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Bounaix L, Schroeder V, Fontana P, Casini A. Management of anticoagulation and factor XIII replacement in a patient with severe factor XIII deficiency and recurrent venous thromboembolic disease: case report and review of literature. Res Pract Thromb Haemost 2024; 8:102371. [PMID: 38595334 PMCID: PMC11002293 DOI: 10.1016/j.rpth.2024.102371] [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: 12/04/2023] [Revised: 02/23/2024] [Accepted: 03/07/2024] [Indexed: 04/11/2024] Open
Abstract
Background Thrombotic events in congenital factor (F)XIII deficiency are extremely rare. To our knowledge, we describe the first case of severe congenital FXIII deficiency associated with recurrent venous thrombotic events. Key Clinician Question How to deal with anticoagulation treatment in patients with severe FXIII deficiency? Clinical Approach The patient was treated with rivaroxaban and plasma-derived FXIII substitution therapy as prophylaxis without bleeding complications. We aimed at FXIII trough levels of 50% during the loading doses of rivaroxaban, then 30% during the maintenance dose of rivaroxaban, and finally 20% during the long-term use of prophylactic dose of rivaroxaban. Conclusion Treatment of thrombotic events with rivaroxaban in patients with severe bleeding disorders seems to be safe, requiring an adaptation of the intensity of the replacement therapy.
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Affiliation(s)
- Laura Bounaix
- Division of Angiology and Haemostasis, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Verena Schroeder
- Experimental Haemostasis Group, Department for BioMedical Research (DBMR), University of Bern, Bern, Switzerland
| | - Pierre Fontana
- Division of Angiology and Haemostasis, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Alessandro Casini
- Division of Angiology and Haemostasis, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
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Casini A, Robert-Ebadi H, Glauser F, Blondon M, Fontana P, Righini M. [Angiology and hemostasis: what's new in 2023]. Rev Med Suisse 2024; 20:15-18. [PMID: 38231093 DOI: 10.53738/revmed.2024.20.856-7.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
We discuss four topics among the angiology and hemostasis studies of importance in 2023. The BASIL-2 study provides new data for the management of chronic limb-threatening ischemia by comparing surgical and endovascular treatment. The new classification of antiphospholipid antibody (aPL) syndrome integrates new clinical elements and gives a different weight among the isotype and titer of aPL. Concizumab, an antibody targeting the tissue factor pathway inhibitor, broadens the therapeutic arsenal for hemophilia A and B as evidenced by the results of the EXPLORER 7 study. The PREVENT-CLOT and CASTING study focus on the prevention of thrombosis after trauma, by testing the role of aspirin or the lack of thromboprophylaxis, respectively.
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Affiliation(s)
- Alessandro Casini
- Service d'angiologie et hémostase, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Helia Robert-Ebadi
- Service d'angiologie et hémostase, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Fréderic Glauser
- Service d'angiologie et hémostase, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Marc Blondon
- Service d'angiologie et hémostase, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Pierre Fontana
- Service d'angiologie et hémostase, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Marc Righini
- Service d'angiologie et hémostase, Hôpitaux universitaires de Genève, 1211 Genève 14
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Hugon-Rodin J, Fontana P, Poncet A, Streuli I, Casini A, Blondon M. Longitudinal profile of estrogen-related thrombotic biomarkers after cessation of combined hormonal contraceptives. Blood 2024; 143:70-78. [PMID: 37939264 DOI: 10.1182/blood.2023021717] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/28/2023] [Accepted: 09/13/2023] [Indexed: 11/10/2023] Open
Abstract
ABSTRACT The persistence of risk of venous thromboembolism (VTE) due to combined hormonal contraceptives (CHCs), after their cessation, is unknown but important to guide clinical practice. The objective of this prospective cohort study was to define the time until normalization of estrogen-related thrombotic biomarkers after CHC cessation. We enrolled women aged 18 to 50 years who had decided to stop their CHC, excluding those with a personal history of VTE, anticoagulation, or pregnancy. The study started before cessation of CHC, with 6 visits afterwards (at 1, 2, 4, 6, and 12 weeks after cessation). Primary outcomes were normalized sensitivity ratios to activated protein C (nAPCsr) and to thrombomodulin (nTMsr), with sex hormone-binding globulin (SHBG) as a secondary end point. We also included control women without CHC. Among 66 CHC users, from baseline until 12 weeks, average levels of nAPCsr, nTMsr, and SHBG decreased from 4.11 (standard deviation [SD], 2.06), 2.53 (SD, 1.03), and 167 nmol/L (SD, 103) to 1.27 (SD, 0.82), 1.11 (SD, 0.58), and 55.4 nmol/L (SD, 26.7), respectively. On a relative scale, 85.8%, 81.3%, and 76.2% of the decrease from baseline until 12 weeks was achieved at 2 weeks and 86.7%, 85.5%, and 87.8% at 4 weeks after CHC cessation, respectively. Levels were not meaningfully modified throughout the study period among 28 control women. In conclusion, CHC cessation is followed by a rapid decrease in estrogen-related thrombotic biomarkers. Two to 4 weeks of cessation before planned major surgery or withdrawal of anticoagulants in patients with VTE appears sufficient for the majority of women. The trial is registered at www.clinicaltrials.gov as #NCT03949985.
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Affiliation(s)
- Justine Hugon-Rodin
- Division of Gynecology, University Hospitals of Geneva and Faculty of Medicine, Geneva, Switzerland
- Gynecology Department, Gynecological Endocrinology Unit, Hospital Saint Joseph, INSERM Unité Mixte de Recherche 1153, Équipe de Recherche en Épidémiologie Obstétricale Périnatale et Pédiatrique, Paris, France
| | - Pierre Fontana
- Division of Angiology and Hemostasis, University Hospitals of Geneva and Faculty of Medicine, Geneva, Switzerland
| | - Antoine Poncet
- Center for Clinical Research, University Hospitals of Geneva and Faculty of Medicine, Geneva, Switzerland
| | - Isabelle Streuli
- Division of Gynecology, University Hospitals of Geneva and Faculty of Medicine, Geneva, Switzerland
| | - Alessandro Casini
- Division of Angiology and Hemostasis, University Hospitals of Geneva and Faculty of Medicine, Geneva, Switzerland
| | - Marc Blondon
- Division of Angiology and Hemostasis, University Hospitals of Geneva and Faculty of Medicine, Geneva, Switzerland
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Mazzolai L, Fontana P, Righini M. Le pouvoir des itinéraires cliniques : assurer une gestion optimale. Rev Med Suisse 2023; 19:2275-2276. [PMID: 38063444 DOI: 10.53738/revmed.2023.19.853.2275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Affiliation(s)
- Lucia Mazzolai
- Service d'angiologie, Centre hospitalier universitaire vaudois et Université de Lausanne
| | - Pierre Fontana
- Service d'angiologie et d'hémostase, Hôpitaux universitaires de Genève et Université de Genève
| | - Marc Righini
- Service d'angiologie et d'hémostase, Hôpitaux universitaires de Genève et Université de Genève
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Terrier J, Gaspar F, Gosselin P, Raboud O, Lenoir C, Rollason V, Csajka C, Samer C, Fontana P, Daali Y, Reny J. Apixaban and rivaroxaban's physiologically-based pharmacokinetic model validation in hospitalized patients: A first step for larger use of a priori modeling approach at bed side. CPT Pharmacometrics Syst Pharmacol 2023; 12:1872-1883. [PMID: 37794718 PMCID: PMC10725260 DOI: 10.1002/psp4.13036] [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] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/21/2023] [Accepted: 08/14/2023] [Indexed: 10/06/2023] Open
Abstract
When used in real-world conditions, substantial interindividual variations in direct oral anticoagulant (DOAC) plasma concentrations are observed for a given dose, leading to a risk of over- or under-exposure and clinically significant adverse events. Physiologically-based pharmacokinetic (PBPK) models could help physicians to tailor DOAC prescriptions in vulnerable patient populations, such as those in the hospital setting. The present study aims to validate prospectively PBPK models for rivaroxaban and apixaban in a large cohort of elderly, polymorbid, and hospitalized patients. In using a model of geriatric population integrating appropriate physiological parameters into models first optimized with healthy volunteer data, observed plasma concentration collected in hospitalized patients on apixaban (n = 100) and rivaroxaban (n = 100) were adequately predicted (ratio predicted/observed area under the concentration curve for a dosing interval [AUCtau ] = 0.97 [0.96-0.99] geometric mean, 90% confidence interval, ratio predicted/observed AUCtau = 1.03 [1.02-1.05]) for apixaban and rivaroxaban, respectively. Validation of the present PBPK models for rivaroxaban and apixaban in in-patients represent an additional step toward the feasibility of bedside use.
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Affiliation(s)
- Jean Terrier
- Division of General Internal MedicineGeneva University HospitalsGenevaSwitzerland
- Geneva Platelet Group, Faculty of MedicineUniversity of GenevaGenevaSwitzerland
- Clinical Pharmacology and Toxicology Service, Anesthesiology, Pharmacology and Intensive Care DepartmentGeneva University HospitalsGenevaSwitzerland
| | - Frédéric Gaspar
- Center for Research and Innovation in Clinical Pharmaceutical SciencesLausanne University Hospital and University of LausanneLausanneSwitzerland
- School of Pharmaceutical SciencesUniversity of GenevaGenevaSwitzerland
- Institute of Pharmaceutical Sciences of Western SwitzerlandUniversity of Geneva, University of LausanneGeneva, LausanneSwitzerland
- Service of Clinical PharmacologyLausanne University Hospital and University of LausanneLausanneSwitzerland
| | - Pauline Gosselin
- Division of General Internal MedicineGeneva University HospitalsGenevaSwitzerland
| | - Olivier Raboud
- Center for Research and Innovation in Clinical Pharmaceutical SciencesLausanne University Hospital and University of LausanneLausanneSwitzerland
- School of Pharmaceutical SciencesUniversity of GenevaGenevaSwitzerland
- Institute of Pharmaceutical Sciences of Western SwitzerlandUniversity of Geneva, University of LausanneGeneva, LausanneSwitzerland
- Service of Clinical PharmacologyLausanne University Hospital and University of LausanneLausanneSwitzerland
| | - Camille Lenoir
- Clinical Pharmacology and Toxicology Service, Anesthesiology, Pharmacology and Intensive Care DepartmentGeneva University HospitalsGenevaSwitzerland
| | - Victoria Rollason
- Clinical Pharmacology and Toxicology Service, Anesthesiology, Pharmacology and Intensive Care DepartmentGeneva University HospitalsGenevaSwitzerland
| | - Chantal Csajka
- School of Pharmaceutical SciencesUniversity of GenevaGenevaSwitzerland
- Institute of Pharmaceutical Sciences of Western SwitzerlandUniversity of Geneva, University of LausanneGeneva, LausanneSwitzerland
- Service of Clinical PharmacologyLausanne University Hospital and University of LausanneLausanneSwitzerland
| | - Caroline Samer
- Clinical Pharmacology and Toxicology Service, Anesthesiology, Pharmacology and Intensive Care DepartmentGeneva University HospitalsGenevaSwitzerland
- School of Pharmaceutical SciencesUniversity of GenevaGenevaSwitzerland
| | - Pierre Fontana
- Geneva Platelet Group, Faculty of MedicineUniversity of GenevaGenevaSwitzerland
- Division of Angiology and HaemostasisGeneva University HospitalsGenevaSwitzerland
| | - Youssef Daali
- Geneva Platelet Group, Faculty of MedicineUniversity of GenevaGenevaSwitzerland
- Clinical Pharmacology and Toxicology Service, Anesthesiology, Pharmacology and Intensive Care DepartmentGeneva University HospitalsGenevaSwitzerland
| | - Jean‐Luc Reny
- Division of General Internal MedicineGeneva University HospitalsGenevaSwitzerland
- Geneva Platelet Group, Faculty of MedicineUniversity of GenevaGenevaSwitzerland
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Gaspar F, Terrier J, Favre S, Gosselin P, Fontana P, Daali Y, Lenoir C, Samer CF, Rollason V, Reny J, Csajka C, Guidi M. Population pharmacokinetics of apixaban in a real-life hospitalized population from the OptimAT study. CPT Pharmacometrics Syst Pharmacol 2023; 12:1541-1552. [PMID: 37723920 PMCID: PMC10583248 DOI: 10.1002/psp4.13032] [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] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 07/19/2023] [Accepted: 08/09/2023] [Indexed: 09/20/2023] Open
Abstract
This study aimed to characterize apixaban pharmacokinetics (PKs) and its variability in a real-world clinical setting of hospitalized patients using a population PK (PopPK) approach. Model-based simulations helped to identify factors that affect apixaban exposure and their clinical significance. A classic stepwise strategy was applied to determine the best PopPK model for describing typical apixaban PKs in hospitalized patients from the OptimAT study (n = 100) and evaluating the associated variability and influencing factors. Apixaban exposure under specific conditions was assessed using the final model. A two-compartment model with first-order absorption and elimination best described the data. The developed PopPK model revealed a major role of renal function and a minor role of P-glycoprotein phenotypic (P-gp) activity in explaining apixaban variability. The final model indicated that a patient with stage 4 chronic kidney disease (creatinine clearance [CLcr] = 15-29 mL/min) would have a 45% higher drug exposure than a patient with normal renal function (CLcr >90 mL/min), with a further 12% increase if the patient was also a poor metabolizer of P-gp. A high interindividual variability in apixaban PKs was observed in a real-life setting, which was partially explained by renal function and by P-gp phenotypic activity. Target apixaban concentrations are reached under standard dosage regimens, but overexposure can rapidly occur in the presence of cumulative factors warranting the development of a predictive tool for tailoring apixaban exposure and its clinical utility in at-risk patients.
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Affiliation(s)
- Frédéric Gaspar
- Center for Research and Innovation in Clinical Pharmaceutical SciencesLausanne University Hospital and University of LausanneLausanneSwitzerland
- School of Pharmaceutical SciencesUniversity of GenevaGenevaSwitzerland
- Institute of Pharmaceutical Sciences of Western SwitzerlandUniversity of Geneva, University of LausanneGeneva, LausanneSwitzerland
| | - Jean Terrier
- Division of General Internal MedicineGeneva University HospitalsGenevaSwitzerland
- Geneva Platelet Group, Faculty of MedicineUniversity of GenevaGenevaSwitzerland
- Division of Clinical Pharmacology and Toxicology, Anesthesiology, Pharmacology, Intensive Care, and Emergency Medicine DepartmentGeneva University HospitalsGenevaSwitzerland
| | - Samantha Favre
- Center for Research and Innovation in Clinical Pharmaceutical SciencesLausanne University Hospital and University of LausanneLausanneSwitzerland
- School of Pharmaceutical SciencesUniversity of GenevaGenevaSwitzerland
- Institute of Pharmaceutical Sciences of Western SwitzerlandUniversity of Geneva, University of LausanneGeneva, LausanneSwitzerland
| | - Pauline Gosselin
- Division of General Internal MedicineGeneva University HospitalsGenevaSwitzerland
- Geneva Platelet Group, Faculty of MedicineUniversity of GenevaGenevaSwitzerland
| | - Pierre Fontana
- Geneva Platelet Group, Faculty of MedicineUniversity of GenevaGenevaSwitzerland
- Division of Angiology and HaemostasisGeneva University HospitalsGenevaSwitzerland
| | - Youssef Daali
- Geneva Platelet Group, Faculty of MedicineUniversity of GenevaGenevaSwitzerland
- Division of Clinical Pharmacology and Toxicology, Anesthesiology, Pharmacology, Intensive Care, and Emergency Medicine DepartmentGeneva University HospitalsGenevaSwitzerland
| | - Camille Lenoir
- Division of Clinical Pharmacology and Toxicology, Anesthesiology, Pharmacology, Intensive Care, and Emergency Medicine DepartmentGeneva University HospitalsGenevaSwitzerland
| | - Caroline Flora Samer
- Division of Clinical Pharmacology and Toxicology, Anesthesiology, Pharmacology, Intensive Care, and Emergency Medicine DepartmentGeneva University HospitalsGenevaSwitzerland
- Faculty of MedicineUniversity of GenevaGenevaSwitzerland
| | - Victoria Rollason
- Division of Clinical Pharmacology and Toxicology, Anesthesiology, Pharmacology, Intensive Care, and Emergency Medicine DepartmentGeneva University HospitalsGenevaSwitzerland
- Faculty of MedicineUniversity of GenevaGenevaSwitzerland
| | - Jean‐Luc Reny
- Division of General Internal MedicineGeneva University HospitalsGenevaSwitzerland
- Geneva Platelet Group, Faculty of MedicineUniversity of GenevaGenevaSwitzerland
| | - Chantal Csajka
- Center for Research and Innovation in Clinical Pharmaceutical SciencesLausanne University Hospital and University of LausanneLausanneSwitzerland
- School of Pharmaceutical SciencesUniversity of GenevaGenevaSwitzerland
- Institute of Pharmaceutical Sciences of Western SwitzerlandUniversity of Geneva, University of LausanneGeneva, LausanneSwitzerland
| | - Monia Guidi
- Center for Research and Innovation in Clinical Pharmaceutical SciencesLausanne University Hospital and University of LausanneLausanneSwitzerland
- Institute of Pharmaceutical Sciences of Western SwitzerlandUniversity of Geneva, University of LausanneGeneva, LausanneSwitzerland
- Service of Clinical PharmacologyLausanne University Hospital and University of LausanneLausanneSwitzerland
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Terrier J, Mach A, Fontana P, Bonhomme F, Casini A. Clinicians' adherence to guidelines for the preoperative management of direct oral anticoagulants in a tertiary hospital: a retrospective study. BMC Anesthesiol 2023; 23:314. [PMID: 37715136 PMCID: PMC10503177 DOI: 10.1186/s12871-023-02276-w] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 09/10/2023] [Indexed: 09/17/2023] Open
Abstract
INTRODUCTION Despite clear, relatively easy-to-use guidance, many clinicians find the preoperative management of direct oral anticoagulants (DOACs) challenging. Inappropriate management can delay procedures and lead to haemorrhagic or thromboembolic complications. We aimed to describe preoperative management practices regarding DOACs in a tertiary hospital and clinicians' adherence to in-house recommendations. METHOD We included all patients being treated with DOACs who underwent elective surgery in 2019 and 2020 (n = 337). In-house recommendations for perioperative management were largely comparable to the 2022 American College of Chest Physicians guidelines. RESULTS Typical patients were older adults with multiple comorbidities and high thrombotic risk stratification scores, and 65.6% (n = 221) had not undergone recommended preoperative anticoagulation management protocols. Patients operated on using local anaesthesia (adjusted OR = 0.30, 95%CI 0.14-0.66; p < 0.01) were less likely to have been treated following institutional recommendations, but no association between their procedure's bleeding risk and adherence was found. Clinicians' failures to adhere to recommendations mostly involved late or non-indicated interruptions of anticoagulation treatment (n = 89, 26.4%) or inappropriate heparin bridging (n = 54, 16.0%). Forty-five (13.3%) procedures had to be postponed. Incorrect preoperative anticoagulation management was directly responsible for 12/45 postponements (26.7% of postponements). CONCLUSION This study highlights clinicians' low adherence rates to institutional recommendations for patients treated with DOACs scheduled for elective surgery in a tertiary hospital centre. To the best of our knowledge, this is the first clinical study addressing the issue of clinicians' adherence to guidelines for the preoperative management of DOACs. Going beyond the issue of whether clinicians are knowledgeable about guidelines or have them available, this study questions how generalisable guidelines are in a tertiary hospital managing many highly polymorbid patients. Further studies should identify the causes of poor adherence.
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Affiliation(s)
- Jean Terrier
- Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland.
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, 4 Rue Gabrielle Perret-Gentil, 1205, Geneva, Switzerland.
| | - Amélie Mach
- Division of Angiology and Hemostasis, Geneva University Hospitals, Geneva, Switzerland
| | - Pierre Fontana
- Division of Angiology and Hemostasis, Geneva University Hospitals, Geneva, Switzerland
| | - Fanny Bonhomme
- Division of Anesthesiology, Geneva University Hospitals, Geneva, Switzerland
| | - Alessandro Casini
- Division of Angiology and Hemostasis, Geneva University Hospitals, Geneva, Switzerland
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8
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Alessi MC, Coxon C, Ibrahim-Kosta M, Bacci M, Voisin S, Rivera J, Greinacher A, Raster J, Pulcinelli F, Devreese KMJ, Mullier F, McCormick AN, Frontroth JP, Pouplard C, Sachs UJ, Diaz I, Bermejo N, Camera M, Fontana P, Bauters A, Stepanian A, Cozzi MR, Sveshnikova AN, Faille D, Hollon W, Chitlur M, Casonato A, Lasne D, Lavenu-Bombled C, Fiore M, Hamidou B, Hurtaud-Roux MF, Saultier P, Goumidi L, Gresele P, Lordkipanidzé M. Multicenter evaluation of light transmission platelet aggregation reagents: communication from the ISTH SSC Subcommittee on Platelet Physiology. J Thromb Haemost 2023; 21:2596-2610. [PMID: 37331519 DOI: 10.1016/j.jtha.2023.05.027] [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: 10/28/2022] [Revised: 05/23/2023] [Accepted: 05/24/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Light transmission aggregation (LTA) is used widely by the clinical and research communities. Although it is a gold standard, there is a lack of interlaboratory harmonization. OBJECTIVES The primary objective was to assess whether sources of activators (mainly adenosine diphosphate [ADP], collagen, arachidonic acid, epinephrine, and thrombin receptor activating peptide6) and ristocetin contribute to poor LTA reproducibility. The secondary objective was to evaluate interindividual variability of results to appreciate the distribution of normal values and consequently better interpret pathologic results. METHODS An international multicenter study involving 28 laboratories in which we compared LTA results obtained with center-specific activators and a comparator that we supplied. RESULTS We report variability in the potency (P) of activators in comparison with the comparator. Thrombin receptor activating peptide 6 (P, 1.32-2.68), arachidonic acid (P, 0.87-1.43), and epinephrine (P, 0.97-1.34) showed the greatest variability. ADP (P, 1.04-1.20) and ristocetin (P, 0.98-1.07) were the most consistent. The data highlighted clear interindividual variability, notably for ADP and epinephrine. Four profiles of responses were observed with ADP from high-responders, intermediate-responders, and low-responders. A fifth profile corresponding to nonresponders (5% of the individuals) was observed with epinephrine. CONCLUSION Based on these data, the establishment and adoption of simple standardization principles should mitigate variability due to activator sources. The observation of huge interindividual variability for certain concentrations of activators should lead to a cautious interpretation before reporting a result as abnormal. Confidence can be taken from the fact that difference between sources is not exacerbated in patients treated with antiplatelet agents.
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Affiliation(s)
- Marie-Christine Alessi
- Laboratory of Hematology, Centre de référence des pathologies plaquettaires, C2VN, INRAE, INSERM, Aix Marseille Université, Marseille, France.
| | - Carmen Coxon
- National Institute for Biological Standards and Control, Blanche Lane, South Mimms, Potters Bar, Hertfordshire, United Kingdom
| | - Manal Ibrahim-Kosta
- Laboratory of Hematology, Centre de référence des pathologies plaquettaires, C2VN, INRAE, INSERM, Aix Marseille Université, Marseille, France
| | - Monica Bacci
- Center for Thrombosis and Hemorrhagic Diseases, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Sophie Voisin
- Laboratoire d'Hématologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - José Rivera
- Servicio de Hematología y Oncología Médica, Hospital Universitario Morales Meseguer, Centro Regional de Hemodonación, Universidad de Murcia, Instituto Murciano De Investigación Biosanitaria, IMIB-Arrixaca, Murcia, Spain
| | - Andreas Greinacher
- Institut für Transfusionsmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Johannes Raster
- Institut für Transfusionsmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Fabio Pulcinelli
- Department of Experimental Medicine, Sapienza University of Rome, Roma, Italy
| | - Katrien M J Devreese
- Department of Diagnostic Sciences, Coagulation Laboratory, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Francois Mullier
- Namur Thrombosis and Hemostasis Center, CHU UCLouvain Namur, Université Catholique de Louvain, Yvoir, Belgium
| | - Aine N McCormick
- Haemostasis and Thrombosis Laboratory, Viapath Analytics, St Thomas' Hospital, London, United Kingdom
| | - Juan Pablo Frontroth
- Laboratorio de Hemostasia y Trombosis, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan," Buenos Aires, Argentina
| | - Claire Pouplard
- Department of Hemostasis, University Hospital of Tours, University of Tours, Tours, France
| | - Ulrich J Sachs
- Department of Thrombosis and Haemostasis, Giessen University Hospital, Giessen, Germany
| | - Isabelle Diaz
- Laboratory of Hematology, University Hospital of Montpellier, Montpellier, France
| | - Nuria Bermejo
- Servicio de Hematología, Hospital San Pedro de Alcántara, Complejo Hospitalario Universitario de Cáceres, Cáceres, Spain
| | - Marina Camera
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico, Milan, Italy
| | - Pierre Fontana
- Division of Angiology and Haemostasis, Geneva University Hospitals, and Geneva Platelet Group, Faculty of Medicine, Geneva, Switzerland
| | - Anne Bauters
- Hemostasis Unit, Hospital University Center Lille, Lille, France
| | - Alain Stepanian
- Hematology Laboratory and Thrombosis Unit, Université Paris Cité, Hospital Group Lariboisière-Fernand Widal, Assistance Publique-Hôpitaux de Paris AP-HP, Paris, France
| | - Maria R Cozzi
- Immunopathology and Cancer Biomarkers Unit Centro di Riferimento Oncologico di Aviano, Aviano, Italy
| | - Anastasia N Sveshnikova
- Hemostasis Research Department, Dmitry Rogachev Pediatric Hematology and Immunology Hospital, Moscow, Russia
| | - Dorothée Faille
- Département d'Hématologie Biologique, Assistance Publique-Hôpitaux de Paris AP-HP, Centre Hospitalo-Universitaire CHU Bichat-Claude Bernard, Paris, France
| | - Wendy Hollon
- Jeanne M. Lusher Special Coagulation Laboratory, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan, USA
| | - Meera Chitlur
- Central Michigan University, Jeanne M. Lusher Special Coagulation Laboratory, Children's Hospital of Michigan, Detroit, Michigan, USA
| | - Alessandra Casonato
- Department of Medicine, University of Padua Medical School, First chair of Internal Medicine, Padua, Italy
| | - Dominique Lasne
- Laboratoire d'Hématologie, Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants malades, Paris, France
| | - Cécile Lavenu-Bombled
- Service Hématologie Biologique, Centre de ressources et compétences de la filière de santé des maladies Hémorragiques constitutionnelles MHEMO, Centre Hospitalo-Universitaire CHU Bicêtre, Assistance Publique-Hôpitaux de Paris, Faculté de médecine Paris Saclay, Le Kremlin-Bicêtre, France
| | - Mathieu Fiore
- Bordeaux University Hospital, Laboratory of Hematology, Centre de Reference des Pathologies Plaquettaires Pessac, France
| | - Bello Hamidou
- Laboratory of Hematology, Centre de référence des pathologies plaquettaires, C2VN, INRAE, INSERM, Aix Marseille Université, Marseille, France
| | - Marie-Francoise Hurtaud-Roux
- Assistance Publique-Hôpitaux de Paris, Centre de Reference des Pathologies Plaquettaires, Hôpital Robert Debré, Paris, France
| | - Paul Saultier
- Laboratory of Hematology, Centre de référence des pathologies plaquettaires, C2VN, INRAE, INSERM, Aix Marseille Université, Marseille, France
| | - Louisa Goumidi
- Laboratory of Hematology, Centre de référence des pathologies plaquettaires, C2VN, INRAE, INSERM, Aix Marseille Université, Marseille, France
| | - Paolo Gresele
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Marie Lordkipanidzé
- Faculté de Pharmacie, Research Center and The Montreal Heart Institute, Université de Montréal, Montréal, Quebec, Canada
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9
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Dargaud Y, Fontana P, Fenaux P, Hermans C. Specialist training in thrombosis and haemostasis across Europe: From aspirations to actions. Haemophilia 2023; 29:1369-1370. [PMID: 37639368 DOI: 10.1111/hae.14829] [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: 05/22/2023] [Revised: 06/24/2023] [Accepted: 07/07/2023] [Indexed: 08/31/2023]
Affiliation(s)
- Yesim Dargaud
- National Reference Centre of Haemophilia, Clinical Haemostasis Unit, Hospices Civils de Lyon and Université Claude Bernard Lyon 1, Lyon, France
| | - Pierre Fontana
- Division of Angiology and Haemostasis, University Hospitals of Geneva, Geneva, Switzerland
| | - Pierre Fenaux
- ERN-EuroBloodNet, the European Reference Network on Rare Hematological Diseases, Paris, France
| | - Cedric Hermans
- Division of Hematology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain (UC Louvain), Louvain, Belgium
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10
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Angelillo-Scherrer A, Casini A, Studt JD, Gerber B, Alberio LA, Fontana P. Recommendations for the use of andexanet alfa in the management of bleeding in patients on oral factor Xa inhibitors in Switzerland: Guideline from the Working Party Hemostasis of the Swiss Society of Hematology. Swiss Med Wkly 2023; 153:40113. [PMID: 37499160 DOI: 10.57187/smw.2023.40113] [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] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
Anticoagulants are essential in preventing and treating thrombosis. Unfortunately, their use is accompanied by an enhanced risk of bleeding. Since the introduction of direct oral anticoagulants (DOACs), the risk of major bleeding has been reduced but not eliminated. Major bleeding events related to the use of factor Xa inhibitors can be challenging to manage. In recent years, four-factor prothrombin complex concentrates have been used in patients with severe bleeding taking oral direct factor Xa inhibitors (apixaban, edoxaban and rivaroxaban). Andexanet alfa (OndexxyaTM, AstraZeneca AG) is a specially designed recombinant version of human factor Xa that acts as a decoy receptor to reverse the effects of factor Xa inhibitors. Since 2 December 2020, andexanet alfa has been used in Switzerland for adult patients receiving apixaban or rivaroxaban when reversal of anticoagulation is required because of life-threatening or uncontrolled bleeding. However, the use of andexanet alfa remains a challenge owing to its cost, the reported thrombotic complications and the fact that its efficacy mainly relates to intracranial haemorrhage. Moreover, the use of nonspecific reversal agents together with andexanet alfa is controversial. The present recommendations on the use of andexanet alfa in the management of bleeding in patients on factor Xa inhibitors in Switzerland were developed by a group of Swiss experts from the Working Party Hemostasis of the Swiss Society of Hematology. These recommendations aim to provide support to clinicians in their decision-making in the management of patients with major bleeding receiving factor Xa inhibitors.
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Affiliation(s)
- Anne Angelillo-Scherrer
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Alessandro Casini
- Division of Angiology and Hemostasis, Geneva University Hospital, Geneva, Switzerland
| | - Jan-Dirk Studt
- University Clinic of Hematology, Zurich University Hospital, Zurich, Switzerland
| | - Bernhard Gerber
- Clinic of Hematology, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Lorenzo A Alberio
- Service and Central Laboratory of Hematology, Lausanne University Hospital, Lausanne, Switzerland
| | - Pierre Fontana
- Division of Angiology and Hemostasis, Geneva University Hospital, Geneva, Switzerland
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11
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Burger A, Studt JD, Mendez A, Alberio L, Fontana P, Wuillemin WA, Schmidt A, Graf L, Gerber B, Bovet C, Sauter TC, Binder NB, Nagler M. Determination of Anti-Xa Inhibitor Plasma Concentrations Using a Universal Edoxaban Calibrator. Diagnostics (Basel) 2023; 13:2128. [PMID: 37371023 DOI: 10.3390/diagnostics13122128] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/18/2023] [Accepted: 06/19/2023] [Indexed: 06/29/2023] Open
Abstract
A universal calibrator for the determination of all anti-Xa inhibitors would support laboratory processes. We aimed to test the clinical performance of an anti-Xa assay utilizing a universal edoxaban calibrator to determine clinically relevant concentrations of all anti-Xa inhibitors. Following a pilot study, we enrolled 553 consecutive patients taking rivaroxaban, edoxaban, or apixaban from nine study centers in a prospective cross-sectional study. The Technochrom® anti-Xa assay was conducted using the Technoview® edoxaban calibrator. Using ultra-high-performance liquid chromatography-tandem mass spectrometry (LC-MS/MS), anti-Xa inhibitor drug concentrations were determined. Sensitivities and specificities to detect three clinically relevant drug concentrations (30 µgL-1, 50 µgL-1, 100 µgL-1) were determined. Overall, 300 patients treated with rivaroxaban, 221 with apixaban, and 32 with edoxaban were included. The overall correlation coefficient (rs) was 0.95 (95% CI 0.94, 0.96). An area under the receiver operating characteristic curve of 0.96 for 30 µgL-1, 0.98 for 50 µgL-1, and 0.99 for 100 µgL-1 was found. The sensitivities were 92.3% (95% CI 89.2, 94.6), 92.7% (89.4, 95.1), and 94.8% (91.1, 97.0), respectively (specificities 82.2%, 93.7%, and 94.4%). In conclusion, the clinical performance of a universal, edoxaban-calibrated anti-Xa assay was solid and most drug concentrations were predicted correctly.
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Affiliation(s)
- Annika Burger
- Department of Clinical Chemistry, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Jan-Dirk Studt
- Division of Medical Oncology and Hematology, University Hospital Zurich, University of Zurich, 8006 Zurich, Switzerland
| | - Adriana Mendez
- Institute for Laboratory Medicine, Kantonsspital Aarau, 5001 Aarau, Switzerland
| | - Lorenzo Alberio
- Service and Central Laboratory of Hematology, Centre Hospitalier Universitaire Vaudois (CHUV), 1011 Lausanne, Switzerland
| | - Pierre Fontana
- Division of Angiology and Hemostasis, Geneva University Hospital, 1205 Geneva, Switzerland
| | - Walter A Wuillemin
- Division of Hematology, Hematology Laboratory, Cantonal Hospital of Lucerne, University of Bern, 3012 Bern, Switzerland
| | - Adrian Schmidt
- Institute of Laboratory Medicine, Clinic of Medical Oncology and Hematology, Municipal City Hospital Zurich Triemli, 8063 Zurich, Switzerland
| | - Lukas Graf
- Centre for Laboratory Medicine, 9001 St. Gallen, Switzerland
| | - Bernhard Gerber
- Clinic of Hematology, Oncology Institute of Southern Switzerland, 6500 Bellinzona, Switzerland
| | - Cédric Bovet
- Department of Clinical Chemistry, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Thomas C Sauter
- Department of Emergency Medicine, Inselspital, Bern University Hospital, 3010 Bern, Switzerland
| | - Nikolaus B Binder
- Technoclone Herstellung von Diagnostika und Arzneimitteln GmbH, 1230 Vienna, Austria
| | - Michael Nagler
- Department of Clinical Chemistry, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
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Casini A, Yaron M, Couzens A, Fontana P, Neerman-Arbez M. Coexpression of factor VIII and factor von Willebrand variants in a woman with heavy menstrual bleeding. Blood Coagul Fibrinolysis 2023; 34:250-253. [PMID: 37017006 PMCID: PMC10448796 DOI: 10.1097/mbc.0000000000001217] [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: 09/21/2022] [Revised: 03/16/2023] [Accepted: 03/21/2023] [Indexed: 04/06/2023]
Abstract
Heavy menstrual bleeding is one of the most common causes of consultation in haematology. We present the clinical case of a 20-year-old woman referred by her gynaecologist due to heavy menstrual bleeding since menarche, complicated by iron deficiency anaemia. Haemostasis work-up was initially suggestive of a von Willebrand disease type 1. Genetic analyses by whole exome sequencing lead to a fortuitous discovery of haemophilia by identifying a heterozygous missense mutation in F8 , exon 8 c.1127T>G:p.Val376Gly, previously reported in a patient with mild haemophilia A. The bleeding phenotype worsened by concomitant low von Willebrand factor (VWF) due to VWF variants influencing VWF levels. Our case highlights how whole exome sequencing can help to correct an erroneous diagnosis and identify polymorphisms that eventually contribute to the overall haemostatic balance.
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Affiliation(s)
- Alessandro Casini
- Division of Angiology and Hemostasis, University Hospitals of Geneva and Faculty of Medicine
| | - Michal Yaron
- Division of Gynaecology, University Hospitals of Geneva
| | - Alexander Couzens
- Department of Genetic Medicine and Development, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Pierre Fontana
- Division of Angiology and Hemostasis, University Hospitals of Geneva and Faculty of Medicine
| | - Marguerite Neerman-Arbez
- Department of Genetic Medicine and Development, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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13
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Pantet O, Combescure C, Ltaief Z, Mazzolai L, Jeanneret S, Manzocchi-Besson S, Stricker H, Cereghetti S, Pugin J, Calmy A, Marti C, Robert-Ebadi H, Fontana P, Righini M, Casini A, Blondon M. Effect of therapeutic anticoagulation on gas exchange in mechanically ventilated COVID-19 patients: A secondary analysis of the COVID-HEP trial. Thromb Res 2023; 224:13-16. [PMID: 36801649 PMCID: PMC9911973 DOI: 10.1016/j.thromres.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/18/2023] [Accepted: 02/03/2023] [Indexed: 02/12/2023]
Affiliation(s)
- Olivier Pantet
- Division of Intensive Care, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | | | - Zied Ltaief
- Division of Intensive Care, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Lucia Mazzolai
- Division of Angiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | | | | | - Hans Stricker
- Division of Angiology, Locarno Regional Hospital, Locarno, Switzerland
| | - Sara Cereghetti
- Division of Intensive Care, Geneva University Hospitals, Geneva, Switzerland
| | - Jérôme Pugin
- Division of Intensive Care, Geneva University Hospitals, Geneva, Switzerland
| | - Alexandra Calmy
- HIV/AIDS Unit, Division of Infectious Disease, Geneva University Hospitals, Geneva, Switzerland
| | - Christophe Marti
- Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Helia Robert-Ebadi
- Division of Angiology and Hemostasis, Geneva University Hospitals, Geneva, Switzerland
| | - Pierre Fontana
- Division of Angiology and Hemostasis, Geneva University Hospitals, Geneva, Switzerland
| | - Marc Righini
- Division of Angiology and Hemostasis, Geneva University Hospitals, Geneva, Switzerland
| | - Alessandro Casini
- Division of Angiology and Hemostasis, Geneva University Hospitals, Geneva, Switzerland
| | - Marc Blondon
- Division of Angiology and Hemostasis, Geneva University Hospitals, Geneva, Switzerland.
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14
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Hermans C, Astermark J, Carvalho M, Dolan G, d'Oiron R, Fontana P, Holme PA, Kenet G, Klamroth R, Mancuso ME, Marquardt N, Nunez R, Katsarou O, Pabinger-Fasching I, Quintavalle G, Rodgers R, van der Valk P, Windyga J, Jimenez Yuste V, Preložnik Zupan I. Prevalence of COVID-19 related hospitalizations and mortality in adults aged ≥40 years with haemophilia: A survey from Europe. Haemophilia 2023; 29:913-916. [PMID: 36802089 DOI: 10.1111/hae.14761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/24/2023] [Accepted: 01/29/2023] [Indexed: 02/20/2023]
Affiliation(s)
- Cedric Hermans
- Division of Haematology, St-Luc University Hospital, Université catholique de Louvain (UCLouvain), Bruxelles, Belgium
| | - Jan Astermark
- Department for Coagulation Disorders, Skåne University Hospital, Malmö, Sweden
| | - Manuela Carvalho
- Congenital Coagulopathies Reference Center, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
| | | | - Roseline d'Oiron
- Reference Centre for Haemophilia and Other Congenital Rare Bleeding Disorders, Congenital Platelets Disorders and von Willebrand Disease, Bicêtre Hospital AP-HP, University Paris XI, Le Kremlin-Bicêtre, Parma, France
| | - Pierre Fontana
- Division of Angiology and Hemostasis, University Hospitals of Geneva, Geneva, Switzerland
| | - Pål André Holme
- Department of Haematology, Oslo University Hospital, and Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Gili Kenet
- Sheba Medical Center, Tel Hashomer& The Amalia Biron Thrombosis Research Institute, Tel Aviv University, Tel Hashomer, Israel
| | | | | | - Natascha Marquardt
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | | | | | - Ingrid Pabinger-Fasching
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Gabriele Quintavalle
- Regional Reference Centre for Inherited Bleeding Disorders, Parma University Hospital, Parma, Italy
| | | | - Paul van der Valk
- Van Creveldkliniek, University Medical Center Utrecht, Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Jerzy Windyga
- Department of Hemostasis Disorders and Internal Medicine, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | | | - Irena Preložnik Zupan
- Department of Haematology, Faculty of Medicine, University Medical Centre Ljubljana, University of Ljubljana, Ljubljana, Slovenia
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15
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Hugon-Rodin J, Casini A, Bénard J, Poncet A, Raverot V, Fontana P, Vulliemoz N, Streuli I. Prothrombotic biomarkers during controlled ovarian stimulation for assisted reproductive technology. Fertil Steril 2023; 119:976-984. [PMID: 36805437 DOI: 10.1016/j.fertnstert.2023.02.009] [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] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 02/08/2023] [Accepted: 02/10/2023] [Indexed: 02/18/2023]
Abstract
OBJECTIVE To assess the impact of 3 different ovarian stimulation protocols on surrogate biomarkers of coagulation. DESIGN Observational multicentre cohort study. SETTING The study was conducted in ART units at the University Hospitals of Geneva and Lausanne (Switzerland). PATIENTS Infertile women undergoing ART in 2017-2019 were included. INTERVENTIONS None. MAIN OUTCOME MEASURES Our primary outcome was the endogenous thrombin potential (ETP) assessed by the calibrated automated thrombogram. ETP was measured before stimulation (baseline), on the day of ovulation triggering and seven days after triggering. Three protocols were prescribed according to the standards used and without hormonal pre-treatment: agonist protocol with hCG trigger (ag-hCG); antagonist protocol with hCG trigger (atg-hCG) or GnRH agonist trigger (atg-GnRH). The evolution of ETP was compared among groups using mixed effects linear regression model. RESULTS 64 women with a mean age of 37.8 years old, participated to the study: 24 received ag-hCG, 16 atg-hCG, and 24 atg-GnRH. As expected, the mean serum estradiol levels in atg-GnRH were statistically higher at triggering and lower 7 days after compared to both ag-hCG and atg-hCG. Overall, the ETP evolution over time was statistically different between groups. Values were similar between groups at baseline and increased at triggering in each group. The greatest difference occurred between triggering and 7 days after triggering in each group. The ETP continued to increase 7 days after triggering in ag-hCG (+110 nM/L x min) and atg-hCG (+171 nM/L x min), but it remained stable in atg-GnRH (-2 nM/L x min). Sex Hormone Binding Globulin still increased 7 days after triggering despite the fall in estradiol levels, particularly in the atg-GnRH group. CONCLUSION The ag-hCG and atg-hCG groups were associated with a higher hypercoagulable state 7 days after triggering, compared to the atg-GnRH group. However, our results show the persistence of a hypercoagulable state after the GnRH agonist triggering despite a sharp drop in estradiol levels. These findings may support the use of atg-GnRH protocol in patients with high thrombotic risk and give us new insight in the fact that coagulation parameters could be disturbed for longer time periods.
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Affiliation(s)
- Justine Hugon-Rodin
- University Hospitals of Geneva and the Faculty of medicine of the Geneva University, DFEA-Ob/Gyn-reproductive medicine, Geneva, Switzerland; Gynecology department, Gynaecological Endocrinology Unit, Hospital Saint Joseph, INSERM UMR 1153, EPOPE group Paris, France.
| | - Alessandro Casini
- Division of Angiology and Haemostasis, University Hospitals of Geneva, Geneva, Switzerland
| | - Julie Bénard
- Division of Gynecology, Department of Woman, Child and Adolescent Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Antoine Poncet
- CRC & Division of clinical-epidemiology, Department of health and community medicine, University of Geneva & University Hospitals of Geneva, Geneva, Switzerland
| | - Véronique Raverot
- Hospices Civils de Lyon, LBMMS, Service de Biochimie et biologie moléculaire, Hormonologie, Bron cedex F-69677, France, Neuroscience Research Center (CRNL), Waking team, Inserm UMRS 1028, Université de Lyon, 69500, Bron, France
| | - Pierre Fontana
- Division of Angiology and Haemostasis, University Hospitals of Geneva, Geneva, Switzerland
| | - Nicolas Vulliemoz
- Lausanne University Hospital, Department Woman-Mother-Child (DFME), Fertility medicine and gynaecological endocrinology, Lausanne, Switzerland
| | - Isabelle Streuli
- University Hospitals of Geneva and the Faculty of medicine of the Geneva University, DFEA-Ob/Gyn-reproductive medicine, Geneva, Switzerland
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16
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Casini A, Blondon M, Righini M, Fontana P. [Angiology and hemostasis : what's new in 2022]. Rev Med Suisse 2023; 19:199-201. [PMID: 36723647 DOI: 10.53738/revmed.2023.19.812.199] [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] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In this article, we have selected four topics that particularly caught our attention during the year 2022, and which are related to anticoagulation, its bleeding complications, and hemophilia. Thus, we discuss the issue of the treatment with rivaroxaban of atrial fibrillation associated with rheumatic valvulopathy, which has been studied in a randomized trial, the intensity of thromboprophylaxis in COVID outpatients and inpatients, and the bleeding risk of anticoagulation in patients with cerebral tumors. Finally, recent data on gene therapy in severe hemophilia A, an upcoming treatment, are discussed.
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Affiliation(s)
- Alessandro Casini
- Service d'angiologie et d'hémostase, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Marc Blondon
- Service d'angiologie et d'hémostase, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Marc Righini
- Service d'angiologie et d'hémostase, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Pierre Fontana
- Service d'angiologie et d'hémostase, Hôpitaux universitaires de Genève, 1211 Genève 14
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17
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Terrier J, Gaspar F, Fontana P, Daali Y, Reny JL, Csajka C, Samer CF. Erratum to 'Drug-Drug Interactions with Direct Oral Anticoagulants: Practical Recommendations for Clinicians' The American Journal of Medicine, Volume 134 (2021), Issue 8, 939-942. Am J Med 2023; 136:216-217. [PMID: 36428162 DOI: 10.1016/j.amjmed.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jean Terrier
- Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland; Geneva Platelet Group, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Clinical Pharmacology and Toxicology Division, Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine Department, Geneva University Hospitals, Geneva, Switzerland.
| | - Frederic Gaspar
- Center for Research and Innovation in Clinical Pharmaceutical Sciences, University Hospital and University of Lausanne, Lausanne, Switzerland; School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland; Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Switzerland
| | - Pierre Fontana
- Geneva Platelet Group, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Division of Angiology and Hemostasis, Geneva University Hospitals, Geneva, Switzerland
| | - Youssef Daali
- Geneva Platelet Group, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Clinical Pharmacology and Toxicology Division, Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine Department, Geneva University Hospitals, Geneva, Switzerland
| | - Jean-Luc Reny
- Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland; Geneva Platelet Group, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Chantal Csajka
- Center for Research and Innovation in Clinical Pharmaceutical Sciences, University Hospital and University of Lausanne, Lausanne, Switzerland; School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland; Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Switzerland
| | - Caroline F Samer
- Clinical Pharmacology and Toxicology Division, Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine Department, Geneva University Hospitals, Geneva, Switzerland
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18
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Klamroth R, Ay C, De Moerloose P, Fontana P, Windyga J, Astermark J, Berntorp E, Carvalho M, Dolan G, Hermans C, Holme PA, Kenet G, Mancuso ME, Marquardt N, Nunez R, Pabinger I, Rodgers R, Valk PVD, Yuste VJ, Zupan IP. Applicability of the European Society of Cardiology Guidelines on the management of acute coronary syndromes to older people with haemophilia A - A modified Delphi consensus by the ADVANCE Working Group. Haemophilia 2023; 29:21-32. [PMID: 36271497 DOI: 10.1111/hae.14674] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 07/01/2022] [Revised: 09/16/2022] [Accepted: 09/20/2022] [Indexed: 01/25/2023]
Abstract
INTRODUCTION As people with haemophilia (PWH) receive better treatment and live longer they are more likely to encounter cardiovascular disease (CVD) and other comorbidities. ESC guidelines for the acute management of patients presenting with acute coronary syndrome (ACS) are based on the non-haemophilia population. AIM To review the guidelines and propose relevant adaptations for PWHA without inhibitors who are treated with prophylaxis and present with ACS. METHODS As part of the ADVANCE Group, 20 European haemophilia experts used a modified Delphi approach to develop and gain consensus on proposed adaptations of the ESC guidelines for PWHA without inhibitors. RESULTS Of the 32 Class I recommendations across both guidelines, adaptions were considered necessary and proposed for 15. The adaptions highlight the need to provide sufficient FVIII trough levels at the time of antithrombotic treatment in people with haemophilia A (HA) without inhibitors. Patients receiving emicizumab prophylaxis and requiring oral anticoagulation therapy or combined single antiplatelet plus oral anticoagulation therapy will require additional FVIII replacement therapy. CONCLUSION In the absence of high-quality clinical evidence, the combined expert opinion used to develop these adaptions to the current ESC guidelines may help to guide clinicians in their treatment decisions when a PWHA presents with ACS.
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Affiliation(s)
| | - Cihan Ay
- Department of Medicine I, Clinical Division of Haematology and Haemostaseology, Medical University of Vienna, Vienna, Austria
| | | | - Pierre Fontana
- Division of Angiology and Hemostasis, University Hospitals of Geneva, Geneva, Switzerland
| | - Jerzy Windyga
- Department of Hemostasis Disorders and Internal Medicine, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | | | | | - Manuela Carvalho
- Congenital Coagulopathies Reference Center, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
| | | | | | | | - Gili Kenet
- Sheba Medical Center, Tel Hashomer & The Amalia Biron Thrombosis Research Institute, Tel Aviv University, Israel
| | | | - Natascha Marquardt
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | | | - Ingrid Pabinger
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | | | - Paul van der Valk
- Van Creveldkliniek, University Medical Center Utrecht, Utrecht, University of Utrecht, The Netherlands
| | | | - Irena Preložnik Zupan
- University Medical Centre Ljubljana, Department of Haematology, University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia
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19
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Stakia P, Fontana P, Casini A. [Bleeding of unknown cause: diagnostic and therapeutic approach]. Rev Med Suisse 2022; 18:2332-2336. [PMID: 36477280 DOI: 10.53738/revmed.2022.18.807.2332] [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] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A bleeding tendency is a frequent cause of hematological consultation. However, despite extensive biological investigations, no hemostasis abnormality is identified in the majority of patients, leading to the diagnosis of bleeding of unknown cause (BUC). Overall, the pathogenesis of BUC is most likely of multifactorial etiology and the accumulation of minor alterations in fibrin clot structure, fibrinolysis, platelet function and thrombin generation can tip the balance of hemostasis towards the bleeding side. In recent years, unconventional biological explorations have found new hemorrhagic abnormalities. Therapeutic options are limited but are usually effective to prevent bleeding.
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Affiliation(s)
- Paraskevi Stakia
- Service d'hématologie, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Pierre Fontana
- Service d'angiologie et d'hémostase, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Alessandro Casini
- Service d'angiologie et d'hémostase, Hôpitaux universitaires de Genève, 1211 Genève 14
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20
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Fontana P, Righini M, Mazzolai L. Vers de nouveaux anticoagulants. Rev Med Suisse 2022; 18:2311-2312. [PMID: 36477275 DOI: 10.53738/revmed.2022.18.807.2311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Pierre Fontana
- Service d'angiologie et d'hémostase, Hôpitaux universitaires de Genève
| | - Marc Righini
- Service d'angiologie et d'hémostase, Hôpitaux universitaires de Genève
| | - Lucia Mazzolai
- Service d'angiologie, Centre hospitalier universitaire vaudois,Lausanne
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21
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Bounaix L, Casini A, Blondon M, Fontana P. [Direct oral anticoagulant for venous thrombosis in unusual sites]. Rev Med Suisse 2022; 18:2314-2318. [PMID: 36477276 DOI: 10.53738/revmed.2022.18.807.2314] [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] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Thrombosis in unusual sites account for approximately 4% of venous thromboembolic events. The safety of direct oral anticoagulants (DOACs) has led to the widespread use of these treatments. However, they have mainly been studied in deep vein thrombosis of the lower limbs and in pulmonary embolism. This review of the literature assesses the current knowledge of the use of DOACs for venous thrombosis in unusual sites (splanchnic, cerebral, ovarian, upper-extremity deep vein thrombosis). Numerous case reports or observational studies have been published, but very few randomized trials. Nevertheless, experts-based guidelines suggest that these anticoagulants may be considered in specific cases.
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Affiliation(s)
- Laura Bounaix
- Service d'angiologie et hémostase, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Alessandro Casini
- Service d'angiologie et hémostase, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Marc Blondon
- Service d'angiologie et hémostase, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Pierre Fontana
- Service d'angiologie et hémostase, Hôpitaux universitaires de Genève, 1211 Genève 14
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22
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Charles S, Guyotat D, Fontana P, Tardy B, Lecompte T, Chalayer E. External validation of the MidiCAT variant of thrombography: Comparison with calibrated automated thrombography and study of the centrifugation scheme. Front Cardiovasc Med 2022; 9:998687. [DOI: 10.3389/fcvm.2022.998687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/30/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionTo perform Calibrated Automated Thrombography (CAT), the use of reduced plasma volumes (referred to as “MidiCAT”) makes it possible to more efficiently use limited volumes of valuable biobanked plasma samples and decreases expenses for reagents. It is, however, unclear whether the MidiCAT procedure is suitable when thrombin generation (TG) is studied in the presence of added thrombomodulin (TG-TM). Moreover, a simplified centrifugation scheme would facilitate biobanking, if appropriate, for more sensitive coagulation studies. We aimed to compare the results of “MidiCAT” (halved plasma and reagent volumes) with those from regular CAT, in the absence or presence of TM, as well as to study the impact of a single-centrifugation scheme for plasma preparation before freezing.Materials and methodsPlasma samples were prepared from the citrated blood from 20 Geneva hospital diverse patients without gross coagulation abnormalities with a single- or double-centrifugation scheme. Samples were kept frozen at −80°C and thawed just before the TG assay in duplicate under two conditions: 1 pM tissue factor (TF) or 5 pM TF + TM.Results and discussion(1) We externally validated “MidiCAT” and also extended the validation to TG-TM. Whatever the method (CAT or MidiCAT), intra-assay (assessed with duplicates) CV was below 6% (1 pM TF) or below 10% (5 pM TF + TM) for ETP. Agreement between the MidiCAT and CAT results was satisfactory; the p coefficients were above 0.95 for ETP and above 0.90 for most other parameters; biases for ETP were +10.0% (1 pM FT) and +13.5% (5 pM + TM). (2) The centrifugation scheme markedly affected the results obtained in the presence of TM, whereas the bias and limit of agreement (difference plots) were low for the no TM condition. The bias in the presence of TM was obvious, more marked with plasma samples sensitive to TM when double centrifuged: the lower the ETP-TM, the greater the relative difference between the ETP-TM of plasma samples prepared with just single centrifugation and the reference plasma samples. Thus, a single-centrifugation procedure, as is often used for plasma biobanking, is suitable for TG study only if it is not performed in the presence of TM.
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23
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Sathanantham V, Alberio L, Bovet C, Fontana P, Gerber B, Graf L, Mendez A, Sauter TC, Schmidt A, Studt JD, Wuillemin WA, Nagler M. Prothrombinase-Induced Clotting Time to Measure Drug Concentrations of Rivaroxaban, Apixaban, and Edoxaban in Clinical Practice: A Cross-Sectional Study. Life (Basel) 2022; 12:life12071027. [PMID: 35888115 PMCID: PMC9324795 DOI: 10.3390/life12071027] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/05/2022] [Accepted: 07/05/2022] [Indexed: 11/17/2022]
Abstract
Prothrombinase-induced clotting time (PiCT) is proposed as a rapid and inexpensive laboratory test to measure direct oral anticoagulant (DOAC) drug levels. In a prospective, multicenter cross-sectional study, including 851 patients, we aimed to study the accuracy of PiCT in determining rivaroxaban, apixaban, and edoxaban drug concentrations and assessed whether clinically relevant drug levels could be predicted correctly. Citrated plasma samples were collected, and the Pefakit® PiCT was utilized. Ultra-high performance liquid chromatography-tandem mass spectrometry (LC-MS/MS) was performed to measure drug concentrations. Cut-off levels were established using receiver-operating characteristics curves. We calculated sensitivities and specificities with respect to clinically relevant drug concentrations. Spearman’s correlation coefficient between PiCT and drug concentrations was 0.85 in the case of rivaroxaban (95% CI 0.82, 0.88), 0.66 for apixaban (95% CI 0.60, 0.71), and 0.78 for edoxaban (95% CI 0.65, 0.86). The sensitivity to detect clinically relevant drug concentrations was 85.1% in the case of 30 µg L−1 (95% CI 82.0, 87.7; specificity 77.9; 72.1, 82.7), 85.7% in the case of 50 µg L−1 (82.4, 88.4; specificity 77.3; 72.5, 81.5), and 85.1% in the case of 100 µg L−1 (80.9, 88.4; specificity 73.2%; 69.1, 76.9). In conclusion, the association of PiCT with DOAC concentrations was fair, and the majority of clinically relevant drug concentrations were correctly predicted.
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Affiliation(s)
- Vepusha Sathanantham
- Department of Clinical Chemistry, Inselspital, Bern University Hospital, 3010 Bern, Switzerland; (V.S.); (C.B.)
| | - Lorenzo Alberio
- Service and Central Laboratory of Hematology, CHUV, Lausanne University Hospital, 1011 Lausanne, Switzerland;
| | - Cédric Bovet
- Department of Clinical Chemistry, Inselspital, Bern University Hospital, 3010 Bern, Switzerland; (V.S.); (C.B.)
| | - Pierre Fontana
- Division of Angiology and Hemostasis, Geneva University Hospital, 1205 Geneva, Switzerland;
| | - Bernhard Gerber
- Clinic of Hematology, Oncology Institute of Southern Switzerland, 6500 Bellinzona, Switzerland;
- Faculty of Medicine, University of Zurich, 8091 Zurich, Switzerland
| | - Lukas Graf
- Centre for Laboratory Medicine St. Gallen, 9001 St. Gallen, Switzerland;
| | - Adriana Mendez
- Department of Laboratory Medicine, Cantonal Hospital Aarau, 5001 Aarau, Switzerland;
| | - Thomas C. Sauter
- Department of Emergency Medicine, Inselspital, Bern University Hospital, 3010 Bern, Switzerland;
| | - Adrian Schmidt
- Clinic of Medical Oncology and Hematology, Institute of Laboratory Medicine, City Hospital Waid and Triemli, 8063 Zurich, Switzerland;
| | - Jan-Dirk Studt
- Division of Medical Oncology and Hematology, University and University Hospital Zurich, 8091 Zurich, Switzerland;
| | - Walter A. Wuillemin
- Division of Hematology and Central Hematology Laboratory, Cantonal Hospital of Lucerne, 6000 Lucerne, Switzerland;
| | - Michael Nagler
- Department of Clinical Chemistry, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
- Correspondence:
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Terrier J, Gaspar F, Guidi M, Fontana P, Daali Y, Csajka C, Reny JL. Population Pharmacokinetic Models for Direct Oral Anticoagulants: A Systematic Review and Clinical Appraisal Using Exposure Simulation. Clin Pharmacol Ther 2022; 112:353-363. [PMID: 35593020 PMCID: PMC9540501 DOI: 10.1002/cpt.2649] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 03/03/2022] [Accepted: 05/13/2022] [Indexed: 01/22/2023]
Abstract
Available data have shown an association between direct oral anticoagulant (DOAC) plasma concentration and clinical, particularly bleeding, events. Factors that may influence DOAC plasma concentration are therefore the focus of particular attention. Population pharmacokinetic (PopPK) analyses can help in identifying such factors while providing predictive models. The main aim of the present study was to identify all the PopPK models to date for the four most frequently used DOACs (dabigatran, apixaban, rivaroxaban, and edoxaban). The secondary aim was to use these models to simulate different DOAC plasma concentration–time profiles in relevant clinical scenarios. The results of our model‐based simulations confirm the clinical relevance of the known major factors influencing DOAC exposure and support the current approved dose adaptation, at least for atrial fibrillation. They also highlight how the accumulation of covariates, not currently considered for dose adaptation due to their seemingly minor influence on DOAC exposure, lead to supratherapeutic blood concentrations and could thus enhance the risk of major bleeding. The present results therefore question DOAC dose adaptation in the presence of these covariates, such as drug–drug interaction or genotypes, alongside the known existing covariates. As the overall effect of accumulation of several covariates could be difficult to apprehend for the clinicians, PopPK modeling could represent an interesting approach for informed precision dosing and to improve personalized prescription of DOACs.
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Affiliation(s)
- Jean Terrier
- Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland.,Geneva Platelet Group, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Clinical Pharmacology and Toxicology Service, Anesthesiology Pharmacology and Intensive Care Department, Geneva University Hospitals, Geneva, Switzerland
| | - Frédéric Gaspar
- Center for Research and Innovation in Clinical Pharmaceutical Sciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland.,Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Geneva, Switzerland
| | - Monia Guidi
- Center for Research and Innovation in Clinical Pharmaceutical Sciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Geneva, Switzerland.,Service of Clinical Pharmacology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Pierre Fontana
- Geneva Platelet Group, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of Angiology and Haemostasis, Geneva University Hospitals, Geneva, Switzerland
| | - Youssef Daali
- Geneva Platelet Group, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Clinical Pharmacology and Toxicology Service, Anesthesiology Pharmacology and Intensive Care Department, Geneva University Hospitals, Geneva, Switzerland
| | - Chantal Csajka
- Center for Research and Innovation in Clinical Pharmaceutical Sciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland.,Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Geneva, Switzerland
| | - Jean-Luc Reny
- Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland.,Geneva Platelet Group, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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25
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Blondon M, Cereghetti S, Pugin J, Marti C, Darbellay Farhoumand P, Reny J, Calmy A, Combescure C, Mazzolai L, Pantet O, Ltaief Z, Méan M, Manzocchi Besson S, Jeanneret S, Stricker H, Robert‐Ebadi H, Fontana P, Righini M, Casini A. Therapeutic anticoagulation to prevent thrombosis, coagulopathy, and mortality in severe COVID‐19: The Swiss COVID‐HEP randomized clinical trial. Res Pract Thromb Haemost 2022; 6:e12712. [PMID: 35599701 PMCID: PMC9116142 DOI: 10.1002/rth2.12712] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 01/18/2022] [Revised: 03/28/2022] [Accepted: 04/05/2022] [Indexed: 12/18/2022] Open
Abstract
Background Hospitalized patients with COVID‐19 suffered initially from high rates of venous thromboembolism (VTE), with possible associations between therapeutic anticoagulation and better clinical outcomes in observational studies. Objective To test whether therapeutic anticoagulation improves clinical outcomes in severe COVID‐19. Patients/Methods In this multicenter, open‐label, randomized controlled trial, we recruited acutely ill medical COVID‐19 patients with D‐dimer >1000 ng/ml or critically ill COVID‐19 patients in four Swiss hospitals, from April 2020 until June 2021, with a 30‐day follow‐up. Participants were randomized to in‐hospital therapeutic anticoagulation versus low‐dose anticoagulation in acutely ill participants/intermediate‐dose anticoagulation in critically ill participants, with enoxaparin or unfractionated heparins. The primary outcome was a centrally adjudicated composite of 30‐day all‐cause mortality, VTE, arterial thrombosis, and disseminated intravascular coagulopathy (DIC), with screening for proximal deep vein thrombosis. Results Among 159 participants, 55.3% were critically ill and 94.3% received corticosteroids. Before study inclusion, pulmonary embolism had been excluded in 71.7%. The primary outcome occurred in 4/79 participants randomized to therapeutic anticoagulation and 4/80 to low/intermediate anticoagulation (5.4% vs. 5.0%; risk difference +0.4%; adjusted hazard ratio 0.76, 95% confidence interval 0.18–3.21), including three deaths in each group. All primary outcomes and major bleeding (n = 3) occurred in critically ill participants. There was no asymptomatic proximal deep vein thrombosis and no difference in major bleeding. Conclusions Among patients with severe COVID‐19 treated with corticosteroids and with exclusion of pulmonary embolism at hospital admission for most, risks of mortality, thrombotic outcomes, and DIC were low at 30 days. The lack of benefit of therapeutic anticoagulation was too imprecise for definite conclusions.
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Affiliation(s)
- Marc Blondon
- Division of Angiology and Hemostasis Geneva University Hospitals and Faculty of Medicine Geneva Switzerland
| | - Sara Cereghetti
- Division of Intensive Care Geneva University Hospitals and Faculty of Medicine Geneva Switzerland
| | - Jérôme Pugin
- Division of Intensive Care Geneva University Hospitals and Faculty of Medicine Geneva Switzerland
| | - Christophe Marti
- Division of General Internal Medicine Geneva University Hospitals and Faculty of Medicine Geneva Switzerland
| | | | - Jean‐Luc Reny
- Division of General Internal Medicine Geneva University Hospitals and Faculty of Medicine Geneva Switzerland
| | - Alexandra Calmy
- HIV/AIDS Unit Division of Infectious Disease Geneva University Hospitals and Faculty of Medicine Geneva Switzerland
| | - Christophe Combescure
- Clinical Research Center Geneva University Hospitals and Faculty of Medicine Geneva Switzerland
| | - Lucia Mazzolai
- Division of Angiology Centre Hospitalier Universitaire Vaudois Lausanne Switzerland
| | - Olivier Pantet
- Division of Intensive Care Centre Hospitalier Universitaire Vaudois Lausanne Switzerland
| | - Zied Ltaief
- Division of Intensive Care Centre Hospitalier Universitaire Vaudois Lausanne Switzerland
| | - Marie Méan
- Division of Internal Medicine Centre Hospitalier Universitaire Vaudois Lausanne Switzerland
| | | | | | - Hans Stricker
- Division of Angiology Locarno Regional Hospital Locarno Switzerland
| | - Helia Robert‐Ebadi
- Division of Angiology and Hemostasis Geneva University Hospitals and Faculty of Medicine Geneva Switzerland
| | - Pierre Fontana
- Division of Angiology and Hemostasis Geneva University Hospitals and Faculty of Medicine Geneva Switzerland
| | - Marc Righini
- Division of Angiology and Hemostasis Geneva University Hospitals and Faculty of Medicine Geneva Switzerland
| | - Alessandro Casini
- Division of Angiology and Hemostasis Geneva University Hospitals and Faculty of Medicine Geneva Switzerland
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26
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Blondon M, Bodmer A, Thouvenin L, Lecompte T, Righini M, Fontana P, Casini A. Differential impact of tamoxifen and aromatase inhibitors on thrombin generation: the prospective HEMOBREAST cohort. Blood Adv 2022; 6:2884-2892. [PMID: 35086148 PMCID: PMC9092409 DOI: 10.1182/bloodadvances.2021006623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/19/2022] [Indexed: 11/20/2022] Open
Abstract
Tamoxifen and aromatase inhibitors (AIs) are potent antitumoral agents against breast cancer. Tamoxifen increases the risk of venous thromboembolism (VTE), but the influence of AIs on the risk of VTE remains unclear. To inform clinical decisions, we evaluated associations of tamoxifen or AIs with changes of surrogate hemostatic biomarkers. This prospective cohort included 107 women with localized breast cancer starting tamoxifen (n = 42) or an AI (n = 65). Thrombin generation (CAT) its sensitivity to thrombomodulin (TM) or activated protein C (APC), and specific coagulation parameters, were measured before and 10-16 weeks after initiation of treatmen Compared with baseline, endogenous thrombin potential and thrombin peak increased in tamoxifen users (+86 nM × min; 95% confidence interval [CI], 30-142; and +33 nM; 95% CI, 21-45) but not in AI users (n = 65; +44 nM × min; 95% CI, -4 to 93; and +7 nM; 95% CI, -3 to 17). Normalized TM sensitivity ratios increased with tamoxifen (+0.26; 95% CI, 0.19-0.33y) but not with AI (+0.02; 95% CI, -0.03 to 0.07). Plasma levels of fibrinogen, antithrombin, protein C, and Tissue Factor Pathway Inhibitor decreased, and free protein S increased with tamoxifen but not with AIs. The observed shift toward increased coagulability associated with tamoxifen is in line with its known increased risk of VTE. In contrast, AIs do not appear to impact hemostasis, suggesting a lack of associated VTE risk. The trial was registered at www.clinicaltrials.gov as #NCT03381963.
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Affiliation(s)
| | - Alexandre Bodmer
- Department of Oncology, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Laure Thouvenin
- Department of Oncology, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
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27
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Meihandoest T, Studt JD, Mendez A, Alberio L, Fontana P, Wuillemin WA, Schmidt A, Graf L, Gerber B, Amstutz U, Bovet C, Sauter TC, Asmis LM, Nagler M. Accuracy of a Single, Heparin-Calibrated Anti-Xa Assay for the Measurement of Rivaroxaban, Apixaban, and Edoxaban Drug Concentrations: A Prospective Cross-Sectional Study. Front Cardiovasc Med 2022; 9:817826. [PMID: 35369293 PMCID: PMC8969025 DOI: 10.3389/fcvm.2022.817826] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 11/18/2021] [Accepted: 02/22/2022] [Indexed: 11/13/2022] Open
Abstract
Background Applying a single anti-Xa assay, calibrated to unfractionated heparin to measure rivaroxaban, apixaban, and edoxaban would simplify laboratory procedures and save healthcare costs. Aim We hypothesized that a heparin-calibrated anti-Xa assay would accurately measure rivaroxaban, apixaban, and edoxaban drug concentrations and correctly predict clinically relevant drug levels. Methods This analysis is part of the Simple-Xa study, a prospective multicenter cross-sectional study conducted in clinical practice. Patients treated with rivaroxaban, apixaban, or edoxaban were included. Anti-Xa activity was measured using the Siemens INNOVANCE® Heparin assay. Drug concentrations were determined using ultra-high performance liquid chromatography-tandem mass spectrometry (LC-MS/MS). Cut-off levels were determined in a derivation dataset (50% of patients) and sensitivities and specificities were calculated in a verification dataset (50% of patients). Results Overall, 845 patients were available for analysis. Correlation coefficients (r s ) between the heparin-calibrated anti-Xa assay and drug concentrations were 0.97 (95% CI 0.97, 0.98) for rivaroxaban, 0.96 (0.96, 0.97) for apixaban, and 0.96 (0.94, 0.99) for edoxaban. The area under the receiver operating characteristics curve (ROC) was 0.99 for all clinically relevant drug concentrations. In the verification dataset, the sensitivity was 94.2% (95% CI 90.8-96.6) for 30 μg L-1, 95.8% (92.4-98.0) for 50 μg L-1, and 98.7% (95.5-99.9) for 100 μg L-1. Specificities were 86.3% (79.2-91.7), 89.8% (84.5-93.7), and 88.7% (84.2-92.2), respectively. Conclusion In a large prospective study in clinical practice, a strong correlation of heparin-calibrated anti-Xa measurements with LC-MS/MS results was observed and clinically relevant drug concentrations were predicted correctly.
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Affiliation(s)
- Tamana Meihandoest
- Department of Epidemiology, Maastricht University, Maastricht, Netherlands.,Department of Clinical Chemistry, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Jan-Dirk Studt
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Adriana Mendez
- Institute for Laboratory Medicine, Kantonsspital Aarau AG, Aarau, Switzerland
| | - Lorenzo Alberio
- Service and Central Laboratory of Hematology, CHUV, Lausanne University Hospital, Lausanne, Switzerland
| | - Pierre Fontana
- Division of Angiology and Hemostasis, Geneva University Hospitals, Geneva, Switzerland
| | - Walter A Wuillemin
- Division of Hematology and Central Hematology Laboratory, Cantonal Hospital of Lucerne and University of Bern, Bern, Switzerland
| | - Adrian Schmidt
- Institute of Laboratory Medicine and Clinic of Medical Oncology and Hematology, City Hospital Zurich, Zurich, Switzerland
| | - Lukas Graf
- Center for Laboratory Medicine, St. Gallen, Switzerland
| | - Bernhard Gerber
- Clinic of Hematology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Ursula Amstutz
- Department of Clinical Chemistry, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Cedric Bovet
- Department of Clinical Chemistry, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Thomas C Sauter
- Department of Emergency Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Lars M Asmis
- Centre for Perioperative Thrombosis and Haemostasis, Zurich, Switzerland
| | - Michael Nagler
- Department of Clinical Chemistry, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
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28
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Jimaja WE, Stirnemann J, Fontana P, Blondon KS. Improving safety of unfractionated heparin: a retrospective, quasi-experimental, observational study of the impact of a pocket card and a computerised prescription aid tool in the University Hospitals of Geneva. BMJ Open 2022; 12:e056912. [PMID: 35292499 PMCID: PMC8928257 DOI: 10.1136/bmjopen-2021-056912] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Despite the rapid rise of direct oral anticoagulants, unfractionated heparin (UFH) remains the mainstay anticoagulant in specific situations such as severe renal failure, perioperative setting or in critical care units. However, its titration is often challenging. OBJECTIVES To investigate the effect of a pocket card and a computerised prescription aid tool (CPAT) on the quality of UFH anticoagulation. DESIGN Monocentric retrospective, quasi-experimental, observational study. SETTING Inpatient primary care centre between 1 January 2016 and 31 December 2019. PARTICIPANTS >18 years-old treated with therapeutic UFH for more than 24 hours. There were 819 and 1169 anticoagulation episodes before and after intervention, respectively. INTERVENTION In October 2017, we implemented a pocket card with evidence-based recommendation for therapeutic UFH initiation, monitoring and dosing adaptation. In October 2019, we implemented a CPAT in a group subset. PRIMARY AND SECONDARY OUTCOMES The primary outcome was the time needed to reach a therapeutic anti-Xa before and after the implementation of the pocket card. The secondary outcomes included a subgroup analysis assessing the effect of the CPAT. Other secondary outcomes were the anti-Xa status (infratherapeutic, therapeutic or supratherapeutic) at 7 and 24 hours of UFH treatment. RESULTS We found a significant increase in the time to reach therapeutic dosing with pocket card-guided recommendations implementation (10.1 vs 14 hours, HR of 0.8, 95% CI: 0.70 to 0.93). However, the CPAT was associated with a significant decrease in the time needed to reach the therapeutic range (13.9 vs 7.1 hours, HR of 1.74, 95% CI: 1.17 to 2.60). CONCLUSION Although we observed an increase in time to reach therapeutic anti-Xa with the pocket card, possibly due to a selection bias (use of activated partial thromboplastin time for monitoring before the pocket card), the implementation of CPAT significantly decreased the delay for effective therapy. Further studies are needed to confirm these findings, and to determine the optimal initial dose of UFH anticoagulation.
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Affiliation(s)
- Wedali E Jimaja
- Medecine, Division of general internal medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Jerome Stirnemann
- Medecine, Division of general internal medicine, University Hospitals of Geneva, Geneva, Switzerland
- Faculty of medecine, University of Geneva, Geneva, Switzerland
| | - Pierre Fontana
- Faculty of medecine, University of Geneva, Geneva, Switzerland
- Medicine, Division of angiology and hemostasis, University Hospitals of Geneva, Geneva, Switzerland
| | - Katherine S Blondon
- Faculty of medecine, University of Geneva, Geneva, Switzerland
- Medical directorate, University Hospitals of Geneva, Geneva, Switzerland
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29
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Fontana P, Casini A, Schweblin C, Glauser F, Righini M, Robert-Ebadi H. [Selected highlights in angiology and haemostasis for the year 2021]. Rev Med Suisse 2022; 18:18-20. [PMID: 35048573 DOI: 10.53738/revmed.2022.18.764-65.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Several topics among those that marked the year 2021 are discussed in this article. Factor XI represents an original target for new anticoagulants, and the first results of a phase 2 study of prophylaxis after knee replacement surgery are very promising. A real-life study confirms that the pulmonary embolism exclusion strategy using an age-adjusted D-dimer cut-off is safe and increases the diagnostic yield. Several studies of tranexamic acid provide further insight into the indications for its use and highlight some potential risks. Finally, the concerns regarding a potential risk of increased mortality related to paclitaxel-eluting technology used in lower limb revascularisation are questioned by the results of the latest trials.
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Affiliation(s)
- Pierre Fontana
- Service d'angiologie et d'hémostase, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Alessandro Casini
- Service d'angiologie et d'hémostase, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Cecilia Schweblin
- Service d'angiologie et d'hémostase, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Frédéric Glauser
- Service d'angiologie et d'hémostase, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Marc Righini
- Service d'angiologie et d'hémostase, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Helia Robert-Ebadi
- Service d'angiologie et d'hémostase, Hôpitaux universitaires de Genève, 1211 Genève 14
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30
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Mazzolai L, Fontana P, Righini M. [Not Available]. Rev Med Suisse 2021; 17:2115. [PMID: 34878737] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Lucia Mazzolai
- Service d'angiologie, Centre hospitalier universitaire vaudois, Lausanne
| | - Pierre Fontana
- Service d'angiologie et d'hémostase, Hôpitaux universitaires de Genève, Genève
| | - Marc Righini
- Service d'angiologie et d'hémostase, Hôpitaux universitaires de Genève, Genève
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Meihandoest T, Studt JD, Mendez A, Alberio L, Fontana P, Wuillemin WA, Schmidt A, Graf L, Gerber B, Maeder GM, Bovet C, Sauter TC, Nagler M. Automated Thrombin Generation Assay for Rivaroxaban, Apixaban, and Edoxaban Measurements. Front Cardiovasc Med 2021; 8:717939. [PMID: 34568459 PMCID: PMC8459937 DOI: 10.3389/fcvm.2021.717939] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 05/31/2021] [Accepted: 08/16/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The thrombin generation assay (TG) is a promising approach to measure the degree of anticoagulation in patients treated with direct oral anticoagulants (DOAC). A strong association with plasma drug concentrations would be a meaningful argument for the potential use to monitor DOAC. Objectives: We aimed to study the correlation of TG with rivaroxaban, apixaban, and edoxaban drug concentrations in a large, prospective multicenter cross-sectional study. Methods: Five-hundred and fifty-nine patients were included in nine tertiary hospitals. The Technothrombin® TG was conducted in addition to an anti-Xa assay; LC-MS/MS was performed as the reference standard. Results: Correlation (rs) between thrombin generation measurements and drug concentrations was -0.72 for peak thrombin generation (95% confidence interval, CI, -0.77, -0.66), -0.55 for area under the curve (AUC; 95% CI -0.61, -0.48), and 0.80 for lag time (95% CI 0.75, 0.84). In contrast, rs was 0.96 with results of the anti-Xa activity (95% CI 0.95-0.97). Sensitivity with regard to the clinically relevant cut-off value of 50 μgL-1 was 49% in case of peak thrombin generation (95% CI, 44, 55), 29% in case of AUC (95% CI, 24, 34), and 64% in case of lag time (95% CI, 58, 69). Sensitivity of the anti-Xa assay was 95% (95% CI, 92, 97). Conclusions: The correlation of thrombin generation measurements with DOAC drug concentrations was weak, and clinically relevant drug levels were not predicted correctly. Our results do not support an application of TG in the monitoring of DOAC.
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Affiliation(s)
- Tamana Meihandoest
- Department of Epidemiology, Maastricht University, Maastricht, Netherlands.,Department of Clinical Chemistry, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Jan-Dirk Studt
- Division of Medical Oncology and Hematology, University and University Hospital Zurich, Zurich, Switzerland
| | - Adriana Mendez
- Department of Laboratory Medicine, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Lorenzo Alberio
- Service and Central Laboratory of Hematology, CHUV, Lausanne University Hospital, Lausanne, Switzerland
| | - Pierre Fontana
- Division of Angiology and Hemostasis, Geneva University Hospital, Geneva, Switzerland
| | - Walter A Wuillemin
- Division of Hematology and Central Hematology Laboratory, Cantonal Hospital of Lucerne and University of Bern, Bern, Switzerland
| | - Adrian Schmidt
- Clinic of Medical Oncology and Hematology and Institute of Laboratory Medicine, City Hospital Waid and Triemli, Zurich, Switzerland
| | - Lukas Graf
- Centre for Laboratory Medicine St. Gallen, St. Gallen, Switzerland
| | - Bernhard Gerber
- Clinic of Hematology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Gabriela Monika Maeder
- Department of Clinical Chemistry, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Cédric Bovet
- Department of Clinical Chemistry, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Thomas C Sauter
- Department of Emergency Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Michael Nagler
- Department of Clinical Chemistry, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.,Department of Hematology, Inselspital, Bern University Hospital, Bern, Switzerland
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Astermark J, Ay C, Carvalho M, D'Oiron R, Moerloose PD, Dolan G, Fontana P, Hermans C, Holme PA, Katsarou O, Kenet G, Klamroth R, Mancuso ME, Marquardt N, Núñez R, Pabinger I, Tait R, Valk PVD. New Inhibitors in the Ageing Population: A Retrospective, Observational, Cohort Study of New Inhibitors in Older People with Hemophilia. Thromb Haemost 2021; 122:905-912. [PMID: 34507368 DOI: 10.1055/a-1642-4067] [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] [Indexed: 10/20/2022]
Abstract
INTRODUCTION A second peak of inhibitors has been reported in patients with severe hemophilia A (HA) aged >50 years in the United Kingdom. The reason for this suggested breakdown of tolerance in the aging population is unclear, as is the potential impact of regular exposure to the deficient factor by prophylaxis at higher age. No data on hemophilia B (HB) have ever been reported. AIM The ADVANCE Working Group investigated the incidence of late-onset inhibitors and the use of prophylaxis in patients with HA and HB aged ≥40 years. METHODS A retrospective, observational, cohort, survey-based study of all patients aged ≥40 years with HA or HB treated at an ADVANCE hemophilia treatment center. RESULTS Information on 3,095 people aged ≥40 years with HA or HB was collected. Of the 2,562 patients with severe HA, the majority (73% across all age groups) received prophylaxis. In patients with severe HA, the inhibitor incidence per 1,000 treatment years was 2.37 (age 40-49), 1.25 (age 50-59), and 1.45 (age 60 + ). Overall, the inhibitor incidence was greatest in those with moderate HA (5.77 [age 40-49], 6.59 [age 50-59], and 4.69 [age 60 + ]) and the majority of inhibitor cases were preceded by a potential immune system challenge. No inhibitors in patients with HB were reported. CONCLUSION Our data do not identify a second peak of inhibitor development in older patients with hemophilia. Prophylaxis may be beneficial in older patients with severe, and possibly moderate HA, to retain a tolerant state at a higher age.
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Affiliation(s)
- Jan Astermark
- Department for Translational Medicine, Skane University Hospital, Lund University, Malmö, Sweden
| | - Cihan Ay
- Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University Vienna, Vienna, Austria
| | - Manuela Carvalho
- Department of Immunohemotherapy, Centro Hospitalar de Sao Joao, Porto, Portugal
| | | | | | - Gerard Dolan
- Centre for Haemostasis and Thrombosis, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Pierre Fontana
- Haemostasis Unit and Laboratory, University Hospitals of Geneva, Geneva, Switzerland
| | - Cedric Hermans
- Haemostasis and Thrombosis Unit, Division of Haematology, Saint-Luc University Hospital, Brussels, Belgium
| | - Pål Andre Holme
- Department of Haematology, Institute of Clinical Medicine, Oslo Universit Hospital, Rikshospitalet, Oslo, Norway
| | - Olga Katsarou
- Department of Hematology, Laiko University Hospital, Athens, Attica, Greece
| | - Gili Kenet
- National Hemophilia Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Sackler Faculty of Medicine, The Amalia Biron Thrombosis Research Institute, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Robert Klamroth
- Department of Angiology and Coagulation Disorders, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Maria Elisa Mancuso
- Hemophilia and Thrombosis Center, Fondazione Ospedale Maggiore Policlinico, Milan, Italy.,Center for Thrombosis and Hemorrhagic Diseases, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Natascha Marquardt
- Institute of Experimental Haematology and Transfusion Medicine, University Clinic Bonn, Bonn, Germany
| | - Ramiro Núñez
- Hemophilia Unit, Hospital Universitario Virgen del Rocio, Sevilla, Andalucía, Spain
| | - Ingrid Pabinger
- Department of Haematology and Haemostaseology, Allgemeines Krankenhaus (AKH) - Innere Medizin, Wien, Austria
| | - Robert Tait
- Haemophilia and Thrombosis Centre, Royal Infirmary Glasgow, Glasgow, Strathclyde, United Kingdom of Great Britain and Northern Ireland
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Streuli I, Casini A, Benard J, Poncet A, Fontana P, Vulliemoz N, Hugon-Rodin J. P–622 Prothrombotic biomarkers during controlled ovarian stimulation for assisted reproductive techniques. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.621] [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] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Does the evolution of prothrombotic biomarkers over time differ between antagonist and long agonist stimulation protocols for assisted reproductive techniques (ART) ?
Summary answer
The hypercoagulable state was higher and persistent in the agonist and antagonist with hCG triggering groups compared to the antagonist with GnRH agonist triggering group.
What is known already
Controlled ovarian stimulation (COS) for ART is associated with supra-physiological serum estradiol levels, a hypercoagulable state and an increased risk of venous thrombosis. Most thromboembolic events associated with COS occur in the context of ovarian hyperstimulation syndrome (OHSS). The use of hCG for final follicular maturation increases the risk of OHSS. In antagonist protocols, GnRH agonist triggering is known to prevent or reduce OHSS and is therefore widely used in women at risk. The impact of the different IVF protocols on pro-thrombotic biomarkers is unknown.
Study design, size, duration
In this prospective observational cohort study, infertile women undergoing COS for ART in 2017–2019 at the University Hospitals of Geneva and Lausanne (Switzerland) were included. We evaluated changes in key coagulation parameters (D-dimers, factor VIII, fibrinogen activity, protein S and protein C) and thrombin generation, our primary outcome, (using 5 pM of tissue factor) by calibrated automated thrombinography before stimulation (T1), on the day of ovulation triggering (T2) and seven days after triggering (T3).
Participants/materials, setting, methods
COS was started without hormonal pre-treatment. Protocols were prescribed according to the standards used in each centre taking into account the risk of OHSS (agonist protocol with hCG trigger in women without OHSS risk (Group 1); antagonist protocol in women at risk of OHSS with hCG trigger (Group 2;) or GnRH agonist trigger (Group 3;); variation of endogenous thrombin potential (ETP) was measured and compared among groups using mixed effects linear regression model.
Main results and the role of chance
A total of 64 women were included: 24 were in group 1, 16 in group 2, and 24 in group 3. The mean age (SD) was 37.8 (2.8), 35.9(5.2) and 34(4.6) years in groups 1, 2 and 3 respectively. As expected, women in group 1 had a statistically lower level of anti-müllerian hormone (p = <0.001), a lower antral follicular count (p = <0.001) and lower number of MII oocytes and embryos obtained (p = <0.001). Mean serum estradiol levels were 1836 (1160), 1628 (815) and 3754 (2165) ng/L at T2, and 945 (471), 1061 (495) and 413 (729) ng/L at T3, in group 1 to 3, respectively. In multivariable regression analysis, the levels in group 3 were statistically higher at T2 and lower at T3 (overall time*group interaction: p < 0.001). The mean ETP was similar between all groups at T1, and increased in all groups at T2 (1442, 1426 and 1486 nM/min in groups 1, 2 and 3, respectively) (p = 0.013). Overall, ETP evolution over time was statistically different between groups, with the lowest increase of ETP between T1 and T3 in group 3. Protein C and protein S levels were stable, while D-dimers, fibrinogen and factor VIII increased at T2 and T3 in all groups.
Limitations, reasons for caution
Stimulation protocols were prescribed according to the clinical profile and OHSS risks; groups therefore differ substantially in regards to age and ovarian reserve. Thromboembolic events are rare events after COS, we therefore evaluated biological markers of hypercoagulability and not clinical events.
Wider implications of the findings: Women with GnRH agonist triggering protocol did not increase mean ETP in the week after ovulation, while women with hCG triggering did. This different prothrombotic profile was independent of the variation of the other coagulation parameters investigated. This effect of ovulation triggering should be confirmed by further studies.
Trial registration number
NCT04188444
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Affiliation(s)
- I Streuli
- University Hospitals of geneva and the Faculty of medicine of the geneva University, DFEA-Ob/Gyn-reproductive medicine, Geneva, Switzerland
| | - A Casini
- University Hospitals of geneva and the Faculty of medicine of the geneva University, Département de médecine - service d’angiologie et d’hémostase, Geneva, Switzerland
| | - J Benard
- University Hospitals of geneva and the Faculty of medicine of the geneva University, DFEA-Ob/Gyn-reproductive medicine, Geneva, Switzerland
| | - A Poncet
- University Hospitals of geneva and the Faculty of medicine of the geneva University, Centre de recherche clinique - service d’épidémiologie clinique, Geneva, Switzerland
| | - P Fontana
- University Hospitals of geneva and the Faculty of medicine of the geneva University, Département de médecine - service d’angiologie et d’hémostase, Geneva, Switzerland
| | - N Vulliemoz
- University Hospitals of Lausanne and the Faculty of medicine of the Lausanne University, DFMA-Ob/Gyn-reproductive medicine, Geneva, Switzerland
| | - J Hugon-Rodin
- University Hospitals of geneva and the Faculty of medicine of the geneva University, DFEA-Ob/Gyn-reproductive medicine, Geneva, Switzerland
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34
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Streuli I, Casini A, Benard J, Poncet A, Fontana P, Vulliemoz N, Hugon-Rodin J. P-622 Prothrombotic biomarkers during controlled ovarian stimulation for assisted reproductive techniques. Hum Reprod 2021. [DOI: 10.1093/humrep/deab125.048] [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] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
Does the evolution of prothrombotic biomarkers over time differ between antagonist and long agonist stimulation protocols for assisted reproductive techniques (ART) ?
Summary answer
The hypercoagulable state was higher and persistent in the agonist and antagonist with hCG triggering groups compared to the antagonist with GnRH agonist triggering group.
What is known already
Controlled ovarian stimulation (COS) for ART is associated with supra-physiological serum estradiol levels, a hypercoagulable state and an increased risk of venous thrombosis. Most thromboembolic events associated with COS occur in the context of ovarian hyperstimulation syndrome (OHSS). The use of hCG for final follicular maturation increases the risk of OHSS. In antagonist protocols, GnRH agonist triggering is known to prevent or reduce OHSS and is therefore widely used in women at risk. The impact of the different IVF protocols on pro-thrombotic biomarkers is unknown.
Study design, size, duration
In this prospective observational cohort study, infertile women undergoing COS for ART in 2017-2019 at the University Hospitals of Geneva and Lausanne (Switzerland) were included. We evaluated changes in key coagulation parameters (D-dimers, factor VIII, fibrinogen activity, protein S and protein C) and thrombin generation, our primary outcome, (using 5 pM of tissue factor) by calibrated automated thrombinography before stimulation (T1), on the day of ovulation triggering (T2) and seven days after triggering (T3).
Participants/materials, setting, methods
COS was started without hormonal pre-treatment. Protocols were prescribed according to the standards used in each centre taking into account the risk of OHSS (agonist protocol with hCG trigger in women without OHSS risk (Group 1); antagonist protocol in women at risk of OHSS with hCG trigger (Group 2;) or GnRH agonist trigger (Group 3;); variation of endogenous thrombin potential (ETP) was measured and compared among groups using mixed effects linear regression model.
Main results and the role of chance
A total of 64 women were included: 24 were in group 1, 16 in group 2, and 24 in group 3. The mean age (SD) was 37.8 (2.8), 35.9(5.2) and 34(4.6) years in groups 1, 2 and 3 respectively. As expected, women in group 1 had a statistically lower level of anti-müllerian hormone (p = < 0.001), a lower antral follicular count (p = < 0.001) and lower number of MII oocytes and embryos obtained (p = < 0.001). Mean serum estradiol levels were 1836 (1160), 1628 (815) and 3754 (2165) ng/L at T2, and 945 (471), 1061 (495) and 413 (729) ng/L at T3, in group 1 to 3, respectively. In multivariable regression analysis, the levels in group 3 were statistically higher at T2 and lower at T3 (overall time*group interaction: p < 0.001).
The mean ETP was similar between all groups at T1, and increased in all groups at T2 (1442, 1426 and 1486 nM/min in groups 1, 2 and 3, respectively) (p = 0.013). Overall, ETP evolution over time was statistically different between groups, with the lowest increase of ETP between T1 and T3 in group 3. Protein C and protein S levels were stable, while D-dimers, fibrinogen and factor VIII increased at T2 and T3 in all groups.
Limitations, reasons for caution
Stimulation protocols were prescribed according to the clinical profile and OHSS risks; groups therefore differ substantially in regards to age and ovarian reserve. Thromboembolic events are rare events after COS, we therefore evaluated biological markers of hypercoagulability and not clinical events.
Wider implications of the findings
Women with GnRH agonist triggering protocol did not increase mean ETP in the week after ovulation, while women with hCG triggering did. This different prothrombotic profile was independent of the variation of the other coagulation parameters investigated. This effect of ovulation triggering should be confirmed by further studies.
Trial registration number
NCT04188444
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Affiliation(s)
- I Streuli
- University Hospitals of geneva and the Faculty of medicine of the geneva University, DFEA-Ob/Gyn-reproductive medicine, Geneva, Switzerland
| | - A Casini
- University Hospitals of geneva and the Faculty of medicine of the geneva University, Département de médecine - service d’angiologie et d’hémostase, Geneva, Switzerland
| | - J Benard
- University Hospitals of geneva and the Faculty of medicine of the geneva University, DFEA-Ob/Gyn-reproductive medicine, Geneva, Switzerland
| | - A Poncet
- University Hospitals of geneva and the Faculty of medicine of the geneva University, Centre de recherche clinique - service d’épidémiologie clinique, Geneva, Switzerland
| | - P Fontana
- University Hospitals of geneva and the Faculty of medicine of the geneva University, Département de médecine - service d’angiologie et d’hémostase, Geneva, Switzerland
| | - N Vulliemoz
- University Hospitals of Lausanne and the Faculty of medicine of the Lausanne University, DFMA-Ob/Gyn-reproductive medicine, Geneva, Switzerland
| | - J Hugon-Rodin
- University Hospitals of geneva and the Faculty of medicine of the geneva University, DFEA-Ob/Gyn-reproductive medicine, Geneva, Switzerland
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Abstract
MicroRNAs (miRNAs) are a class of non-coding RNAs known to repress mRNA translation and subsequent protein production. miRNAs are predicted to modulate many targets and are involved in regulating various cellular processes. Identifying their role in cell function regulation may allow circulating miRNAs to be used as diagnostic or prognostic markers of various diseases. Increasing numbers of clinical studies have shown associations between circulating miRNA levels and platelet reactivity or the recurrence of cardiovascular events. However, these studies differed regarding population selection, sample types used, miRNA quantification procedures, and platelet function assays. Furthermore, they often lacked functional validation of the miRNA identified in such studies. The latter step is essential to identifying causal relationships and understanding if and how miRNAs regulate platelet function. This review describes recent advances in translational research dedicated to identifying miRNAs' roles in platelet function regulation.
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Affiliation(s)
- A Garcia
- Geneva Platelet Group, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | | | - P Fontana
- Geneva Platelet Group, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of Angiology and Haemostasis, Geneva University Hospitals, Geneva, Switzerland
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36
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Willekens G, Studt JD, Mendez A, Alberio L, Fontana P, Wuillemin WA, Schmidt A, Graf L, Gerber B, Bovet C, Sauter TC, Nagler M. A universal anti-Xa assay for rivaroxaban, apixaban, and edoxaban measurements: method validation, diagnostic accuracy and external validation. Br J Haematol 2021; 193:1203-1212. [PMID: 33954979 PMCID: PMC8252105 DOI: 10.1111/bjh.17470] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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] [Received: 01/15/2021] [Accepted: 03/19/2021] [Indexed: 11/28/2022]
Abstract
A universal anti‐Xa assay for the determination of rivaroxaban, apixaban and edoxaban drug concentrations would simplify laboratory procedures and facilitate widespread implementation. Following two pilot studies analysing spiked samples and material from 698 patients, we conducted a prospective multicentre cross‐sectional study, including 867 patients treated with rivaroxaban, apixaban or edoxaban in clinical practice to comprehensively evaluate a simple, readily available anti‐Xa assay that would accurately measure drug concentrations and correctly predict relevant levels in clinical practice. Anti‐Xa activity was measured by an assay calibrated with low‐molecular‐weight heparin (LMWH) in addition to ultra‐high performance liquid chromatography‐tandem mass spectrometry (LC‐MS/MS). As an external validation, LMWH‐calibrated anti‐Xa activity was also determined in nine external laboratories. The LMWH‐calibrated anti‐Xa activity correlated strongly with rivaroxaban, apixaban or edoxaban drug levels [rs = 0·98, 95% confidence interval (CI) 0·98–0·98]. The sensitivity for the clinically relevant cut‐off levels of 30, 50 and 100 µg/l was 96·2% (95% CI 94·4–97·4), 96·4% (95% CI 94·4–97·7) and 96·7% (95% CI 94·3–98·1) respectively. Concordant results were obtained in the external validation study. In conclusion, a universal, LMWH‐calibrated anti‐Xa assay accurately measured rivaroxaban, apixaban and edoxaban concentrations and correctly predicted relevant drug concentrations in clinical practice.
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Affiliation(s)
- Guido Willekens
- Department of Epidemiology, Maastricht University, Maastricht, the Netherlands.,Department of Clinical Chemistry, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jan-Dirk Studt
- Division of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Adriana Mendez
- Department of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Lorenzo Alberio
- Service and Central Laboratory of Hematology, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Pierre Fontana
- Division of Angiology and Hemostasis, Geneva University Hospital, Geneva, Switzerland
| | - Walter A Wuillemin
- Division of Hematology and Central Hematology Laboratory, Cantonal Hospital of Lucerne, University of Bern, Bern, Switzerland
| | - Adrian Schmidt
- Institute of Laboratory Medicine and Clinic of Medical Oncology and Hematology, City Hospital Waid and Triemli, Zurich, Switzerland
| | - Lukas Graf
- Cantonal Hospital of St Gallen, St Gallen, Switzerland
| | - Bernhard Gerber
- Clinic of Hematology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Cedric Bovet
- Department of Clinical Chemistry, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas C Sauter
- Department of Emergency Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Michael Nagler
- Department of Clinical Chemistry, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Hematology, Inselspital, Bern University Hospital, Bern, Switzerland
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Garcia A, Dunoyer-Geindre S, Nolli S, Strassel C, Reny JL, Fontana P. miR-204-5p and Platelet Function Regulation: Insight into a Mechanism Mediated by CDC42 and GPIIbIIIa. Thromb Haemost 2021; 121:1206-1219. [PMID: 33940656 PMCID: PMC8421094 DOI: 10.1055/a-1497-9649] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 12/13/2022]
Abstract
BACKGROUND Several platelet-derived microRNAs are associated with platelet reactivity (PR) and clinical outcome in cardiovascular patients. We previously showed an association between miR-204-5p and PR in stable cardiovascular patients, but data on functional mechanisms are lacking. AIMS To validate miR-204-5p as a regulator of PR in platelet-like structures (PLS) derived from human megakaryocytes and to address mechanistic issues. METHODS Human hematopoietic stem cells were differentiated into megakaryocytes, enabling the transfection of miR-204-5p and the recovery of subsequent PLS. The morphology of transfected megakaryocytes and PLS was characterized using flow cytometry and microscopy. The functional impact of miR-204-5p was assessed using a flow assay, the quantification of the activated form of the GPIIbIIIa receptor, and a fibrinogen-binding assay. Quantitative polymerase chain reaction and western blot were used to evaluate the impact of miR-204-5p on a validated target, CDC42. The impact of CDC42 modulation was investigated using a silencing strategy. RESULTS miR-204-5p transfection induced cytoskeletal changes in megakaryocytes associated with the retracted protrusion of proPLS, but it had no impact on the number of PLS released. Functional assays showed that the PLS produced by megakaryocytes transfected with miR-204-5p were more reactive than controls. This phenotype is mediated by the regulation of GPIIbIIIa expression, a key contributor in platelet-fibrinogen interaction. Similar results were obtained after CDC42 silencing, suggesting that miR-204-5p regulates PR, at least in part, via CDC42 downregulation. CONCLUSION We functionally validated miR-204-5p as a regulator of the PR that occurs through CDC42 downregulation and regulation of fibrinogen receptor expression.
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Affiliation(s)
- Alix Garcia
- Geneva Platelet Group, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | | | - Séverine Nolli
- Geneva Platelet Group, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | | | - Jean-Luc Reny
- Geneva Platelet Group, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Pierre Fontana
- Geneva Platelet Group, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of Angiology and Haemostasis, Geneva University Hospitals, Geneva, Switzerland
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Gresele P, Falcinelli E, Bury L, Pecci A, Alessi MC, Borhany M, Heller PG, Santoro C, Cid AR, Orsini S, Fontana P, De Candia E, Podda G, Kannan M, Jurk K, Castaman G, Falaise C, Guglielmini G, Noris P. The ISTH bleeding assessment tool as predictor of bleeding events in inherited platelet disorders: Communication from the ISTH SSC Subcommittee on Platelet Physiology. J Thromb Haemost 2021; 19:1364-1371. [PMID: 33880867 DOI: 10.1111/jth.15263] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 10/29/2020] [Revised: 01/18/2021] [Accepted: 02/04/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND The ISTH Bleeding Assessment Tool (ISTH-BAT) has been validated for clinical screening of suspected von Willebrand disease (VWD) and for bleeding prediction. Recently it has been validated for subjects with inherited platelet disorders (IPD) (BAT-VAL study). OBJECTIVES To determine whether the ISTH-BAT bleeding score (BS) predicts subsequent bleeding events requiring treatment in IPD patients. METHODS Patients with IPD, type 1 VWD (VWD-1) and age- and sex-matched healthy controls enrolled in the BAT-VAL study were prospectively followed-up for 2 years and bleeding episodes requiring treatment were recorded. RESULTS Of the 1098 subjects initially enrolled, 955 were followed-up and 124 suffered hemorrhages during follow-up, 60% of whom had inherited platelet function disorders (IPFD). Total number of events was significantly higher in IPFD (n = 235) than VWD-1 (n = 52) or inherited thrombocytopenia (IT; n = 20). Events requiring transfusions were 66% in IPFD, 5.7% in VWD-1, and 3% in IT. Baseline BS was significantly higher in IPFD patients with a bleeding event at follow-up than in those without (p < .01) and the percentage of subjects suffering a bleeding event increased proportionally to baseline BS quartile. A significant association between the BS and the chance of suffering severe bleeding was found in the overall, IPFD, and VWD-1 populations. Similar results were obtained for the pediatric population. CONCLUSIONS Inherited platelet function disorder patients with high BS at enrollment are more likely to suffer from bleeding events requiring treatment at follow-up. Moreover, the higher the baseline BS quartile the greater the incidence of subsequent events, suggesting that independently from diagnosis a high BS is associated with a greater risk of subsequent hemorrhage.
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Affiliation(s)
- Paolo Gresele
- Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Emanuela Falcinelli
- Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Loredana Bury
- Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Alessandro Pecci
- Department of Internal Medicine, IRCCS Policlinico S. Matteo Foundation, University of Pavia, Pavia, Italy
| | - Marie-Christine Alessi
- Centre for CardioVascular and Nutrition Research (C2VN, INSERM 1263, INRA 1260, Marseille, France
| | - Munira Borhany
- Department of Hematology, Haemostasis & Thrombosis at National Institute of Blood Disease & Bone Marrow Transplantation, Karachi, Pakistan
| | - Paula G Heller
- Instituto de Investigaciones Médicas A. Lanari, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
- Departamento Hematología Investigación, Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET, Universidad de Buenos Aires, Instituto de Investigaciones Médicas (IDIM, Buenos Aires, Argentina
| | - Cristina Santoro
- Hematology, Azienda Ospedaliera Universitaria Policlinico Umberto I, Rome, Italy
| | - Ana Rosa Cid
- Unidad de Hemostasia y Trombosis, Hospital Universitario y Politecnico La Fe, Valencia, Spain
| | - Sara Orsini
- Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Pierre Fontana
- Geneva Platelet Group and Division of Angiology and Hemostasis, University Hospitals of Geneva, Geneva, Switzerland
| | - Erica De Candia
- Hemostasis and Thrombosis Unit, Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy
- Institute of Internal Medicine and Geriatrics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gianmarco Podda
- Medicina III, ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Meganathan Kannan
- Division of Blood and Vascular Biology, Department of Life Sciences, School of Life Sciences, Central University of Tamil Nadu, Thiruvarur, India
| | - Kerstin Jurk
- Center for Thrombosis and Hemostasis, University Medical Center, Mainz, Germany
| | - Giancarlo Castaman
- Department of Oncology, Center for Bleeding Disorders and Coagulation, Careggi University Hospital, Florence, Italy
| | - Céline Falaise
- Centre for CardioVascular and Nutrition Research (C2VN, INSERM 1263, INRA 1260, Marseille, France
| | - Giuseppe Guglielmini
- Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Patrizia Noris
- Department of Internal Medicine, IRCCS Policlinico S. Matteo Foundation, University of Pavia, Pavia, Italy
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Brodard J, Kremer Hovinga JA, Fontana P, Studt JD, Gruel Y, Greinacher A. COVID-19 patients often show high-titer non-platelet-activating anti-PF4/heparin IgG antibodies. J Thromb Haemost 2021; 19:1294-1298. [PMID: 33550713 PMCID: PMC8013750 DOI: 10.1111/jth.15262] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Heparin-induced thrombocytopenia (HIT) is a severe adverse reaction to heparin caused by heparin-dependent, platelet-activating anti-platelet factor 4 (PF4)/heparin antibodies. Heparin is a cornerstone of treatment in critically ill COVID-19 patients. HIT antibodies can be detected by antigen tests and functional tests. Often strong reactivity in the antigen test is used as a surrogate marker for the presence of clinically relevant, platelet-activating antibodies. We observed an unexpectedly high percentage of COVID-19 patients, clinically suspected to have HIT, with high titer anti-PF4/heparin antibodies, but a negative functional test. OBJECTIVE We investigated whether in COVID-19 patients a serum-derived factor inhibits the heparin-induced platelet activation test (HIPA). METHODS AND RESULTS Twelve COVID-19 patients with suspected HIT were tested. Three samples tested negative in all assays; nine samples tested positive by antigen tests, among which only three tested also positive by HIPA. When we spiked COVID-19 serum or control serum with the human HIT antibody like monoclonal antibody 5B9, reactivity of 5B9 remained the same. Also, the purified IgG fractions of COVID-19 sera testing strongly positive in the PF4/heparin antigen test but negative in the functional test did not show increased reactivity in the functional test in comparison to the original serum. Both results make a functionally inhibitory factor in the serum/plasma of COVID-19 patients highly unlikely. CONCLUSION COVID-19 patients often present with strong reactivity in PF4/heparin antigen tests without the presence of platelet-activating antibodies. Diagnosis of HIT requires confirmation of heparin-dependent, platelets activating antibodies to avoid overdiagnosis and overtreatment with non-heparin anticoagulants.
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Affiliation(s)
- Justine Brodard
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Johanna A Kremer Hovinga
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Pierre Fontana
- Division of Angiology and Haemostasis, University Hospitals of Geneva, Geneva, Switzerland
| | - Jan-Dirk Studt
- Department of Medical Oncology and Hematology, University Hospital Zürich, Zürich, Switzerland
| | - Yves Gruel
- Department of Hematology-Hemostasis, University Hospital of Tours, Tours, France
| | - Andreas Greinacher
- Institut für Immunologie und Transfusionsmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
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40
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Garcia A, Dunoyer-Geindre S, Nolli S, Reny JL, Fontana P. An Ex Vivo and In Silico Study Providing Insights into the Interplay of Circulating miRNAs Level, Platelet Reactivity and Thrombin Generation: Looking beyond Traditional Pharmacogenetics. J Pers Med 2021; 11:jpm11050323. [PMID: 33919053 PMCID: PMC8143175 DOI: 10.3390/jpm11050323] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 04/14/2021] [Accepted: 04/19/2021] [Indexed: 12/18/2022] Open
Abstract
Platelet reactivity (PR), a key pharmacodynamic (PD) component of the action of antiplatelet drugs in cardiovascular disease (CVD) patients, is highly variable. PR is associated with occurrence or recurrence of thrombotic and bleeding events, but this association is modulated by several factors. Conventional pharmacogenetics explains a minor part of this PR variability, and among determinants of PR, circulating microRNAs (miRNAs) have been the focus of attention during these last years as biomarkers to predict PR and clinical outcomes in CVD. This being said, the impact of miRNAs on platelet function and the mechanisms behind it are largely unknown. The level of a set of candidate miRNAs including miR-126-3p, miR-150-5p, miR-204-5p and miR-223-3p was quantified in plasma samples of stable CVD patients and correlated with PR as assessed by light-transmission aggregometry and in vivo thrombin generation markers. Finally, miRNA target networks were built based on genes involved in platelet function. We show that all candidate miRNAs were associated with platelet aggregation, while only miR-126-3p and miR-223-3p were positively correlated with in vivo thrombin generation markers. In silico analysis identified putative miRNA targets involved in platelet function regulation. Circulating miRNAs were associated with different aspects of platelet reactivity, including platelet aggregation and platelet-supported thrombin generation. This paves the way to a personalized antithrombotic treatment according to miRNA profile in CVD patients.
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Affiliation(s)
- Alix Garcia
- Geneva Platelet Group, Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland; (A.G.); (S.D.-G.); (S.N.); (J.-L.R.)
| | - Sylvie Dunoyer-Geindre
- Geneva Platelet Group, Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland; (A.G.); (S.D.-G.); (S.N.); (J.-L.R.)
| | - Séverine Nolli
- Geneva Platelet Group, Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland; (A.G.); (S.D.-G.); (S.N.); (J.-L.R.)
| | - Jean-Luc Reny
- Geneva Platelet Group, Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland; (A.G.); (S.D.-G.); (S.N.); (J.-L.R.)
- Division of General Internal Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Pierre Fontana
- Geneva Platelet Group, Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland; (A.G.); (S.D.-G.); (S.N.); (J.-L.R.)
- Division of Angiology and Haemostasis, Geneva University Hospitals, 1205 Geneva, Switzerland
- Correspondence: ; Tel.: +41-22-372-97-51
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41
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Barbolini L, Terrier J, Marti C, Samer C, Daali Y, Fontana P, Reny JL. Mixing Drugs and Genetics: A Complex Hemorrhagic Cocktail. Am J Med 2021; 134:e211-e212. [PMID: 32858019 DOI: 10.1016/j.amjmed.2020.07.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 07/27/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Laura Barbolini
- Division of General Internal Medicine, Geneva University Hospitals, Switzerland
| | - Jean Terrier
- Division of General Internal Medicine, Geneva University Hospitals, Switzerland; Geneva Platelet Group, Faculty of Medicine, University of Geneva, Switzerland; Clinical Pharmacology and Toxicology Service, Anesthesiology, Pharmacology and Intensive Care Department, Geneva University Hospitals, Switzerland.
| | - Christophe Marti
- Division of General Internal Medicine, Geneva University Hospitals, Switzerland
| | - Caroline Samer
- Clinical Pharmacology and Toxicology Service, Anesthesiology, Pharmacology and Intensive Care Department, Geneva University Hospitals, Switzerland
| | - Youssef Daali
- Geneva Platelet Group, Faculty of Medicine, University of Geneva, Switzerland; Clinical Pharmacology and Toxicology Service, Anesthesiology, Pharmacology and Intensive Care Department, Geneva University Hospitals, Switzerland
| | - Pierre Fontana
- Geneva Platelet Group, Faculty of Medicine, University of Geneva, Switzerland; Division of Angiology and Haemostasis, Geneva University Hospitals, Switzerland
| | - Jean-Luc Reny
- Division of General Internal Medicine, Geneva University Hospitals, Switzerland; Geneva Platelet Group, Faculty of Medicine, University of Geneva, Switzerland
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42
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Gassmann N, Viviano M, Righini M, Fontana P, Martinez de Tejada B, Blondon M. Estimating the risk thresholds used by guidelines to recommend postpartum thromboprophylaxis. J Thromb Haemost 2021; 19:452-459. [PMID: 33176061 DOI: 10.1111/jth.15166] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 08/09/2020] [Revised: 10/08/2020] [Accepted: 11/04/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Guidelines for postpartum thromboprophylaxis are mostly expert based. Acceptable postpartum venous thromboembolism (VTE) risk thresholds to justify the use of thromboprophylaxis are ill defined. OBJECTIVE To compare the proportion of postpartum women with recommended thromboprophylaxis according to the Royal College of Obstetricians and Gynecologists (RCOG), American College of Obstetricians and Gynecologists (ACOG), and American College of Chest Physicians (ACCP) guidelines, and to estimate their threshold of risk of VTE. METHODS We collected maternal, obstetrical, and fetal characteristics among all women who delivered at the Geneva University Hospitals in January 2019 through medical chart review. We determined for each woman the recommended strategy of thromboprophylaxis according to each guideline. We indirectly estimated individual absolute VTE risks using a validated risk prediction model (Sultan). RESULTS Among 344 women (mean age 32.2 years), with 23.3% of cesarean deliveries (CD), the RCOG guideline categorized 40.1% of all deliveries, 25.4% of vaginal deliveries (VD), and 88.8% of CD as requiring thromboprophylaxis. The ACOG and ACCP guidelines, which focus on CD, categorized fewer women as high risk (35.0% and 40.0% of CD, respectively). The mean estimated risk of VTE was 0.07% in all participants, 0.12% in those with recommended thromboprophylaxis according to the RCOG, and 0.20% among women after CD with recommended thromboprophylaxis by the ACOG and ACCP guidelines. CONCLUSIONS Our data highlight important variations in the proportion of thromboprophylaxis recommendation between guidelines. Risk thresholds to recommend the use of heparin appear very low, and may correlate with a high, and perhaps undesirable, number needed to treat to prevent VTE events.
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Affiliation(s)
| | - Manuela Viviano
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Obstetrics, Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
| | - Marc Righini
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Angiology and Hemostasis, Geneva University Hospitals, Geneva, Switzerland
| | - Pierre Fontana
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Angiology and Hemostasis, Geneva University Hospitals, Geneva, Switzerland
| | - Begoña Martinez de Tejada
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Obstetrics, Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
| | - Marc Blondon
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Angiology and Hemostasis, Geneva University Hospitals, Geneva, Switzerland
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43
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Fontana P, Robert-Ebadi H, Righini M. [Towards new indications for direct oral anticoagulants]. Rev Med Suisse 2021; 17:20-23. [PMID: 33443825] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Direct oral anticoagulants (DOAC) represent commonly prescribed drugs in everyday clinical practice for indications such as atrial fibrillation, prevention of venous thromboembolic disease (VTE) after major orthopaedic surgery, treatment of deep vein thrombosis and pulmonary embolism, and long term prevention of VTE recurrence. More recently, the efficacy of DOAC has been demonstrated in new clinical situations, such as heparin-induced thrombocytopenia, cancer-associated VTE and secondary prevention of cardiovascular events in patients with atherothrombotic arterial disease. This article's aims is to present the recent data on which these new indications are based.
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Affiliation(s)
- Pierre Fontana
- Service d'angiologie et d'hémostase, HUG, 1211 Genève 14
| | | | - Marc Righini
- Service d'angiologie et d'hémostase, HUG, 1211 Genève 14
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44
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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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45
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Righini M, Mazzolai L, Fontana P. [Not Available]. Rev Med Suisse 2020; 16:2359-2360. [PMID: 33300693] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Marc Righini
- Service d'angiologie et d'hémostase, HUG, Genève
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46
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Blondon M, Casini A, Fontana P, Hugon-Rodin J. [Contraception and venous thromboembolism]. Rev Med Suisse 2020; 16:2383-2386. [PMID: 33300698] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Combined oral contraceptives remain in 2020 the most used contraceptive method in Switzerland and Europe, and are found in about half of venous thromboembolism (VTE) occurring in women aged up to 50 years. In this narrative review, we describe the determinants of the VTE risk, related to the types of oral contraceptives and to genetic or acquired risk factors of users, while summarizing several current recommendations of prescription for contraceptives. The complex management of contraception at the time of VTE should be discussed with patients, in order to minimize the risks of undesired pregnancy, abnormal uterine bleeding and recurrent VTE.
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Affiliation(s)
- Marc Blondon
- Service d'angiologie et d'hémostase, HUG, 1211 Genève 14, et Faculté de médecine, Université de Genève, 1211 Genève 4
| | - Alessandro Casini
- Service d'angiologie et d'hémostase, HUG, 1211 Genève 14, et Faculté de médecine, Université de Genève, 1211 Genève 4
| | - Pierre Fontana
- Service d'angiologie et d'hémostase, HUG, 1211 Genève 14, et Faculté de médecine, Université de Genève, 1211 Genève 4
| | - Justine Hugon-Rodin
- Service de gynécologie, Groupe hospitalier Paris Saint-Joseph, INSERM, Obstetrical, perinatal and pediatric epidemiology research team, Center for epidemiology and statistics, Rue Raymond-Losserand 185, 75014 Paris
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47
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Lewis JP, Backman JD, Reny JL, Bergmeijer TO, Mitchell BD, Ritchie MD, Déry JP, Pakyz RE, Gong L, Ryan K, Kim EY, Aradi D, Fernandez-Cadenas I, Lee MTM, Whaley RM, Montaner J, Gensini GF, Cleator JH, Chang K, Holmvang L, Hochholzer W, Roden DM, Winter S, Altman RB, Alexopoulos D, Kim HS, Gawaz M, Bliden KP, Valgimigli M, Marcucci R, Campo G, Schaeffeler E, Dridi NP, Wen MS, Shin JG, Fontana P, Giusti B, Geisler T, Kubo M, Trenk D, Siller-Matula JM, Ten Berg JM, Gurbel PA, Schwab M, Klein TE, Shuldiner AR. Pharmacogenomic polygenic response score predicts ischaemic events and cardiovascular mortality in clopidogrel-treated patients. Eur Heart J Cardiovasc Pharmacother 2020; 6:203-210. [PMID: 31504375 DOI: 10.1093/ehjcvp/pvz045] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 08/15/2019] [Accepted: 08/29/2019] [Indexed: 01/23/2023]
Abstract
AIMS Clopidogrel is prescribed for the prevention of atherothrombotic events. While investigations have identified genetic determinants of inter-individual variability in on-treatment platelet inhibition (e.g. CYP2C19*2), evidence that these variants have clinical utility to predict major adverse cardiovascular events (CVEs) remains controversial. METHODS AND RESULTS We assessed the impact of 31 candidate gene polymorphisms on adenosine diphosphate (ADP)-stimulated platelet reactivity in 3391 clopidogrel-treated coronary artery disease patients of the International Clopidogrel Pharmacogenomics Consortium (ICPC). The influence of these polymorphisms on CVEs was tested in 2134 ICPC patients (N = 129 events) in whom clinical event data were available. Several variants were associated with on-treatment ADP-stimulated platelet reactivity (CYP2C19*2, P = 8.8 × 10-54; CES1 G143E, P = 1.3 × 10-16; CYP2C19*17, P = 9.5 × 10-10; CYP2B6 1294 + 53 C > T, P = 3.0 × 10-4; CYP2B6 516 G > T, P = 1.0 × 10-3; CYP2C9*2, P = 1.2 × 10-3; and CYP2C9*3, P = 1.5 × 10-3). While no individual variant was associated with CVEs, generation of a pharmacogenomic polygenic response score (PgxRS) revealed that patients who carried a greater number of alleles that associated with increased on-treatment platelet reactivity were more likely to experience CVEs (β = 0.17, SE 0.06, P = 0.01) and cardiovascular-related death (β = 0.43, SE 0.16, P = 0.007). Patients who carried eight or more risk alleles were significantly more likely to experience CVEs [odds ratio (OR) = 1.78, 95% confidence interval (CI) 1.14-2.76, P = 0.01] and cardiovascular death (OR = 4.39, 95% CI 1.35-14.27, P = 0.01) compared to patients who carried six or fewer of these alleles. CONCLUSION Several polymorphisms impact clopidogrel response and PgxRS is a predictor of cardiovascular outcomes. Additional investigations that identify novel determinants of clopidogrel response and validating polygenic models may facilitate future precision medicine strategies.
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Affiliation(s)
- Joshua P Lewis
- Department of Medicine and Program for Personalized and Genomic Medicine, University of Maryland, 670 W. Baltimore St., Baltimore, MD 21201, USA
| | - Joshua D Backman
- Department of Medicine and Program for Personalized and Genomic Medicine, University of Maryland, 670 W. Baltimore St., Baltimore, MD 21201, USA
| | - Jean-Luc Reny
- Department of Internal Medicine, Béziers Hospital, 2 Rue Valentin Hau, BP 740, Béziers 34525, France.,Department of Medicine, Geneva Platelet Group, University of Geneva School of Medicine, University Hospitals of Geneva, 24 rue du Général-Dufour, Genève 4 CH-1211, Switzerland
| | - Thomas O Bergmeijer
- Department of Cardiology, Antonius Center for Platelet Function Research, St Antonius Hospital, P O Box 2500, Nieuwegein 3432 EM, The Netherlands
| | - Braxton D Mitchell
- Department of Medicine and Program for Personalized and Genomic Medicine, University of Maryland, 670 W. Baltimore St., Baltimore, MD 21201, USA.,Geriatrics Research and Education Clinical Center, Baltimore Veterans Administration Medical Center, 10 N. Greene St., Baltimore, MD 21201, USA
| | - Marylyn D Ritchie
- Center for Translational Bioinformatics, Institute for Biomedical Informatics, University of Pennsylvania, A301 Richards Building, 3700 Hamilton Walk, Philadelphia, PA 19104, USA
| | - Jean-Pierre Déry
- Quebec Heart and Lung Institute, University Laval, 2725 chemin Sainte-Foy, Quebec City G1V 4G5, Canada
| | - Ruth E Pakyz
- Department of Medicine and Program for Personalized and Genomic Medicine, University of Maryland, 670 W. Baltimore St., Baltimore, MD 21201, USA
| | - Li Gong
- Department of Biomedical Data Science, Stanford University, 443 Via Ortega, Room 213, Stanford, CA 94305, USA
| | - Kathleen Ryan
- Department of Medicine and Program for Personalized and Genomic Medicine, University of Maryland, 670 W. Baltimore St., Baltimore, MD 21201, USA
| | - Eun-Young Kim
- Department of Clinical Pharmacology, Inje University, Busan Paik Hospital, Bokji-ro 75, Busangjin-gu, Busan 614-735, South Korea
| | - Daniel Aradi
- Department of Cardiology, Heart Center Balatonfüred, 2 Gyogy Ter, Balatonfured 8230, Hungary
| | - Israel Fernandez-Cadenas
- Stroke Pharmacogenomics and Genetic Group, Fundació Docencia i Recerca Mutuaterrassa, 508221 Terrassa, Barcelona 8041, Spain.,Department of Neurology, Vall d'Hebron Institute of Research, Passeig Vall d'Hebron, Barcelona 8035, Spain
| | - Ming Ta Michael Lee
- Genomic Medicine Institute, Geisinger Health System, 100 N. Academy Ave., Danville, PA 17822, USA
| | - Ryan M Whaley
- Department of Biomedical Data Science, Stanford University, 443 Via Ortega, Room 213, Stanford, CA 94305, USA
| | - Joan Montaner
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Passeig Vall d'Hebron 119-129, Barcelona 8035, Spain
| | - Gian Franco Gensini
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, Florence 50055, Italy
| | - John H Cleator
- Division of Cardiology, Vanderbilt University Medical Center, 2215B Garland Avenue, Nashville, TN 37232, USA.,Department of Pharmacology, Vanderbilt University Medical Center, 2215B Garland Avenue, Nashville, TN 37232, USA
| | - Kiyuk Chang
- Department of Internal Medicine, Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-Gu, Seoul 6591, South Korea
| | - Lene Holmvang
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Inge Lehmannsvej 7 - 2142, Copenhagen 2100, Denmark
| | - Willibald Hochholzer
- Department of Cardiology and Angiology II, University Heart Center Freiburg, Suedring 15, Bad Krozingen 79189, Germany
| | - Dan M Roden
- Department of Pharmacology, Vanderbilt University Medical Center, 2215B Garland Avenue, Nashville, TN 37232, USA.,Department of Medicine, Vanderbilt University Medical Center, 2215B Garland Avenue, Nashville, TN 37232, USA.,Department of Biomedical Informatics, Vanderbilt University Medical Center, 2215B Garland Avenue, Nashville, TN 37232, USA
| | - Stefan Winter
- Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Auerbachstrasse 112, Stuttgart, 70376 Germany
| | - Russ B Altman
- Department of Bioengineering, Genetics, and Medicine, Stanford University, 443 Via Ortega Drive, Shriram Room 209, Stanford, CA 94305, USA
| | | | - Ho-Sook Kim
- Department of Clinical Pharmacology, Inje University, Busan Paik Hospital, Gaegum2-dong 622-165, Busanjin-Gu, Busan 614-735, South Korea
| | - Meinrad Gawaz
- Department of Cardiology and Angiology, University of Tübingen, Otfired-Müller-Straße 10, Tübingen 72076, Germany
| | - Kevin P Bliden
- Center for Thrombosis Research and Drug Development, Inova Heart and Vascular Institute, 3300 Gallows Rd, Falls Church, VA 22042, USA
| | - Marco Valgimigli
- Department of Cardiology, Bern University Hospital, Freiburgstrasse 8, Bern 3010, Switzerland
| | - Rossella Marcucci
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, Florence 50055, Italy.,Atherothrombotic Diseases Center, Careggi University Hospital, Largo G. Alessandro Brambilla, Florence 50134, Italy
| | - Gianluca Campo
- Department of Cardiology, University Hospital of Ferrara, Via Aldo Moro 8, Cona (FE), Ferrara 44123, Italy.,GVM Care & Research, Maria Cecilia Hospital, Via Madonna di Genova, 1, Cotignola 48033, Italy
| | - Elke Schaeffeler
- Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Auerbachstrasse 112, Stuttgart, 70376 Germany
| | - Nadia P Dridi
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Inge Lehmannsvej 7 - 2142, Copenhagen 2100, Denmark
| | - Ming-Shien Wen
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou and School of Medicine, Chang Gung University, No. 5, Fuxing St, Guishan Dist., Taoyuan City 333, Taiwan
| | - Jae Gook Shin
- Department of Clinical Pharmacology, Inje University, Busan Paik Hospital, Gaegum2-dong 622-165, Busanjin-Gu, Busan 614-735, South Korea
| | - Pierre Fontana
- Department of Medicine, Geneva Platelet Group, University of Geneva School of Medicine, University Hospitals of Geneva, 24 rue du Général-Dufour, Genève 4 CH-1211, Switzerland.,Division of Angiology and Haemostasis, University Hospitals of Geneva, 24 Rue Gabrielle-Perret-Gentil, Geneva 1205, Switzerland
| | - Betti Giusti
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, Florence 50055, Italy.,Atherothrombotic Diseases Center, Careggi University Hospital, Largo G. Alessandro Brambilla, Florence 50134, Italy
| | - Tobias Geisler
- Department of Cardiology and Angiology, University of Tübingen, Otfired-Müller-Straße 10, Tübingen 72076, Germany
| | - Michiaki Kubo
- Laboratory for Genotyping Development, RIKEN Center for Integrative Medical Sciences, 1-7-22, Suehiro-cho, Tsurumi, Yokohama 230-0045, Japan
| | - Dietmar Trenk
- Department of Cardiology and Angiology II, Clinical Pharmacology, University Heart Centre Freiburg, Suedring 15, Bad Krozingen D-79189, Germany
| | - Jolanta M Siller-Matula
- Department of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria
| | - Jurriën M Ten Berg
- Department of Cardiology, Antonius Center for Platelet Function Research, St Antonius Hospital, P O Box 2500, Nieuwegein 3432 EM, The Netherlands
| | - Paul A Gurbel
- Department of Cardiology and Angiology, University of Tübingen, Otfired-Müller-Straße 10, Tübingen 72076, Germany
| | - Matthias Schwab
- Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Auerbachstrasse 112, Stuttgart, 70376 Germany.,Department of Clinical Pharmacology, University of Tuebingen, Otfried-Mueller-Strasse 10, Tuebingen 72076, Germany.,Department of Pharmacy and Biochemistry, University of Tuebingen, Otfried-Mueller-Strasse 10, Tuebingen 72076, Germany
| | - Teri E Klein
- Department of Biomedical Data Science, Stanford University, 443 Via Ortega, Room 213, Stanford, CA 94305, USA.,Department of Bioengineering, Genetics, and Medicine, Stanford University, 443 Via Ortega Drive, Shriram Room 209, Stanford, CA 94305, USA
| | - Alan R Shuldiner
- Department of Medicine and Program for Personalized and Genomic Medicine, University of Maryland, 670 W. Baltimore St., Baltimore, MD 21201, USA
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48
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Hardy M, Douxfils J, Bareille M, Lessire S, Gouin-Thibault I, Fontana P, Lecompte T, Mullier F. Studies on hemostasis in COVID-19 deserve careful reporting of the laboratory methods, their significance, and their limitations. J Thromb Haemost 2020; 18:3121-3124. [PMID: 32790951 PMCID: PMC7436855 DOI: 10.1111/jth.15061] [Citation(s) in RCA: 14] [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: 08/07/2020] [Accepted: 08/08/2020] [Indexed: 01/20/2023]
Affiliation(s)
- Michael Hardy
- Université catholique de Louvain, CHU UCL Namur, Hematology Laboratory, Namur Thrombosis and Hemostasis Center (NTHC), NARILIS, Yvoir, Belgium
- Université catholique de Louvain, CHU UCL Namur, Anesthesiology Department, Namur Thrombosis and Hemostasis Center (NTHC), NARILIS, Yvoir, Belgium
| | - Jonathan Douxfils
- Département Pharmacie, Namur Thrombosis and Hemostasis Center (NTHC), NARILIS, Université de Namur, Namur, Belgium
- Qualiblood s.a., Namur, Belgium
| | - Marion Bareille
- Université catholique de Louvain, CHU UCL Namur, Hematology Laboratory, Namur Thrombosis and Hemostasis Center (NTHC), NARILIS, Yvoir, Belgium
| | - Sarah Lessire
- Université catholique de Louvain, CHU UCL Namur, Anesthesiology Department, Namur Thrombosis and Hemostasis Center (NTHC), NARILIS, Yvoir, Belgium
| | - Isabelle Gouin-Thibault
- Département d'Hématologie Biologique, INSERM, CIC 1414 (Centre d'Investigation Clinique de Rennes), CHU de Rennes, Université de Rennes, Rennes, France
| | - Pierre Fontana
- Département de Médecine, Service d'angiologie et d'hémostase et Faculté de Médecine, Geneva Platelet Group (GpG), Hôpitaux Universitaires de Genève, Université de Genève, Geneva, Switzerland
| | - Thomas Lecompte
- Département de Médecine, Service d'angiologie et d'hémostase et Faculté de Médecine, Geneva Platelet Group (GpG), Hôpitaux Universitaires de Genève, Université de Genève, Geneva, Switzerland
| | - François Mullier
- Université catholique de Louvain, CHU UCL Namur, Hematology Laboratory, Namur Thrombosis and Hemostasis Center (NTHC), NARILIS, Yvoir, Belgium
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49
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Abstract
MicroRNAs (miRNAs) are small noncoding RNAs modulating protein production. They are key players in regulation of cell function and are considered as biomarkers in several diseases. The identification of the proteins they regulate, and their impact on cell physiology, may delineate their role as diagnostic or prognostic markers and identify new therapeutic strategies. During the last 3 decades, development of a large panel of techniques has given rise to multiple models dedicated to the study of miRNAs. Since plasma samples are easily accessible, circulating miRNAs can be studied in clinical trials. To quantify miRNAs in numerous plasma samples, the choice of extraction and purification techniques, as well as normalization procedures, are important for comparisons of miRNA levels in populations and over time. Recent advances in bioinformatics provide tools to identify putative miRNAs targets that can then be validated with dedicated assays. In vitro and in vivo approaches aim to functionally validate candidate miRNAs from correlations and to understand their impact on cellular processes. This review describes the advantages and pitfalls of the available techniques for translational research to study miRNAs with a focus on their role in regulating platelet reactivity.
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Affiliation(s)
- Alix Garcia
- Geneva Platelet Group, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | | | - Richard J Fish
- Department of Genetic Medicine and Development, University of Geneva, Geneva, Switzerland
| | - Marguerite Neerman-Arbez
- Department of Genetic Medicine and Development, University of Geneva, Geneva, Switzerland.,iGE3, Institute of Genetics and Genomics in Geneva, Geneva, Switzerland
| | - Jean-Luc Reny
- Geneva Platelet Group, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Pierre Fontana
- Geneva Platelet Group, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of Angiology and Haemostasis, Geneva University Hospitals, Geneva, Switzerland
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50
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Terrier J, Daali Y, Fontana P, Csajka C, Reny JL. Towards Personalized Antithrombotic Treatments: Focus on P2Y 12 Inhibitors and Direct Oral Anticoagulants. Clin Pharmacokinet 2020; 58:1517-1532. [PMID: 31250210 DOI: 10.1007/s40262-019-00792-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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]
Abstract
Oral anticoagulants and antiplatelet drugs are commonly prescribed to lower the risk of cardiovascular diseases, such as venous and arterial thrombosis, which represent the leading causes of mortality worldwide. A significant percentage of patients taking antithrombotics will nevertheless experience bleeding or recurrent ischemic events, and this represents a major public health issue. Cardiovascular medicine is now questioning the one-size-fits-all policy, and more personalized approaches are increasingly being considered. However, the available tools are currently limited and they are only moderately able to predict clinical events or have a significant impact on clinical outcomes. Predicting concentrations of antithrombotics in blood could be an effective means of personalization as they have been associated with bleeding and recurrent ischemia. Target concentration interventions could take advantage of physiologically based pharmacokinetic (PBPK) and population-based pharmacokinetic (POPPK) models, which are increasingly used in clinical settings and have attracted the interest of governmental regulatory agencies, to propose dosages adapted to specific population characteristics. These models have the benefit of combining parameters from different sources, such as experimental in vitro data and patients' demographic, genetic, and physiological in vivo data, to characterize the dose-concentration relationships of compounds of interest. As such, they can be used to predict individual drug exposure. In the near future, these models could therefore be a valuable means of predicting personalized antithrombotic blood concentrations and, hopefully, of preventing clinical non-response or bleeding in a given patient. Existing approaches for personalization of antithrombotic prescriptions will be reviewed using practical examples for P2Y12 inhibitors and direct oral anticoagulants. The review will additionally focus on the existing PBPK and POPPK models for these two categories of drugs. Lastly, we address potential scenarios for their implementation in clinics, along with the main limitations and challenges.
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Affiliation(s)
- Jean Terrier
- Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland.,Geneva Platelet Group, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Youssef Daali
- Geneva Platelet Group, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland.,Clinical Pharmacology and Toxicology Service, Anesthesiology, Pharmacology and Intensive Care Department, Geneva University Hospitals, Geneva, Switzerland
| | - Pierre Fontana
- Geneva Platelet Group, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of Angiology and Haemostasis, Geneva University Hospitals, Geneva, Switzerland
| | - Chantal Csajka
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland
| | - Jean-Luc Reny
- Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland. .,Geneva Platelet Group, Faculty of Medicine, University of Geneva, Geneva, Switzerland. .,Division of Internal Medicine and Rehabilitation, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.
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