casini A, Gerber B, Graf L, Hegemann I, Korte W, Martinez M, Studt JD, Tsakiris DA, Wuillemin WA, Kremer Hovinga JA. Management of bleeding events and invasive procedures in patients with haemophilia A without inhibitors treated with emicizumab. Swiss Med Wkly 2020; 150:w20422. [PMID: 33338252 DOI: 10.4414/smw.2020.20422] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Emicizumab (Hemlibra®, Hoffmann-La Roche, Switzerland) is now available for haemophilia A patients with or without factor VIII inhibitors. Management of bleeding events and replacement therapy for invasive procedures have to be adapted. OBJECTIVE To provide a practical guidance for the management of breakthrough bleeding events and elective or urgent surgery in adult and paediatric patients with haemophilia A without inhibitors treated with emicizumab. METHODS Based on the available literature and the experiences collected from adult and paediatric patients treated in Switzerland, the Working Party on Haemostasis of the Swiss Society of Haematology and the Swiss Haemophilia Network worked together to reach a consensus on the management of bleeding events and invasive procedures. RESULTS AND CONCLUSION Minor bleeding events and invasive procedures associated with low bleeding risk can be treated without factor replacement therapy in most cases, whereas major bleeding events and high-risk surgery require additional factor VIII replacement at usual doses, at least for the first days. Emicizumab treatment should be continued throughout the procedure and during the postoperative period. Elective major surgery should be planned according to emicizumab dosing for patients with a once-a-month posology. Of note, so far only few data are available on the management of major bleeds and surgery in patients with haemophilia A treated with emicizumab and this practical guidance will have to be regularly updated with growing experience.  .
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Affiliation(s)
- Pierre Fontana
- Division of Angiology and Haemostasis, University Hospitals of Geneva, Switzerland
| | - Lorenzo Alberio
- Service and Central Laboratory of Haematology, Lausanne University Hospital, Lausanne, Switzerland
| | - Manuela Albisetti
- Division of Haematology, University Children's Hospital, Zurich, Switzerland
| | - Anne Angelillo-Scherrer
- Department of Haematology and Central Haematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Lars M Asmis
- Centre for perioperative Thrombosis and Haemostasis, Zurich, Switzerland
| | - Alessandro Casini
- Division of Angiology and Haemostasis, University Hospitals of Geneva, Switzerland
| | - Bernhard Gerber
- Clinic of Haematology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | | | | | | | - Maria Martinez
- Dagnostic Haematology, Basel University Hospital, Basel, Switzerland
| | - Jan-Dirk Studt
- Department of Medical Oncology and Haematology, University Hospital Zurich, Switzerland
| | | | - Walter A Wuillemin
- Division of Hematology and Central Hematology Laboratory, Cantonal Hospital of Lucerne, Lucerne, and University of Bern, Switzerland
| | - Johanna A Kremer Hovinga
- Department of Haematology and Central Haematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Switzerland
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18
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Tschan-Plessl A, Kalberer CP, Wieboldt R, Stern M, Siegler U, Wodnar-Filipowicz A, Gerull S, Halter J, Heim D, Tichelli A, Tsakiris DA, Malmberg KJ, Passweg JR, Bottos A. Cellular immunotherapy with multiple infusions of in vitro-expanded haploidentical natural killer cells after autologous transplantation for patients with plasma cell myeloma. Cytotherapy 2020; 23:329-338. [PMID: 33268029 DOI: 10.1016/j.jcyt.2020.09.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/18/2020] [Accepted: 09/22/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND AIMS To investigate the feasibility and safety of haploidentical natural killer (NK) cell infusions as consolidation immunotherapy after autologous stem cell transplant (ASCT) in patients with plasma cell myeloma. METHODS Ten patients (median age, 59 years) received induction treatment followed by high-dose melphalan (200 mg/m2) at day -1, ASCT at day 0 and increasing NK cell doses (1.5 × 106, 1.5 × 107 and multiple doses of 1.0 × 108 cells/kg body weight) from day +1 to day +30 after ASCT. NK cells were harvested and purified from peripheral blood of haploidentical donors and expanded for 19 days with interleukin (IL)-2 and IL-15 under Good Manufacturing Practice conditions. RESULTS NK cell numbers increased 56.0-fold (37.4- to 75.5-fold). Patients received a median of 3.8 × 108 (0.9-5.7 × 108) NK cells/kg body weight in six (three to eight) infusions. Multiparametric mass cytometry analysis demonstrated an altered surface receptor repertoire of expanded NK cells with increased degranulation and cytokine production activities but diminished expression of perforin. Donor NK cells were detectable in the peripheral blood, peaking 1 h after each dose (up to 90% donor NK cells). The treatment was safe and well tolerated, without evidence of graft-versus-host disease. Comparison with a control patient population receiving ASCT without NK cell infusions showed no significant difference in relapse, progression-free survival and overall survival. CONCLUSIONS This study demonstrates reliable manufacturing of high numbers of activated NK cells for multiple-dose infusions and safe administration of these cellular products. The trial was registered at ClinicalTrials.gov (identifier no. NCT01040026).
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Affiliation(s)
- Astrid Tschan-Plessl
- Clinical and Diagnostic Hematology, University Hospital Basel, Basel, Switzerland.
| | - Christian P Kalberer
- Clinical and Diagnostic Hematology, University Hospital Basel, Basel, Switzerland
| | - Ronja Wieboldt
- Clinical and Diagnostic Hematology, University Hospital Basel, Basel, Switzerland
| | - Martin Stern
- Clinical and Diagnostic Hematology, University Hospital Basel, Basel, Switzerland
| | - Uwe Siegler
- Clinical and Diagnostic Hematology, University Hospital Basel, Basel, Switzerland
| | | | - Sabine Gerull
- Clinical and Diagnostic Hematology, University Hospital Basel, Basel, Switzerland
| | - Jörg Halter
- Clinical and Diagnostic Hematology, University Hospital Basel, Basel, Switzerland
| | - Dominik Heim
- Clinical and Diagnostic Hematology, University Hospital Basel, Basel, Switzerland
| | - André Tichelli
- Clinical and Diagnostic Hematology, University Hospital Basel, Basel, Switzerland
| | - Dimitrios A Tsakiris
- Clinical and Diagnostic Hematology, University Hospital Basel, Basel, Switzerland
| | - Karl-Johan Malmberg
- Department of Cancer Immunology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway; Department of Medicine, Huddinge, Center for Infectious Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Jakob R Passweg
- Clinical and Diagnostic Hematology, University Hospital Basel, Basel, Switzerland
| | - Alessia Bottos
- Clinical and Diagnostic Hematology, University Hospital Basel, Basel, Switzerland
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19
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Studer U, Khanna N, Leuzinger K, Hirsch HH, Heim D, Lengerke C, Tsakiris DA, Halter J, Gerull S, Passweg J, Medinger M, Gwerder M. Incidence of CMV Replication and the Role of Letermovir Primary/Secondary Prophylaxis in the Early Phase After Allogeneic Hematopoietic Stem Cell Transplantation - A Single Centre Study. Anticancer Res 2020; 40:5909-5917. [PMID: 32988922 DOI: 10.21873/anticanres.14611] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 08/27/2020] [Accepted: 08/28/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Cytomegalovirus (CMV) replication may cause life-threatening complications after allogeneic haematopoietic stem cell transplantation (allo-HSCT). The aim of the study was to characterize CMV events, and the outcome of letermovir (LTV) CMV prophylaxis. PATIENTS AND METHODS In this retrospective analysis of patients treated with an allo-HSCT between 2010 and 2020, we determined plasma CMV events, as well as associated risk factors. RESULTS We identified 423 patients who had undergone allo-HSCT between 2010 and 2020. CMV DNAemia was found in 130/423 (30.7%) of patients. CMV reactivation rate was significantly higher in patients with acute graft-versus-host disease, HLA mismatch, and CMV IgG seropositivity of donors and recipients. Among 42 patients receiving LTV prophylaxis those, 5 (11.9%) showed CMV DNAemia under LTV versus 87/353 (24.6%) in a control group. CONCLUSION Despite the development of better approaches with weekly monitoring and early treatment initiation, CMV reactivations play an important role after allo-HSCT.
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Affiliation(s)
- Ursina Studer
- Division of Hematology, University Hospital Basel, Basel, Switzerland
| | - Nina Khanna
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Karoline Leuzinger
- Clinical Virology, Laboratory Medicine, University Hospital Basel, Basel, Switzerland.,Transplantation and Clinical Virology, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Hans H Hirsch
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland.,Clinical Virology, Laboratory Medicine, University Hospital Basel, Basel, Switzerland.,Transplantation and Clinical Virology, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Dominik Heim
- Division of Hematology, University Hospital Basel, Basel, Switzerland
| | - Claudia Lengerke
- Division of Hematology, University Hospital Basel, Basel, Switzerland
| | | | - Joerg Halter
- Division of Hematology, University Hospital Basel, Basel, Switzerland
| | - Sabine Gerull
- Division of Hematology, University Hospital Basel, Basel, Switzerland
| | - Jakob Passweg
- Division of Hematology, University Hospital Basel, Basel, Switzerland
| | - Michael Medinger
- Division of Hematology, University Hospital Basel, Basel, Switzerland .,Division of Internal Medicine, Department of Medicine, University Hospital Basel, Basel, Switzerland
| | - Malena Gwerder
- Division of Hematology, University Hospital Basel, Basel, Switzerland
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20
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Donat C, Kölm R, Csorba K, Tuncer E, Tsakiris DA, Trendelenburg M. Complement C1q Enhances Primary Hemostasis. Front Immunol 2020; 11:1522. [PMID: 32765527 PMCID: PMC7381122 DOI: 10.3389/fimmu.2020.01522] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 06/09/2020] [Indexed: 12/11/2022] Open
Abstract
The cross-talk between the inflammatory complement system and hemostasis is becoming increasingly recognized. The interaction between complement C1q, initiation molecule of the classical pathway, and von Willebrand factor (vWF), initiator molecule of primary hemostasis, has been shown to induce platelet rolling and adhesion in vitro. As vWF disorders result in prolonged bleeding, a lack of C1q as binding partner for vWF might also lead to an impaired hemostasis. Therefore, this study aimed to investigate the in vivo relevance of C1q-dependent binding of vWF in hemostasis. For this purpose, we analyzed parameters of primary and secondary hemostasis and performed bleeding experiments in wild type (WT) and C1q-deficient (C1qa−/−) mice, with reconstitution experiments of C1q in the latter. Bleeding tendency was examined by quantification of bleeding time and blood loss. First, we found that complete blood counts and plasma vWF levels do not differ between C1qa−/− mice and WT mice. Moreover, platelet aggregation tests indicated that the platelets of both strains of mice are functional. Second, while the prothrombin time was comparable between both groups, the activated partial thromboplastin time was shorter in C1qa−/− mice. In contrast, tail bleeding times of C1qa−/− mice were prolonged accompanied by an increased blood loss. Upon reconstitution of C1qa−/− mice with C1q, parameters of increased bleeding could be reversed. In conclusion, our data indicate that C1q, a molecule of the first-line of immune defense, actively participates in primary hemostasis by promoting arrest of bleeding. This observation might be of relevance for the understanding of thromboembolic complications in inflammatory disorders, where excess of C1q deposition is observed.
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Affiliation(s)
- Claudia Donat
- Laboratory of Clinical Immunology, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Robert Kölm
- Laboratory of Clinical Immunology, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Kinga Csorba
- Laboratory of Clinical Immunology, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Eylul Tuncer
- Laboratory of Clinical Immunology, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Dimitrios A Tsakiris
- Department of Diagnostic Hematology, University Hospital Basel, Basel, Switzerland
| | - Marten Trendelenburg
- Laboratory of Clinical Immunology, Department of Biomedicine, University of Basel, Basel, Switzerland.,Division of Internal Medicine, University Hospital Basel, Basel, Switzerland
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21
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Alberio L, Angelillo-Scherrer A, Asmis L, Casini A, Fontana P, Graf L, Hegemann I, Kremer Hovinga JA, Korte W, Lecompte T, Martinez M, Nagler M, Studt JD, Tsakiris DA, Wuillemin W. Recommendations on the use of anticoagulants for the treatment of patients with heparin-induced thrombocytopenia in Switzerland. Swiss Med Wkly 2020; 150:w20210. [PMID: 32329806 DOI: 10.4414/smw.2020.20210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Heparin-induced thrombocytopenia (HIT) is an immune-mediated adverse drug effect that occurs in 0.1–5% of heparin treated patients. Management of acute HIT currently involves (1) cessation of heparin exposure, and (2) inhibition of coagulation with an anticoagulant other than heparin. Several anticoagulants can be considered for the treatment of HIT. Anticoagulant monitoring, management of drug-induced adverse events including bleeding, and therapeutic dosing schedules in selected clinical settings represent challenges to the clinician treating HIT patients. Moreover, the fact that not all registered anticoagulants are approved for HIT in Switzerland further complicates the management of HIT. The present recommendations on the anticoagulant treatment of HIT in Switzerland have been elaborated by a panel of Swiss experts belonging to the Working Party Hemostasis (WPH) of the Swiss Society of Hematology (SGH-SSH). They are intended to support clinicians in their decision making when treating HIT patients.
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Affiliation(s)
- Lorenzo Alberio
- Service and Central Laboratory of Hematology, Lausanne University Hospital, Switzerland
| | - Anne Angelillo-Scherrer
- Department of Hematology and Central Haematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Lars Asmis
- Centre for Perioperative Thrombosis and Hemostasis, Zurich, Switzerland
| | - Alessandro Casini
- Centre for Perioperative Thrombosis and Hemostasis, Zurich, Switzerland
| | - Pierre Fontana
- Division of Angiology and Hemostasis, Geneva University Hospital, Geneva, Switzerland
| | - Lukas Graf
- Cantonal Hospital of St Gallen, Switzerland
| | - Inga Hegemann
- Division of Medical Oncology and Hematology, University Hospital Zurich, Switzerland
| | - Johanna A Kremer Hovinga
- Department of Hematology and Central Haematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | | | - Thomas Lecompte
- Division of Angiology and Hemostasis, Geneva University Hospital, Geneva, Switzerland
| | - Martina Martinez
- Division of Hematology, Basel University Hospital, Basel, Switzerland
| | - Michael Nagler
- Department of Hematology and Central Haematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Jan-Dirk Studt
- Division of Medical Oncology and Hematology, University Hospital Zurich, Switzerland
| | | | - Walter Wuillemin
- Division of Hematology and Central Hematology Laboratory, Cantonal Hospital of Lucerne and University of Bern, Switzerland
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22
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Fuchs J, Faber K, Tuchscherer DT, Tsakiris DA, Weiler S, Hofer KE. Bite by a juvenile Bothrops venezuelensis (Venezuelan lancehead) resulting in severe envenomation: A case report. Toxicon 2020; 180:39-42. [PMID: 32289355 DOI: 10.1016/j.toxicon.2020.04.002] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 03/31/2020] [Accepted: 04/03/2020] [Indexed: 11/26/2022]
Abstract
Bothrops venezuelensis is a venomous snake of the Viperidae family. It is associated with a high snakebite-related morbidity and mortality in Venezuela, although clinical case descriptions are scarce. Bites by other Bothrops sp. can result in coagulopathy and acute kidney injury. We describe a bite by a captive juvenile B. venezuelensis that caused local swelling, severe pain, endothelial damage, excessive fibrinolysis (INR >12, aPTT 136s, fibrinogen 0.3g/l) and incoagulable blood within 1.5 hours after the bite. The patient was treated with prothrombin complex factors concentrate, fibrinogen and antivenom (Antivipmyn®, Instituto Bioclon, Mexico) 4.5 h after the bite, which improved coagulation parameters progressively. Subsequently signs of compensated disseminated intravascular coagulation manifested and the patient received fresh frozen plasma and erythrocyte concentrate. The patient developed acute kidney injury with macroscopic hematuria. Fluid overload resulted in pulmonary edema requiring intermittent ventilation and diuretic treatment with furosemide. He was discharged with moderately elevated creatinine 16 days after hospitalization. Creatinine level normalized within another week. This case displays the life-threatening toxicity even after juvenile B. venezuelensis bites and the comparability to bites by other Bothrops sp.
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Affiliation(s)
- Joan Fuchs
- National Poisons Information Centre, Tox Info Suisse, Associated Institute of the University of Zurich, Zurich, Switzerland.
| | - Katrin Faber
- National Poisons Information Centre, Tox Info Suisse, Associated Institute of the University of Zurich, Zurich, Switzerland
| | - Daniel T Tuchscherer
- Department of Anesthesiology, Operative Intensive Care, Preclinical Emergency Medicine and Pain Management, University Hospital Basel, Basel, Switzerland
| | | | - Stefan Weiler
- National Poisons Information Centre, Tox Info Suisse, Associated Institute of the University of Zurich, Zurich, Switzerland; Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH, Zurich, Switzerland
| | - Katharina E Hofer
- National Poisons Information Centre, Tox Info Suisse, Associated Institute of the University of Zurich, Zurich, Switzerland
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23
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Gavriilaki E, Touloumenidou T, Sakellari I, Batsis I, Mallouri D, Psomopoulos F, Tsagiopoulou M, Koutra M, Yannaki E, Papalexandri A, Taylor P, Nikolousis E, Stamouli M, Holbro A, Baltadakis I, Liga M, Spyridonidis A, Tsirigotis P, Charchalakis N, Tsakiris DA, Brodsky RA, Passweg J, Stamatopoulos K, Anagnostopoulos A. Pretransplant Genetic Susceptibility: Clinical Relevance in Transplant-Associated Thrombotic Microangiopathy. Thromb Haemost 2020; 120:638-646. [DOI: 10.1055/s-0040-1702225] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AbstractTransplant-associated thrombotic microangiopathy (TA-TMA) is a life-threatening complication of allogeneic hematopoietic cell transplantation (HCT). We hypothesized that pretransplant genetic susceptibility is evident in adult TA-TMA and further investigated the association of TMA-associated variants with clinical outcomes. We studied 40 patients with TA-TMA, donors of 18 patients and 40 control non-TMA HCT recipients, without significant differences in transplant characteristics. Genomic DNA from pretransplant peripheral blood was sequenced for TMA-associated genes. Donors presented significantly lower frequency of rare variants and variants in exonic/splicing/untranslated region (UTR) regions, compared with TA-TMA patients. Controls also showed a significantly lower frequency of rare variants in ADAMTS13, CD46, CFH, and CFI. The majority of TA-TMA patients (31/40) presented with pathogenic or likely pathogenic variants. Patients refractory to conventional treatment (62%) and patients that succumbed to transplant-related mortality (65%) were significantly enriched for variants in exonic/splicing/UTR regions. In conclusion, increased incidence of pathogenic, rare and variants in exonic/splicing/UTR regions of TA-TMA patients suggests genetic susceptibility not evident in controls or donors. Notably, variants in exonic/splicing/UTR regions were associated with poor response and survival. Therefore, pretransplant genomic screening may be useful to intensify monitoring and early intervention in patients at high risk for TA-TMA.
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Affiliation(s)
- Eleni Gavriilaki
- Hematology Department–BMT Unit, G. Papanicolaou Hospital, Thessaloniki, Greece
| | | | - Ioanna Sakellari
- Hematology Department–BMT Unit, G. Papanicolaou Hospital, Thessaloniki, Greece
| | - Ioannis Batsis
- Hematology Department–BMT Unit, G. Papanicolaou Hospital, Thessaloniki, Greece
| | - Despina Mallouri
- Hematology Department–BMT Unit, G. Papanicolaou Hospital, Thessaloniki, Greece
| | - Fotis Psomopoulos
- Department of Hematology, Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - Maria Tsagiopoulou
- Department of Hematology, Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - Maria Koutra
- Hematology Department–BMT Unit, G. Papanicolaou Hospital, Thessaloniki, Greece
| | - Evangelia Yannaki
- Hematology Department–BMT Unit, G. Papanicolaou Hospital, Thessaloniki, Greece
| | | | - Pat Taylor
- Department of Haematology, University Hospitals Birmingham, Birmingham, United Kingdom
| | - Emmanuel Nikolousis
- Department of Haematology, University Hospitals Birmingham, Birmingham, United Kingdom
| | - Maria Stamouli
- Division of Hematology, Second Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Andreas Holbro
- Division of Hematology, Department of Medicine, University Hospital Basel, Basel, Switzerland
| | - Ioannis Baltadakis
- Department of Hematology, Bone Marrow Transplantation Unit, Evangelismos Hospital, Athens, Greece
| | - Maria Liga
- Department of Hematology, BMT Unit, University Hospital of Patras, Patras, Greece
| | | | - Panagiotis Tsirigotis
- Division of Hematology, Second Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Charchalakis
- Department of Hematology, Bone Marrow Transplantation Unit, Evangelismos Hospital, Athens, Greece
| | - Dimitrios A. Tsakiris
- Division of Hematology, Department of Medicine, University Hospital Basel, Basel, Switzerland
| | - Robert A. Brodsky
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Jacob Passweg
- Division of Hematology, Department of Medicine, University Hospital Basel, Basel, Switzerland
| | - Kostas Stamatopoulos
- Department of Hematology, Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
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24
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Karakioulaki M, Martinez M, Medinger M, Heim D, Passweg JR, Tsakiris DA. Peripheral blood schistocytes in the acute phase after allogeneic or autologous stem cell transplantation assessed by digital microscopy. Int J Lab Hematol 2019; 42:145-151. [DOI: 10.1111/ijlh.13130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 09/05/2019] [Accepted: 10/08/2019] [Indexed: 12/13/2022]
Affiliation(s)
| | - Maria Martinez
- Division of Hematology University Hospital Basel Basel Switzerland
| | - Michael Medinger
- Division of Hematology University Hospital Basel Basel Switzerland
| | - Dominik Heim
- Division of Hematology University Hospital Basel Basel Switzerland
| | - Jakob R. Passweg
- Division of Hematology University Hospital Basel Basel Switzerland
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25
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Infanti L, Holbro A, Passweg J, Bolliger D, Tsakiris DA, Merki R, Plattner A, Tappe D, Irsch J, Lin JS, Corash L, Benjamin RJ, Buser A. Clinical impact of amotosalen-ultraviolet A pathogen-inactivated platelets stored for up to 7 days. Transfusion 2019; 59:3350-3361. [PMID: 31574181 PMCID: PMC6900102 DOI: 10.1111/trf.15511] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 08/07/2019] [Accepted: 08/07/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Universal pathogen inactivation of platelet concentrates (PCs) using amotosalen/ultraviolet A with 7‐day storage was implemented in Switzerland in 2011. Routine‐use data were analyzed at the University Hospital Basel, Switzerland. STUDY DESIGN A retrospective two‐cohort study of patient and PC characteristics, component usage, patient outcomes, count increments (CIs), and adverse events were analyzed for two consecutive 5‐year periods with either 0‐ to 5‐day‐old conventional PC (C‐PC) (n = 14,181) or 0‐ to 7‐day‐old pathogen‐inactivated PC (PI‐PC) (n = 22,579). RESULTS In both periods, PCs were issued for transfusion on a “first in, first out” basis. With 7‐day PI‐PC, wastage was reduced from 8.7% to 1.5%; 16.6% of transfused PI‐PCs were more than 5 days old. Transfusion of PI‐PC more than 5 days old compared with 5 days old or less did not increase platelet and RBC use on the same or next day as an indirect measure of hemostasis and did not increase transfusion reactions. Mean corrected count increments (CCIs) for PI‐PC stored for 5 days or less were 22.6% lower than for C‐PC (p < 0.001), and declined with increasing storage duration for both, although the correlation was weak (r2 = 0.005‐0.014). Mean number of PCs used per patient and duration of PC support were not different for hematology/oncology, allogeneic and autologous hematopoietic stem cell transplant (HSCT), and general medical/surgical patients, who used the majority (~92.0%) of PI‐PCs. Five‐year treatment‐related mortality in allogeneic HSCT was unchanged in the PI‐PC period. CONCLUSIONS PI‐PCs with 7‐day storage reduced wastage and did not increase PC or red blood cell utilization or adverse reactions compared with fresh PI‐PC or a historical control group, demonstrating preserved efficacy and safety.
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Affiliation(s)
- Laura Infanti
- Regional Blood Transfusion Service, Swiss Red Cross, Basel, Switzerland
| | - Andreas Holbro
- Regional Blood Transfusion Service, Swiss Red Cross, Basel, Switzerland.,Hematology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Jakob Passweg
- Hematology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Daniel Bolliger
- Department for Anesthesia, Prehospital Emergency Medicine, and Pain Therapy, University Hospital Basel, University of Basel, Basel, Switzerland
| | | | - Ramona Merki
- Hematology, University Hospital Basel, University of Basel, Basel, Switzerland
| | | | | | | | | | | | | | - Andreas Buser
- Regional Blood Transfusion Service, Swiss Red Cross, Basel, Switzerland.,Hematology, University Hospital Basel, University of Basel, Basel, Switzerland
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26
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Buser TA, Martinez M, Drexler B, Tschan-Plessl A, Heim D, Passweg J, Tsakiris DA. Biological markers of hemostasis and endothelial activation in patients with a hematological malignancy with or without stem cell transplants. Eur J Haematol 2019; 103:472-477. [PMID: 31390488 DOI: 10.1111/ejh.13310] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 07/29/2019] [Accepted: 08/01/2019] [Indexed: 11/27/2022]
Abstract
INTRODUCTION In this study, we analyzed the changes of thrombin generation as marker of coagulation activation and von Willebrand factor (vWF) levels as a marker of endothelial activation in patients undergoing chemotherapy, autologous, or allogeneic HSCT. We studied possible associations to triggering factors, including acute GVHD, thrombosis, time to engraftment, and bleeding complications. METHODS Seventy-six patients treated for hematologic malignancies at the University Hospital Basel between 2005 and 2008 took part in this study. Blood samples were collected before the start of chemotherapy or conditioning regime (median day -2), in an early phase (median day + 12), and at a later point in time (median day + 24). RESULTS Thrombin generation decreased in all three groups to about 50% of the initial value. Patients undergoing autologous or allogeneic HSCT showed significantly (P = .026 and P = .01) higher vWF levels than patients undergoing chemotherapy. Eighteen patients (42%) receiving allogeneic HSCT developed GVHD, vWF levels in patients with GVHD were significantly (P = .008) higher than in patients without GVHD. DISCUSSION Patients receiving autologous or allogeneic HSCT had significantly higher vWF levels in the acute phase after the transplant than patients receiving chemotherapy alone, implicating a persistent stimulation of the endothelium, possibly within the context of GVHD.
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Affiliation(s)
| | - Maria Martinez
- Department of Haematology, University Hospital Basel, Basel, Switzerland
| | - Beatrice Drexler
- Department of Haematology, University Hospital Basel, Basel, Switzerland
| | | | - Dominik Heim
- Department of Haematology, University Hospital Basel, Basel, Switzerland
| | - Jakob Passweg
- Department of Haematology, University Hospital Basel, Basel, Switzerland
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Rohner N, Passweg JR, Tsakiris DA, Halter JP, Heim D, Buser AS, Infanti L, Holbro A. The value of the post-thaw CD34+ count with and without DMSO removal in the setting of autologous stem cell transplantation. Transfusion 2018; 59:1052-1060. [PMID: 30556582 DOI: 10.1111/trf.15107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 11/06/2018] [Accepted: 11/12/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND CD34+ cell count correlates with engraftment potency after autologous stem cell transplantation. Assessment of CD34+ mainly occurs after apheresis and before cryopreservation with dimethyl sulfoxide (DMSO). The influence of postthaw CD34+ cell numbers over time to engraftment is not well studied, and determination of postthaw CD34+ cell counts is challenging for a variety of reasons. The aim of this retrospective study was to systematically assess the value of postthaw CD34+ cell counts in autologous grafts with and without DMSO removal. STUDY DESIGN AND METHODS Between January 2008 and December 2015, 236 adult patients underwent a total of 292 autologous stem cell transplantations. Median age at transplantation was 56 years, and the main indication was multiple myeloma (60%). DMSO removal was done in 96 grafts (33%), either by centrifugation or by Sepax method. RESULTS Patients receiving grafts containing DMSO showed a significantly faster platelet (p = 0.02) and RBC (p = 0.001) engraftment. DMSO removal was not associated with fewer infusion-related adverse events. We observed a good correlation between CD34+ cell count after apheresis and CD34+ cell count after thawing/washing (r = 0.931). Ninety grafts (31%) showed a significant loss of viable CD34+ cells, which translated into a delayed engraftment. CONCLUSION DMSO removal was associated with delayed platelet and RBC engraftment without preventing adverse events. CD34+ cell enumeration after thawing remains difficult to perform, but grafts showing higher cell loss during cryopreservation and thawing are associated with slower engraftment. Prospective studies on the role of DMSO removal and postthaw CD34+ enumeration using defined protocols are needed.
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Affiliation(s)
- Nicolai Rohner
- Division of Hematology, University Hospital Basel, Switzerland
| | - Jakob R Passweg
- Division of Hematology, University Hospital Basel, Switzerland
| | | | - Jörg P Halter
- Division of Hematology, University Hospital Basel, Switzerland
| | - Dominik Heim
- Division of Hematology, University Hospital Basel, Switzerland
| | - Andreas S Buser
- Division of Hematology, University Hospital Basel, Switzerland.,Blood Transfusion Center, Swiss Red Cross, Basel, Switzerland
| | - Laura Infanti
- Division of Hematology, University Hospital Basel, Switzerland.,Blood Transfusion Center, Swiss Red Cross, Basel, Switzerland
| | - Andreas Holbro
- Division of Hematology, University Hospital Basel, Switzerland.,Blood Transfusion Center, Swiss Red Cross, Basel, Switzerland
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Bianchi M, Heim D, Lengerke C, Halter J, Gerull S, Kleber M, Tsakiris DA, Passweg J, Tzankov A, Medinger M. Cyclosporine levels > 195 μg/L on day 10 post-transplant was associated with significantly reduced acute graft-versus-host disease following allogeneic hematopoietic stem cell transplantation. Ann Hematol 2018; 98:971-977. [DOI: 10.1007/s00277-018-3577-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 12/06/2018] [Indexed: 11/30/2022]
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29
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Moiseev IS, Tsvetkova T, Aljurf M, Alnounou RM, Bogardt J, Chalandon Y, Drokov MY, Dvirnyk V, Faraci M, Friis LS, Giglio F, Greinix HT, Kornblit BT, Koelper C, Koenecke C, Lewandowski K, Niederwieser D, Passweg JR, Peczynski C, Penack O, Peric Z, Piekarska A, Ronchi PE, Rovo A, Rzepecki P, Scuderi F, Sigrist D, Siitonen SM, Stoelzel F, Sulek K, Tsakiris DA, Wilkowojska U, Duarte RF, Ruutu T, Basak GW. Clinical and morphological practices in the diagnosis of transplant-associated microangiopathy: a study on behalf of Transplant Complications Working Party of the EBMT. Bone Marrow Transplant 2018; 54:1022-1028. [DOI: 10.1038/s41409-018-0374-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 09/25/2018] [Accepted: 10/02/2018] [Indexed: 11/09/2022]
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30
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Kraft S, Bollinger N, Bodenmann B, Heim D, Bucher C, Lengerke C, Kleber M, Tsakiris DA, Passweg J, Tzankov A, Medinger M. High mortality in hematopoietic stem cell transplant-associated thrombotic microangiopathy with and without concomitant acute graft-versus-host disease. Bone Marrow Transplant 2018; 54:540-548. [DOI: 10.1038/s41409-018-0293-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 06/14/2018] [Accepted: 07/09/2018] [Indexed: 11/09/2022]
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31
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Tsakiris DA, Kappos L, Reber G, Marbet GA, Le Floch-Rohr J, Roux E, de Moerloose P. Lack of Association Between Antiphospholipid Antibodies and Migraine. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1651625] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryWe prospectively studied the prevalence of lupus anticoagulant, anticardiolipin antibodies (aCL) and various haemostatic parameters in 71 patients with migraine and compared the results with a control group of 32 subjects with back pain never having experienced migraine. The patients with migraine were divided into two groups: group I with migraine without (n = 18) and with aura lasting less than 60 min (n = 24) and group II with migraine with prolonged aura or migrainous infarction (complicated migraine, n = 29). The following results were obtained: a) no difference in aCL positivity was noted between migrainous patients and controls and between common migraine and complicated migraine patients and b) no statistically significant difference in haemostatic parameters (except for thrombin-antithrombin III complexes) was found between the two groups of migraine and between aCL positive and negative migrainous patients. These data suggest that anticardiolipin antibodies are not involved in the pathogenesis of migraine complications.
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Affiliation(s)
- D A Tsakiris
- The Coagulation and Fibrinolysis Laboratory, University Hospital of Basel, Switzerland
| | - L Kappos
- Department of Neurology, University Hospital of Basel, Switzerland
| | - G Reber
- Haemostasis Unit, University Cantonal Hospital, Geneva, Switzerland
| | - G A Marbet
- The Coagulation and Fibrinolysis Laboratory, University Hospital of Basel, Switzerland
| | - J Le Floch-Rohr
- Department of Neurology, University Cantonal Hospital, Geneva, Switzerland
| | - E Roux
- Division of Rheumatology, University Cantonal Hospital, Geneva, Switzerland
| | - P de Moerloose
- Haemostasis Unit, University Cantonal Hospital, Geneva, Switzerland
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Abstract
SummaryBlood coagulation, fibrinolysis and platelet aggregability were assessed in 8 physicians aged 30-40 years, who had travelled nonstop by car from Salonica to Athens (510 km) and returned to Salonica after 48 h of rest and after administration of 1 g of aspirin. At the end of journey A, platelet aggregability was found to be increased (6 out of 8 persons), AT III was decreased by 30% (p <0.001), the FVIIIiC / FVIIIRiAg ratio was decreased (p <0.02) and ELT was prolonged. At the end of journey B the findings were the following: platelet aggregation was not affected, the decrease of AT III was not statistically significant and ELT was significantly shortened (p <0.005).A common finding of both journeys was the increase of platelet counts at the end (p <0.005).The correlation between long lasting sitting and the response of the haemostatic balance is suggested. The influence of aspirin is discussed.
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Affiliation(s)
- P E Makris
- The 1st Medical Propedeutic Dept University of Thessaloniki, Greece
| | - C Louizou
- The 2nd Reg. Blood Transfusion Centre, Laikon Hospital Athens, Greece
| | - C Markakis
- The 2nd Reg. Blood Transfusion Centre, Laikon Hospital Athens, Greece
| | - D A Tsakiris
- The 1st Medical Propedeutic Dept University of Thessaloniki, Greece
- The 2nd Reg. Blood Transfusion Centre, Laikon Hospital Athens, Greece
| | - T Mandalaki
- The 2nd Reg. Blood Transfusion Centre, Laikon Hospital Athens, Greece
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Vischer UM, Ingerslev J, Wollheim CB, Mestries JC, Tsakiris DA, Haefeli WE, Kruithof EKO. Acute von Willebrand Factor Secretion from the Endothelium In Vivo: Assessment through Plasma Propeptide (vWf:AgII) Levels. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1655973] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryElevated plasma concentrations of von Willebrand factor (vWf) are increasingly recognized as a cardiovascular risk factor, and are used as a marker of endothelial activation. However, the factors which determine the rate of vWf release from the endothelium in vivo have not been defined clearly. In addition, vWf plasma levels may also be influenced by adhesion of vWf to the vascular wall or to platelets, and by its rate of degradation. The propeptide of vWf (also called vWf:AgII) is stored and released in equimolar amounts with vWf. In the present study we attempted to determine whether this propeptide could be a more reliable marker of endothelial secretion than vWf itself. To accomplish this we developed an ELISA based on monoclonal antibodies. The propeptide levels in normal plasma were found to be 0.7 µg/ml, more than 10 times lower than vWf itself. Administration of desmopressin (DDAVP) induced a rapid relative increase in propeptide (from 106 to 879%) and in vWf (from 112 to 272%). However, the increases in vWf and propeptide were equivalent when expressed in molar units. A time course study indicated a half-life of the propeptide of 3 h or less. In a baboon model of disseminated intravascular coagulation (DIC) induced by FXa, vWf increased by less than 100%, whereas the propeptide concentrations increased by up to 450%. In view of the massive thrombin generation (as assessed by fibrinogen depletion), the increases in vWf are small, compared to the strong secretory response to thrombin and fibrin previously observed in vitro. Our results suggest that due to its rapid turnover, the propeptide could provide a sensitive plasma marker of acute endothelial secretion.
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Affiliation(s)
| | - Jørgen Ingerslev
- Hemophilia Center and Coagulation Laboratory, University Hospital Aarhus/Skejby, Aarhus, Denmark
| | | | | | | | | | - Egbert K O Kruithof
- Division d’Angiologie et d’Hémostase, Department of Internal Medicine, HCUG, Geneva, Switzerland
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Affiliation(s)
| | | | - L Linder
- University Hospital Basel, Switzerland
| | - B Steiner
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
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35
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Tsakiris DA, Marbet GA, Makris PE, Settas L, Duckert F. Impaired Fibrinolysis as an Essential Contribution to Thrombosis in Patients with Lupus Anticoagulant. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1646554] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryLupus anticoagulants (LA) are IgG or IgM antibodies against phospholipids which in vivo represent an important thrombophilic factor despite their in vitro anticoagulant activity. We investigated the fibrinolytic system of 20 patients with connective tissue disease and positive LA, compared to a control group of 24 age- and disease-matched patients without LA. There was no statistically significant difference of alpha2-antiplasmin, plasminogen, fibrinogen, t-PA activity, D-dimers and heparin cofactor II, between the two groups. Although t-PA was uniformly low in both groups, plasminogen activator inhibitor activity (PAI) was significantly higher in LA cases (p <0.001). Increased PAI levels represent an inhibitory factor of the fibrinolytic defense mechanism, which together with other functional deviations may contribute to the thrombophilic tendency of LA patients.
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Affiliation(s)
- D A Tsakiris
- The Coagulation and Fibrinolysis Laboratory, Kantonsspital Basel, Switzerland
| | - G A Marbet
- The Coagulation and Fibrinolysis Laboratory, Kantonsspital Basel, Switzerland
| | - P E Makris
- The A’Medical Propaedeutic Department, Aristotelian University of Thessaloniki, Greece
| | - L Settas
- The A’Medical Propaedeutic Department, Aristotelian University of Thessaloniki, Greece
| | - F Duckert
- The Coagulation and Fibrinolysis Laboratory, Kantonsspital Basel, Switzerland
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36
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Colucci G, Helsing K, Biasiutti FD, Raio L, Schmid P, Tsakiris DA, Eberle B, Surbek D, Lämmle B, Alberio L. Standardized Management Protocol in Severe Postpartum Hemorrhage: A Single-Center Study. Clin Appl Thromb Hemost 2018; 24:884-893. [PMID: 29669438 PMCID: PMC6714733 DOI: 10.1177/1076029618758956] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Severe postpartum hemorrhage (sPPH) is an obstetric emergency that needs prompt and effective therapy to reduce the risk of complications. In this study, women who developed sPPH (study cohort, n = 27) were treated according to a standardized management protocol prescribing sequential administration of uterotonic drugs, crystalloids, tranexamic acid, labile blood products, low-dose fibrinogen, and recombinant activated factor VII (rFVIIa). This group was compared to patients treated with different strategies during 2 preceding periods: an in-house guideline regulating the administration of rFVIIa (historical cohort 1, n = 20) and no specific guideline (historical cohort 2, n = 27). The management protocol was used over 33 months. The study cohort had a lower estimated blood loss (P = .004) and required less red blood cell concentrates (P = .007), fresh frozen plasma units (P = .004), and platelet concentrates (P = .020) compared to historical cohort 1 and historical cohort 2, respectively. The necessity of emergency postpartum hysterectomy was lower in the study group (P = .012). In conclusion, in patients with sPPH treated with this standardized management protocol, we observed a decreased requirement of labile blood products and lower need to proceed to emergency postpartum hysterectomy.
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Affiliation(s)
- Giuseppe Colucci
- 1 Department of Hematology and Central Hematology Laboratory, University Hospital and University of Bern, Bern, Switzerland.,2 Service of Hematology, Clinica Luganese Moncucco, Lugano, Switzerland
| | - Karin Helsing
- 1 Department of Hematology and Central Hematology Laboratory, University Hospital and University of Bern, Bern, Switzerland
| | - Franziska Demarmels Biasiutti
- 1 Department of Hematology and Central Hematology Laboratory, University Hospital and University of Bern, Bern, Switzerland
| | - Luigi Raio
- 3 Department of Obstetrics and Gynecology, University Hospital and University of Bern, Bern, Switzerland
| | - Pirmin Schmid
- 1 Department of Hematology and Central Hematology Laboratory, University Hospital and University of Bern, Bern, Switzerland
| | | | - Balthasar Eberle
- 5 Department of Anesthesiology and Pain Medicine, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Daniel Surbek
- 3 Department of Obstetrics and Gynecology, University Hospital and University of Bern, Bern, Switzerland
| | - Bernhard Lämmle
- 1 Department of Hematology and Central Hematology Laboratory, University Hospital and University of Bern, Bern, Switzerland.,6 Center for Thrombosis and Hemostasis, University Medical Center, Mainz, Germany
| | - Lorenzo Alberio
- 1 Department of Hematology and Central Hematology Laboratory, University Hospital and University of Bern, Bern, Switzerland.,7 Service et laboratoire central d'hématologie, CHUV, University Hospital of Lausanne, Lausanne, Switzerland
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Kaspar M, Imfeld S, Partovi S, Aschwanden M, Baldi T, Dikkes A, Vogt DR, Tsakiris DA, Staub D. Perivascular Perfusion on Contrast-Enhanced Ultrasound (CEUS) Is Associated with Inflammation in Patients with Acute Deep Vein Thrombosis. Thromb Haemost 2017; 117:2146-2155. [PMID: 28933797 DOI: 10.1160/th17-05-0332] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Inflammatory processes of the venous wall in acute deep vein thrombosis (DVT) play a role in thrombus formation and resolution. However, direct evaluation of the perivascular inflammation is currently not feasible. Objective To assess perivascular perfusion in acute proximal DVT using contrast-enhanced ultrasound (CEUS) reflecting perivenous inflammation and its association with systemic inflammatory markers in a single-centre, prospective observational study. Patients/Methods Twenty patients with proximal DVT underwent CEUS imaging in the thrombosed and contralateral popliteal vein at baseline and after 2 weeks and 3 months. Perfusion was quantified by measuring peak enhancement (PE) and wash-in rate (WiR) in a perivenous region after bolus injection of the contrast agent. High-sensitive C-reactive protein (hsCRP) and interleukin-6 (IL-6) were determined at the time of each CEUS imaging. Results PE and WiR were significantly higher in the thrombosed compared with the unaffected leg at baseline (1,007 vs. 34 au and 103 vs. 4 au/s) and 2-week follow-up (903 vs. 35 au and 70 vs. 4 au/s). Compared with baseline, PE and WiR in the thrombosed leg significantly decreased to 217 au and 18 au/s at 3-month follow-up.At baseline, hsCRP and IL-6 were elevated at 20.1 mg/mL and 8.2 pg/mL and decreased significantly to 2.8 mg/mL and 2.6 pg/mL at 2-week follow-up, remaining low after 3 months. There was a weak association between the level of inflammatory markers and the CEUS parameters at baseline on the thrombosed leg. Conclusion Elevated perivascular perfusion assessed by CEUS imaging is associated with the inflammatory response in acute DVT.
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Affiliation(s)
- Mathias Kaspar
- Department of Angiology, University Hospital Basel, University of Basel, Switzerland
| | - Stephan Imfeld
- Department of Angiology, University Hospital Basel, University of Basel, Switzerland
| | - Sasan Partovi
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, United States
| | - Markus Aschwanden
- Department of Angiology, University Hospital Basel, University of Basel, Switzerland
| | - Thomas Baldi
- Department of Angiology, University Hospital Basel, University of Basel, Switzerland
| | - Alexander Dikkes
- Department of Angiology, University Hospital Basel, University of Basel, Switzerland
| | - Deborah R Vogt
- Clinical Trial Unit, Department of Clinical Research, University Hospital Basel, University of Basel, Switzerland
| | - Dimitrios A Tsakiris
- Department of Diagnostic Haematology, University Hospital Basel, University of Basel, Switzerland
| | - Daniel Staub
- Department of Angiology, University Hospital Basel, University of Basel, Switzerland
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Seiffge DJ, Traenka C, Polymeris AA, Thilemann S, Wagner B, Hert L, Müller MD, Gensicke H, Peters N, Nickel CH, Stippich C, Sutter R, Marsch S, Fisch U, Guzman R, De Marchis GM, Lyrer PA, Bonati LH, Tsakiris DA, Engelter ST. Intravenous Thrombolysis in Patients with Stroke Taking Rivaroxaban Using Drug Specific Plasma Levels: Experience with a Standard Operation Procedure in Clinical Practice. J Stroke 2017; 19:347-355. [PMID: 28877563 PMCID: PMC5647628 DOI: 10.5853/jos.2017.00395] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 04/25/2017] [Accepted: 05/22/2017] [Indexed: 12/29/2022] Open
Abstract
Background and Purpose Standard operating procedures (SOP) incorporating plasma levels of rivaroxaban might be helpful in selecting patients with acute ischemic stroke taking rivaroxaban suitable for IVthrombolysis (IVT) or endovascular treatment (EVT). Methods This was a single-center explorative analysis using data from the Novel-Oral-Anticoagulants-in-Stroke-Patients-registry (clinicaltrials.gov:NCT02353585) including acute stroke patients taking rivaroxaban (September 2012 to November 2016). The SOP included recommendation, consideration, and avoidance of IVT if rivaroxaban plasma levels were <20 ng/mL, 20‒100 ng/mL, and >100 ng/mL, respectively, measured with a calibrated anti-factor Xa assay. Patients with intracranial artery occlusion were recommended IVT+EVT or EVT alone if plasma levels were ≤100 ng/mL or >100 ng/mL, respectively. We evaluated the frequency of IVT/EVT, door-to-needle-time (DNT), and symptomatic intracranial or major extracranial hemorrhage. Results Among 114 acute stroke patients taking rivaroxaban, 68 were otherwise eligible for IVT/EVT of whom 63 had plasma levels measured (median age 81 years, median baseline National Institutes of Health Stroke Scale 6). Median rivaroxaban plasma level was 96 ng/mL (inter quartile range [IQR] 18‒259 ng/mL) and time since last intake 11 hours (IQR 4.5‒18.5 hours). Twenty-two patients (35%) received IVT/EVT (IVT n=15, IVT+EVT n=3, EVT n=4) based on SOP. Median DNT was 37 (IQR 30‒60) minutes. None of the 31 patients with plasma levels >100 ng/mL received IVT. Among 14 patients with plasma levels ≤100 ng/mL, the main reason to withhold IVT was minor stroke (n=10). No symptomatic intracranial or major extracranial bleeding occurred after treatment. Conclusions Determination of rivaroxaban plasma levels enabled IVT or EVT in one-third of patients taking rivaroxaban who would otherwise be ineligible for acute treatment. The absence of major bleeding in our pilot series justifies future studies of this approach.
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Affiliation(s)
- David J Seiffge
- Stroke Center and Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christopher Traenka
- Stroke Center and Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Alexandros A Polymeris
- Stroke Center and Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Sebastian Thilemann
- Stroke Center and Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Benjamin Wagner
- Stroke Center and Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Lisa Hert
- Stroke Center and Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Mandy D Müller
- Stroke Center and Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Henrik Gensicke
- Stroke Center and Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Nils Peters
- Stroke Center and Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christian H Nickel
- Emergency Department and Stroke Center, University Hospital Basel, Basel, Switzerland
| | - Christoph Stippich
- Neuroradiology and Stroke Center, University Hospital Basel, Basel, Switzerland
| | - Raoul Sutter
- Intensive Care Unit and Stroke Center, University Hospital Basel, Basel, Switzerland
| | - Stephan Marsch
- Intensive Care Unit and Stroke Center, University Hospital Basel, Basel, Switzerland
| | - Urs Fisch
- Neurosurgery and Stroke Center, University Hospital Basel, Basel, Switzerland
| | - Raphael Guzman
- Neurosurgery and Stroke Center, University Hospital Basel, Basel, Switzerland
| | - Gian Marco De Marchis
- Stroke Center and Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Philippe A Lyrer
- Stroke Center and Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Leo H Bonati
- Stroke Center and Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Dimitrios A Tsakiris
- Department of Diagnostic Hematology, University Hospital Basel, Basel, Switzerland
| | - Stefan T Engelter
- Stroke Center and Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland.,Neurorehabilitation Unit, University Center for Medicine of Aging and Rehabilitation, Felix Platter Hospital, University of Basel, Basel, Switzerland
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Studt JD, Alberio L, Angelillo-Scherrer A, Asmis LM, Fontana P, Korte W, Mendez A, Schmid P, Stricker H, Tsakiris DA, Wuillemin WA, Nagler M. Accuracy and consistency of anti-Xa activity measurement for determination of rivaroxaban plasma levels. J Thromb Haemost 2017; 15:1576-1583. [PMID: 28574652 DOI: 10.1111/jth.13747] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 01/19/2017] [Indexed: 12/18/2022]
Abstract
Essentials Accurate determination of anticoagulant plasma concentration is important in clinical practice. We studied the accuracy and consistency of anti-Xa assays for rivaroxaban in a multicentre study. In a range between 50 and 200 μg L-1 , anti-Xa activity correlated well with plasma concentrations. The clinical value might be limited by overestimation and intra- and inter-individual variation. SUMMARY Background Determining the plasma level of direct oral anticoagulants reliably is important in the work-up of complex clinical situations. Objectives To study the accuracy and consistency of anti-Xa assays for rivaroxaban plasma concentration in a prospective, multicenter evaluation study employing different reagents and analytical platforms. Methods Rivaroxaban 20 mg was administered once daily to 20 healthy volunteers and blood samples were taken at peak and trough levels (clinicaltrials.gov NCT01710267). Anti-Xa activity was determined in 10 major laboratories using different reagents and analyzers; corresponding rivaroxaban plasma concentrations were measured by high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS). Findings Overall Pearson's correlation coefficient of anti-Xa levels and HPLC-MS results was 0.99 for Biophen® Heparin (95% CI, 0.99, 0.99), Biophen® DiXaI (95% CI, 0.99, 0.99) and STA® anti-Xa liquid (95% CI, 0.99, 1.00). Correlation was lower in rivaroxaban concentrations below 50 μg L-1 and above 200 μg L-1 . The overall bias of the Bland-Altman difference plot was 14.7 μg L-1 for Biophen Heparin, 17.9 μg L-1 for Biophen DiXal and 19.0 μg L-1 for STA anti-Xa liquid. Agreement between laboratories was high at peak level but limited at trough level. Conclusions Anti-Xa activity correlated well with rivaroxaban plasma concentrations, especially in a range between 50 and 200 μg L-1 . However, anti-Xa assays systematically overestimated rivaroxaban concentration as compared with HPLC-MS, particularly at higher concentrations. This overestimation, coupled with an apparent interindividual variation, might affect the interpretation of results in some situations.
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Affiliation(s)
- J-D Studt
- Division of Haematology, University Hospital and University of Zurich, Zurich, Switzerland
| | - L Alberio
- Service and Central Laboratory of Haematology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - A Angelillo-Scherrer
- Department of Haematology, Inselspital, Bern University Hospital, Berne, Switzerland
- Department of Clinical Research, University of Bern, Berne, Switzerland
| | | | - P Fontana
- Division of Angiology and Haemostasis, University Hospitals of Geneva, Geneva, Switzerland
| | - W Korte
- Institute for Clinical Chemistry and Haematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - A Mendez
- Centre for Laboratory Medicine, Cantonal Hospital Aarau, Aarau, Switzerland
| | - P Schmid
- Division of Haematology and Central Haematology Laboratory, Luzerner Kantonsspital, Lucerne, Switzerland
| | - H Stricker
- Division of Surgery, Regional Hospital La Carita, Locarno, Switzerland
| | - D A Tsakiris
- Diagnostic Haematology, University Hospital of Basel, Basel, Switzerland
| | - W A Wuillemin
- Division of Haematology and Central Haematology Laboratory, Luzerner Kantonsspital, Lucerne, Switzerland
- Department of Clinical Research, University of Berne, Berne, Switzerland
| | - M Nagler
- Department of Haematology, Inselspital, Bern University Hospital, Berne, Switzerland
- Division of Haematology and Central Haematology Laboratory, Luzerner Kantonsspital, Lucerne, Switzerland
- Department of Clinical Research, University of Berne, Berne, Switzerland
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Bulla O, Poncet A, Alberio L, Asmis LM, Gähler A, Graf L, Nagler M, Studt JD, Tsakiris DA, Fontana P. Impact of a product-specific reference standard for the measurement of a PEGylated rFVIII activity: the Swiss Multicentre Field Study. Haemophilia 2017; 23:e335-e339. [PMID: 28544263 DOI: 10.1111/hae.13250] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2017] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Measuring factor VIII (FVIII) activity can be challenging when it has been modified, such as when FVIII is pegylated to increase its circulating half-life. Use of a product-specific reference standard may help avoid this issue. AIM Evaluate the impact of using a product-specific reference standard for measuring the FVIII activity of BAX 855 - a pegylated FVIII - in eight of Switzerland's main laboratories. METHODS Factor VIII-deficient plasma, spiked with five different concentrations of BAX 855, plus a control FVIII sample, was sent to the participating laboratories. They measured FVIII activity by using either with a one-stage (OSA) or the chromogenic assay (CA) against their local or a product-specific reference standard. RESULTS When using a local reference standard, there was an overestimation of BAX 855 activity compared to the target concentrations, both with the OSA and CA. The use of a product-specific reference standard reduced this effect: mean recovery ranged from 127.7% to 213.5% using the OSA with local reference standards, compared to 110% to 183.8% with a product-specific reference standard, and from 146.3% to 182.4% using the CA with local reference standards compared to 72.7% to 103.7% with a product-specific reference standard. CONCLUSION In this in vitro study, the type of reference standard had a major impact on the measurement of BAX 855 activity. Evaluation was more accurate and precise when using a product-specific reference standard.
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Affiliation(s)
- O Bulla
- Division of Angiology and Haemostasis and Laboratory of Haemostasis, Geneva University Hospitals, Geneva, Switzerland
| | - A Poncet
- CRC and Division of Clinical Epidemiology, Department of Health and Community Medicine, University of Geneva and University Hospitals of Geneva, Geneva, Switzerland
| | - L Alberio
- Division of Haematology and Haematology Central Laboratory, CHUV Lausanne University Hospital, Lausanne, Switzerland
| | - L M Asmis
- Center for Perioperative Thrombosis and Haemostasis and Unilabs Coagulation Laboratory, Zurich, Switzerland
| | - A Gähler
- Division of haematology and Laboratory of haematology, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - L Graf
- Centre for Laboratory Medicine, Haemostasis and Haemophilia Centre St Gallen, St Gallen, Switzerland
| | - M Nagler
- Department of Haematology and Central Haematology Laboratory, Inselspital University Hospital, Bern, Switzerland.,Department of Clinical Research, University of Bern, Bern, Switzerland
| | - J-D Studt
- Division of Haematology, University Hospital Zürich, Zürich, Switzerland
| | - D A Tsakiris
- Diagnostic Haematology, University Hospital Basel, Basel, Switzerland
| | - P Fontana
- Division of Angiology and Haemostasis and Laboratory of Haemostasis, Geneva University Hospitals, Geneva, Switzerland
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Fontana P, Alberio L, Angelillo-Scherrer A, Asmis LM, Korte W, Mendez A, Schmid P, Stricker H, Studt JD, Tsakiris DA, Wuillemin WA, Nagler M. Impact of rivaroxaban on point-of-care assays. Thromb Res 2017; 153:65-70. [DOI: 10.1016/j.thromres.2017.03.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 01/11/2017] [Accepted: 03/19/2017] [Indexed: 12/25/2022]
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Abstract
Zusammenfassung. Während der Behandlung mit direkten oralen Antikoagulantien (DOACs) sind meist keine Kontrollen der gerinnungshemmenden Wirkung oder der Medikamenten-Plasmaspiegel erforderlich. Bei Überdosierung, Medikamenteninteraktionen, Nieren- oder Leberinsuffizienz, sowie in vielen Notfallsituationen können solche Kontrollen erforderlich werden. Es sind Test-Kits zur Plasmaspiegel-Messung der meisten DOACs erhältlich. Stehen diese im Alltag nicht zur Verfügung, kann die Bestimmung der Faktor-Xa-Aktivität, der Thrombinzeit oder der aktivierten partiellen Thromboplastinzeit hilfreich sein. Der zeitliche Abstand der Blutentnahme zur Einnahme eines DOAC hat einen entscheidenden Einfluss auf die Resultate der Gerinnungstests.
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Affiliation(s)
- Ramona Merki
- 1 Diagnostische Hämatologie, Universitätsspital Basel
| | - Heike Schwarb
- 1 Diagnostische Hämatologie, Universitätsspital Basel
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Paczulla AM, Dirnhofer S, Konantz M, Medinger M, Salih HR, Rothfelder K, Tsakiris DA, Passweg JR, Lundberg P, Lengerke C. Long-term observation reveals high-frequency engraftment of human acute myeloid leukemia in immunodeficient mice. Haematologica 2017; 102:854-864. [PMID: 28183848 PMCID: PMC5477604 DOI: 10.3324/haematol.2016.153528] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 02/06/2017] [Indexed: 12/13/2022] Open
Abstract
Repopulation of immunodeficient mice remains the primary method for functional assessment of human acute myeloid leukemia. Published data report engraftment in ~40–66% of cases, mostly of intermediate- or poor-risk subtypes. Here we report that extending follow-up beyond the standard analysis endpoints of 10 to 16 weeks after transplantation permitted leukemic engraftment from nearly every case of xenotransplanted acute myeloid leukemia (18/19, ~95%). Xenogeneic leukemic cells showed conserved immune pheno-types and genetic signatures when compared to corresponding pre-transplant cells and, furthermore, were able to induce leukemia in re-transplantation assays. Importantly, bone marrow biopsies taken at standardized time points failed to detect leukemic cells in 11/18 of cases that later showed robust engraftment (61%, termed “long-latency engrafters”), indicating that leukemic cells can persist over months at undetectable levels without losing disease-initiating properties. Cells from favorable-risk leukemia subtypes required longer to become detectable in NOD/SCID/IL2Rγnull mice (27.5±9.4 weeks) than did cells from intermediate-risk (21.9±9.4 weeks, P<0.01) or adverse-risk (17±7.6 weeks; P<0.0001) subtypes, explaining why the engraftment of the first was missed with previous protocols. Mechanistically, leukemic cells engrafting after a prolonged latency showed inferior homing to the bone marrow. Finally, we applied our model to favorable-risk acute myeloid leukemia with inv(16); here, we showed that CD34+ (but not CD34−) blasts induced robust, long-latency engraftment and expressed enhanced levels of stem cell genes. In conclusion, we provide a model that allows in vivo mouse studies with a wide range of molecular subtypes of acute myeloid leukemia subtypes which were previously considered not able to engraft, thus enabling novel insights into leukemogenesis.
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Affiliation(s)
- Anna M Paczulla
- University of Basel and University Hospital Basel, Department of Biomedicine, Switzerland
| | - Stephan Dirnhofer
- University of Basel and University Hospital Basel, Department of Pathology, Switzerland
| | - Martina Konantz
- University of Basel and University Hospital Basel, Department of Biomedicine, Switzerland
| | - Michael Medinger
- University of Basel and University Hospital Basel, Clinic for Hematology, Switzerland
| | - Helmut R Salih
- Clinical Collaboration Unit Translational Immunology, German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Partner site Tübingen, Department for Internal Medicine II, Tübingen, Germany.,Department of Hematology and Oncology, Eberhard-Karls-University, Tübingen, Germany
| | - Kathrin Rothfelder
- Clinical Collaboration Unit Translational Immunology, German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Partner site Tübingen, Department for Internal Medicine II, Tübingen, Germany.,Department of Hematology and Oncology, Eberhard-Karls-University, Tübingen, Germany
| | - Dimitrios A Tsakiris
- University of Basel and University Hospital Basel, Diagnostic Hematology, Switzerland
| | - Jakob R Passweg
- University of Basel and University Hospital Basel, Clinic for Hematology, Switzerland
| | - Pontus Lundberg
- University of Basel and University Hospital Basel, Diagnostic Hematology, Switzerland
| | - Claudia Lengerke
- University of Basel and University Hospital Basel, Department of Biomedicine, Switzerland .,University of Basel and University Hospital Basel, Clinic for Hematology, Switzerland.,Department of Hematology and Oncology, Eberhard-Karls-University, Tübingen, Germany
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Abstract
The utility of thrombophilia testing in clinical practice is still a matter of debate because studies have not shown a benefit in the reduction of recurrent venous thromboembolism (VTE) risk in patients with thrombosis, despite the clearly higher VTE risk for first thrombosis. Screening for thrombophilia is indicated in selected patients. Particularly in selected young patients, especially women of childbearing age, the knowledge of the genetic thrombophilic defect may help in specific situations to decrease the risk of VTE events. Avoidance of modifiable risk factors and/or prophylactic thromboembolic procedures may be evaluated in selected patients. A comprehensive workup including personal and familial history, clinical examination, and laboratory test results including hereditary thrombophilia remains helpful in assessing the cumulative risk and the management of this group of selected patients.
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Affiliation(s)
- Giuseppe Colucci
- 1 Service of Hematology, Clinica Luganese Moncucco, Lugano and synlab Suisse, Lucerne, Switzerland.,2 Diagnostic Hematology, Department of Hematology, University Hospital Basel, Basel, Switzerland
| | - Dimitrios A Tsakiris
- 2 Diagnostic Hematology, Department of Hematology, University Hospital Basel, Basel, Switzerland
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Sadlon AH, Tsakiris DA. Direct oral anticoagulants in the elderly: systematic review and meta-analysis of evidence, current and future directions. Swiss Med Wkly 2016; 146:w14356. [PMID: 27683276 DOI: 10.4414/smw.2016.14356] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Concerns regarding the use of direct oral anticoagulants (DOACs: apixaban, dabigatran, edoxaban, rivaroxaban) in the elderly persist owing to the lack of randomised controlled trials targeting this age group. OBJECTIVES The aim of this study was to assess the efficacy and safety of DOACs in elderly patients (aged 75 years or more) with atrial fibrillation or venous thromboembolism (VTE), based on already published large randomised trials. METHODS EMBASE, MEDLINE and the Cochrane Library were searched from inception to June 2015 for phase III trials. Pooled odds ratios with 95% confidence intervals were calculated for the target population using the fixed effect model. Heterogeneity between trials was assessed using the I2 Higgins test. RESULTS A total of 30 655 participants aged 75 or older from eight studies (two apixaban, one dabigatran, two edoxaban, three rivaroxaban) were included in the statistical evaluation. Pooled analysis revealed that treatment with a DOAC was associated with a statistically significant odds reduction for stroke and embolism in elderly patients with atrial fibrillation. Also, DOACs significantly reduced the number of recurrent VTE events or VTE-related deaths in the participants aged 75 years or more with VTE. There was no statistically significant difference in safety outcome for both indications with DOAC compared with vitamin K antagonists although some differences in safety profiles between the DOACs were apparent. CONCLUSION DOACs show the same or greater efficacy than vitamin K antagonists in elderly patients with atrial fibrillation and VTE. Individual differences between DOACs in terms of safety profile cannot be excluded on the basis of current evidence. Direct head-to-head comparisons are needed to investigate possible divergence in pharmacological profiles between DOACs. Additionally, further studies conducted in real-word settings and in the frail elderly are ongoing and it would be interesting to target this particular patient group.
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Affiliation(s)
- Angelique H Sadlon
- Department of Diagnostic Haematology, University Hospital Basel, Switzerland
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Schwarb H, Tsakiris DA. New Direct Oral Anticoagulants (DOAC) and Their Use Today. Dent J (Basel) 2016; 4:dj4010005. [PMID: 29563447 PMCID: PMC5851208 DOI: 10.3390/dj4010005] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Revised: 03/05/2016] [Accepted: 03/09/2016] [Indexed: 12/19/2022] Open
Abstract
The ideal anticoagulant is oral, has a wide therapeutic range, predictable pharmacokinetics and pharmacodynamics, a rapid onset of action, an available antidote, minimal side effects and minimal interactions with other drugs or food. With the development of the novel direct oral anticoagulants (DOAC), we now have an alternative to the traditional vitamin K antagonists (VKA) for the prevention and treatment of thrombosis. DOACs have limited monitoring requirements and very predictable pharmacokinetic profiles. They were shown to be non-inferior or superior to VKA in the prophylaxis or treatment of thromboembolic events. Particularly in terms of safety they were associated with less major bleeding, including intracranial bleeding, thus providing a superior benefit for the prevention of stroke in patients with atrial fibrillation. Despite these advantages, there are remaining limitations with DOACs: their dependence on renal and hepatic function for clearance and the lack of an approved reversal agent, whereas such antidotes are successively being made available. DOACs do not need regular monitoring to assess the treatment effect but, on the other hand, they interact with other drugs and interfere with functional coagulation assays. From a practical point of view, the properties of oral administration, simple dosing without monitoring, a short half-life allowing for the possibility of uncomplicated switching or bridging, and proven safety overwhelm the disadvantages, making them an attractive option for short- or long-term anticoagulation.
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Affiliation(s)
- Heike Schwarb
- Heike Schwarb, Diagnostic Hematology, University Hospital Basel, CH-4031 Basel, Switzerland.
| | - Dimitrios A Tsakiris
- Heike Schwarb, Diagnostic Hematology, University Hospital Basel, CH-4031 Basel, Switzerland.
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Timper K, Seelig E, Tsakiris DA, Donath MY. Safety, pharmacokinetics, and preliminary efficacy of a specific anti-IL-1alpha therapeutic antibody (MABp1) in patients with type 2 diabetes mellitus. J Diabetes Complications 2015; 29:955-60. [PMID: 26139558 DOI: 10.1016/j.jdiacomp.2015.05.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 05/24/2015] [Accepted: 05/26/2015] [Indexed: 10/23/2022]
Abstract
AIMS The role of the IL-1 system in development of type 2 diabetes is well established. Using an IL-1 receptor antagonist, which blocks IL-1alpha and -beta activity, or by specifically neutralizing IL-1beta, several clinical studies have demonstrated improvement in insulin secretion and glycaemia. However, the role of IL-1alpha remains to be investigated. METHODS We evaluated the safety and preliminary efficacy of a neutralizing true human™ monoclonal antibody against IL-1alpha (MABp1) in an open label trial in patients with type 2 diabetes. Seven patients between 50 to 66years with type 2 diabetes mellitus were enrolled in the study. The study subjects received four biweekly intravenous infusions of MABp1 at 1.25mg/kg body weight up to day 60 and were followed up for a total of 90days. RESULTS Compared to baseline, after the 60-day period of treatment HbA1c was numerically reduced by 0.14±0.21% (p=0.15), fasting C-peptide was increased by 88% (p=0.03), pro-insulin by 48% (p=0.03) and insulin numerically increased by 74% (p=0.11). Systolic blood pressure numerically decreased by 11mmHg (p=0.2). Both HbA1c and blood pressure rebounded to baseline levels thirty days after the end of MABp1 application. Treatment with MABp1 was well tolerated, and no adverse events occurred during the study. CONCLUSION The results point to a role of IL-1alpha in type 2 diabetes and encourage further investigations. (ClinicalTrials.gov number NCT01427699).
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Affiliation(s)
- Katharina Timper
- University Hospital of Basel, Department of Endocrinology, Diabetes, and Metabolism, Basel, Switzerland.
| | - Eleonora Seelig
- University Hospital of Basel, Department of Endocrinology, Diabetes, and Metabolism, Basel, Switzerland
| | - Dimitrios A Tsakiris
- University Hospital of Basel, Department of Diagnostic Hematology, Basel, Switzerland
| | - Marc Y Donath
- University Hospital of Basel, Department of Endocrinology, Diabetes, and Metabolism, Basel, Switzerland
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Schäfer C, O'Meara A, Tsakiris DA, Medinger M, Passweg JR, Stern M. Influence of selective serotonin reuptake inhibitors on bleeding risk in patients with severe thrombocytopenia after chemotherapy: a retrospective study. Acta Haematol 2014; 133:317-20. [PMID: 25471100 DOI: 10.1159/000366551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 08/12/2014] [Indexed: 11/19/2022]
Affiliation(s)
- Claudia Schäfer
- Division of Hematology, University Hospital Basel, Basel, Switzerland
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Abstract
Direct oral anticoagulants (DOACs) have been established and already registered for clinical use on a wide basis in the United States and Europe. Different from the vitamin K antagonists (VKA), their mode of action is based on the direct inhibition of the single coagulation enzymes factor Xa or IIa. Other laboratory tests of hemostasis, such as the global tests prothrombin time (PT/INR) and activated partial thromboplastin time (APTT), or various functional coagulation assays involving generation of factor Xa or IIa for their endpoints, can be negatively influenced by the presence of the anticoagulant in the test sample. This interference has been well documented for rivaroxaban, apixaban, and dabigatran and is most prominent during the first hours after intake of the respective agent. Thus, the potential influence of DOACs has always to be considered when interpreting abnormal functional coagulation assays.
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Holbro A, Graf L, Topalidou M, Bucher C, Passweg JR, Tsakiris DA. Cryopreserved stem cell products containing dimethyl sulfoxide lead to activation of the coagulation system without any impact on engraftment. Transfusion 2013; 54:1508-14. [PMID: 24304039 DOI: 10.1111/trf.12511] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 10/14/2013] [Accepted: 10/22/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Dimethyl sulfoxide (DMSO) is extensively used as a cryoprotectant in stem cell preservation. Little is known on direct hemostatic changes in recipients of hematopoietic stem cell transplantation (HSCT), immediately after DMSO administration. The objectives of the current study were to measure hemostatic changes during HSCT. STUDY DESIGN AND METHODS In this prospective analysis, changes in plasma biomarkers, platelets (PLTs), or endothelial cells (D-dimers, thrombin-antithrombin complex [TAT], microparticle activity as thrombin-generation potential [MPA], whole blood aggregation, von Willebrand factor) were measured before and immediately after HSCT. Furthermore, associations with clinical complications were recorded. RESULTS A total of 54 patients were included in the study. Mean MPA and TAT increased significantly immediately after HSCT, returning to baseline the day after the procedure (p<0.01). No significant differences in engraftment for neutrophils and PLTs were found in patients presenting a high increase of TAT or MPA compared with those presenting with a smaller increase. Patients with a high increase in TAT and MPA had received a greater number of total mononucleated cells (p<0.001) and higher transplant volumes (p=0.002). CONCLUSIONS Infusion of stem cells containing DMSO reversibly activated coagulation, measured as thrombin generation. This finding was not associated with acute adverse events and did not influence engraftment. Further studies are needed to compare variable DMSO concentrations as well as DMSO-free products, to better address the influence of DMSO on hemostasis.
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Affiliation(s)
- Andreas Holbro
- Department of Hematology and Diagnostic Hematology, University Hospital Basel, Basel, Switzerland; Blood Transfusion Centre, Swiss Red Cross, Basel, Switzerland
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