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Jiménez-Yuste V, Álvarez-Román MT, Berrueco R, Bonanad S, Calvo-Villas JM, González-González R, Porras JRG, Núñez-Vázquez RJ, Rodríguez-López M. Management of Urgent Bleeding in Patients with Hemophilia A: Focus on the Use of Emicizumab. TH Open 2024; 8:e194-e201. [PMID: 38633730 PMCID: PMC11023713 DOI: 10.1055/s-0044-1785525] [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: 12/11/2023] [Accepted: 02/23/2024] [Indexed: 04/19/2024] Open
Abstract
Management of patients with hemophilia A (HA) requires the knowledge and experience of specialized health care professionals. However, these patients may need to be attended in emergencies, outside the referral hospital, where health care professionals do not know about hemophilia and/or new innovative treatments. This study aimed to develop a simple and practical algorithm that could be used in emergency situations by nonspecialized treaters in HA and bleeding with or without factor VIII (FVIII) inhibitors under emicizumab prophylaxis. A group of experts agreed on a simple algorithm, easy to operate, adapted from previous international guidelines, and based on their clinical experience. The proposed algorithm starts with identifying the patient, confirming the diagnosis of HA, prophylaxis with emicizumab, and/or use of other treatments. After stabilizing the patient and stratifying the bleeding risk, the patient is managed according to the presence/absence of FVIII inhibitors. Patients without FVIII inhibitors should receive FVIII concentrate. Dose and follow-up depend on bleeding localization and severity. Patients with FVIII inhibitors should preferably receive recombinant activated factor VII as bypass agent. A basic coagulation assay, FVIII assessment, and FVIII inhibitors detection assays are necessary in an emergency. However, these tests should be interpreted with caution and appropriately chosen, as emicizumab may alter the results. The management of patients with HA is challenging in emergency situations, especially if they are treated with new agents. Nonspecialized in coagulopathies health care professionals have limited understanding of the disease, highlighting the need for an algorithm to assist them in making informed decisions.
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Affiliation(s)
- Víctor Jiménez-Yuste
- Hematology Department, La Paz University Hospital-IdiPaz, Universidad Autónoma, Madrid, Spain
| | - María T. Álvarez-Román
- Hematology Department, La Paz University Hospital-IdiPaz, Universidad Autónoma, Madrid, Spain
| | - Rubén Berrueco
- Pediatric Hematology Unit, Hospital Sant Joan de Deu, Barcelona, Spain
| | - Santiago Bonanad
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | | | | | - Ramiro J. Núñez-Vázquez
- Hematology Department, Hospital Universitario Virgen del Rocío, Instituto deBiomedicina de Sevilla (IBIS), Sevilla, Spain
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Pérez-Alenda S, Carrasco JJ, Querol-Fuentes F, Megías-Vericat JE, Querol-Giner F, Luz Sánchez-Sánchez M, Bonanad S, Núñez-Cortés R. Benefits of physical activity self-monitoring in patients with haemophilia: a prospective study with one-year follow-up. Haemophilia 2024. [PMID: 38470981 DOI: 10.1111/hae.14988] [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: 11/15/2023] [Revised: 03/01/2024] [Accepted: 03/01/2024] [Indexed: 03/14/2024]
Abstract
INTRODUCTION Activity wristbands have been shown to be effective in relation to self-monitoring activity levels and increasing exercise adherence. However, previous reports have been based on short-term follow-ups in people with haemophilia (PWH). AIM (1) To evaluate compliance with physical activity (PA) recommendations in PWH during a 1-year follow-up period using activity wristbands to record daily steps and intensity; (2) To determine the effect of PA self-monitoring on clinical outcomes. METHODS A prospective observational study was conducted in 27 adults with severe haemophilia undergoing prophylactic treatment. The Fitbit Charge HR was used to track daily PA for an entire year. The participants were encouraged to try to reach a goal of 10,000 steps/day and to track their progress. The pre- and post-evaluation included quality of life (A36 Hemophilia-QoL Questionnaire), joint health (Haemophilia Joint Health Score), functionality (Timed Up and Go test), and muscle strength. RESULTS A total of 323.63 (95%CI: 194-364) valid days (i.e., > 2000 steps) were recorded. The annual average number of steps per day taken by participants was 10,379. Sixteen (59%) PWH reached 10,000 steps/day at baseline and 17 (63%) at 1 year follow-up, with no significant differences (x2 = .33; p = .56). A statistically significant improvement was observed in daily moderate activity time (p = .012) and in the 'physical health' quality of life subscale (mean difference: 2.15 points; 95%CI: .64-3.65; p = .007). CONCLUSION Our results suggest that patients with severe haemophilia who self-managed their PA can improve their long-term quality of life in the domain of physical health and also the daily time spent in moderate-intensity PA.
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Affiliation(s)
- Sofía Pérez-Alenda
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Juan J Carrasco
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
- Intelligent Data Analysis Laboratory, University of Valencia, Valencia, Spain
| | - Felipe Querol-Fuentes
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | | | - Felipe Querol-Giner
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - María Luz Sánchez-Sánchez
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Santiago Bonanad
- Haemostasis and Thrombosis Unit, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Rodrigo Núñez-Cortés
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
- Departament of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
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3
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Álvarez-Román MT, Jiménez-Yuste V, Martín-Salces M, De la Corte-Rodríguez H, Bonanad S, Núñez R, Fernández-Mosteirín N, García-Frade LJ, Martinoli C, Kim HK. A post hoc comparative real-world analysis of HEAD-US score for joint health assessment of patients with severe haemophilia A and B in Spain. Haemophilia 2024; 30:513-522. [PMID: 38282205 DOI: 10.1111/hae.14924] [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: 04/25/2023] [Revised: 11/29/2023] [Accepted: 12/11/2023] [Indexed: 01/30/2024]
Abstract
AIM Joint damage due to haemarthrosis can be effectively monitored with point-of care ultrasound using the Haemophilia Early Arthropathy Detection with US (HEAD-US) scoring system. A post hoc comparative analysis of the joint status of patients with severe haemophilia A (HA) or B (HB) was performed. METHODS The databases of two observational, cross-sectional studies that recruited patients with HA or HB from 12 Spanish centres were analysed to compare the status of the elbows, knees and ankles in patients with severe disease according to treatment modality. The HEAD-US score was calculated in both studies by the same trained operators. RESULTS Overall, 95 HA and 41 HB severe patients were included, with a mean age of 35.2 ± 11.8 and 32.7 ± 14.2 years, respectively. The percentage of patients who received prophylaxis, over on-demand (OD) treatment, was much higher in HA (91.6%) than in HB (65.8%) patients. With a similar number of target joints, the HEAD-US score was zero in 6.3% HA and 22.0% HB patients (p < .01), respectively. The HA population showed significantly worse HEAD-US scores. Whilst osteochondral damage occurred more frequently in patients OD or tertiary prophylaxis, our data suggest that articular damage is less prominent in primary/secondary prophylaxis, regardless of the type of haemophilia. These latter treatment modalities were also associated with a lower prevalence of synovial hypertrophy, particularly in HB patients. CONCLUSION This post hoc analysis indicates that joint status seems to be significantly influenced by haemophilia type (HA or HB) and treatment modality in these severe Spanish populations with severe disease. Continuing HEAD-US monitoring for the early detection and management of intra-articular abnormalities, as well as more efficiently tailored therapies should be warranted.
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Affiliation(s)
| | | | | | | | | | - Ramiro Núñez
- Hospital Universitario Virgen del Rocio, Seville, Spain
| | | | | | - Carlo Martinoli
- Department of Health Sciences (DISSAL), Università di Genova, Genova, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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4
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Querol F, Querol-Giner F, Aguilar M, Bonanad S, Marqués E, Blasco JM, Pérez-Alenda S. Haemophilic arthropathy: basic protocols for clinical examination and imaging. Blood Coagul Fibrinolysis 2023; 34:S29-S32. [PMID: 37254729 DOI: 10.1097/mbc.0000000000001215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
In haemophilia, screening protocols in the prevention and treatment of common lesions still require unification of criteria. Patients with haemophilia seek medical consultation exclusively for two reasons: because they have requested an appointment for a routine check-up (1-2 times a year in case of severe haemophilia) or because they have developed acute bleeding that requires treatment. The purpose of this paper is to emphasize the importance of an early differential diagnosis of joint damage and to review the techniques that allow an effective evaluation. The World Federation of Haemophilia recommends the 'Primary Prophylaxis' treatment modality, and today, severe haemophilia patients adhering to that factor VIII/IX therapy have significantly reduced common injuries: haematomas, haemarthrosis, synovitis, and haemophilic arthropathy. The basic protocols and minimum data for the control of musculoskeletal health are described. In summary, the primary goal of the haematologist-led multidisciplinary care team treating patients with haemophilia is likely to restore and/or preserve joint and musculoskeletal health, which is essential to promoting quality of life. Appropriate factor replacement regimens are required to prevent bleeding, these should be combined with physical activity and a physiotherapy program, in accordance with the recommendations of the World Health Organization for the general population.
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Affiliation(s)
- F Querol
- Departamento de Fisioterapia, Universidad de Valencia
| | - F Querol-Giner
- Unidad de Hemostasia y Trombosis, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - M Aguilar
- Unidad de Hemostasia y Trombosis, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - S Bonanad
- Departamento de Fisioterapia, Universidad de Valencia
- Unidad de Hemostasia y Trombosis, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - E Marqués
- Unidad de Hemostasia y Trombosis, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - J M Blasco
- Unidad de Hemostasia y Trombosis, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - S Pérez-Alenda
- Unidad de Hemostasia y Trombosis, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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5
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Herranz R, Oto J, Hueso M, Plana E, Cana F, Castaño M, Cordón L, Ramos-Soler D, Bonanad S, Vera-Donoso CD, Martínez-Sarmiento M, Medina P. Bladder cancer patients have increased NETosis and impaired DNaseI-mediated NET degradation that can be therapeutically restored in vitro. Front Immunol 2023; 14:1171065. [PMID: 37275882 PMCID: PMC10237292 DOI: 10.3389/fimmu.2023.1171065] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/09/2023] [Indexed: 06/07/2023] Open
Abstract
Background Neutrophils, key players of the immune system, also promote tumor development through the formation of neutrophil extracellular traps (NETs) in a process called NETosis. NETs are extracellular networks of DNA, histones and cytoplasmic and granular proteins (calprotectin, myeloperoxidase, elastase, etc.) released by neutrophils upon activation. NETs regulate tumor growth while promoting angiogenesis and invasiveness, and tumor cells also stimulate NETosis. Although NETosis seems to be increased in cancer patients, an increase of NETs in plasma may also be mediated by an impaired degradation by plasma DNaseI, as evidenced in several immunological disorders like lupus nephritis. However, this has never been evidenced in bladder cancer (BC) patients. Herein, we aimed to evaluate the occurrence of increased NETosis in plasma and tumor tissue of BC patients, to ascertain whether it is mediated by a reduced DNaseI activity and degradation, and to in vitro explore novel therapeutic interventions. Methods We recruited 71 BC patients from whom we obtained a plasma sample before surgery and a formalin-fixed paraffin embedded tumor tissue sample, and 64 age- and sex-matched healthy controls from whom we obtained a plasma sample. We measured NETs markers (cell-free fDNA, calprotectin, nucleosomes and neutrophil elastase) and the DNaseI activity in plasma with specific assays. We also measured NETs markers in BC tissue by immunofluorescence. Finally, we evaluated the ability of BC and control plasma to degrade in vitro-generated NETs, and evaluated the performance of the approved recombinant human DNaseI (rhDNaseI, Dornase alfa, Pulmozyme®, Roche) to restore the NET-degradation ability of plasma. In vitro experiments were performed in triplicate. Statistical analysis was conducted with Graphpad (v.8.0.1). Results NETosis occurs in BC tissue, more profusely in the muscle-invasive subtype (P<0.01), that with the worst prognosis. Compared to controls, BC patients had increased NETosis and a reduced DNaseI activity in plasma (P<0.0001), which leads to an impairment to degrade NETs (P<0.0001). Remarkably, this can be therapeutically restored with rhDNaseI to the level of healthy controls. Conclusion To the best of our knowledge, this is the first report demonstrating that BC patients have an increased NETosis systemically and in the tumor microenvironment, in part caused by an impaired DNaseI-mediated NET degradation. Remarkably, this defect can be therapeutically restored in vitro with the approved Dornase alfa, thus Pulmozyme® could become a potential therapeutic tool to locally reduce BC progression.
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Affiliation(s)
- Raquel Herranz
- Haemostasis, Thrombosis, Arteriosclerosis and Vascular Biology Research Group, Medical Research Institute Hospital La Fe, Valencia, Spain
| | - Julia Oto
- Haemostasis, Thrombosis, Arteriosclerosis and Vascular Biology Research Group, Medical Research Institute Hospital La Fe, Valencia, Spain
| | - Marta Hueso
- Haemostasis, Thrombosis, Arteriosclerosis and Vascular Biology Research Group, Medical Research Institute Hospital La Fe, Valencia, Spain
| | - Emma Plana
- Haemostasis, Thrombosis, Arteriosclerosis and Vascular Biology Research Group, Medical Research Institute Hospital La Fe, Valencia, Spain
- Angiology and Vascular Surgery Service, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Fernando Cana
- Haemostasis, Thrombosis, Arteriosclerosis and Vascular Biology Research Group, Medical Research Institute Hospital La Fe, Valencia, Spain
| | - María Castaño
- Haemostasis, Thrombosis, Arteriosclerosis and Vascular Biology Research Group, Medical Research Institute Hospital La Fe, Valencia, Spain
| | - Lourdes Cordón
- Hematology Research Group, Medical Research Institute Hospital La Fe, CIBERONC (CB16/12/00284), Valencia, Spain
| | - David Ramos-Soler
- Department of Pathology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Santiago Bonanad
- Haemostasis, Thrombosis, Arteriosclerosis and Vascular Biology Research Group, Medical Research Institute Hospital La Fe, Valencia, Spain
- Thrombosis and Haemostasis Unit, Haematology Service, La Fe University and Polytechnic Hospital, Valencia, Spain
| | | | | | - Pilar Medina
- Haemostasis, Thrombosis, Arteriosclerosis and Vascular Biology Research Group, Medical Research Institute Hospital La Fe, Valencia, Spain
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6
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Cruz-Montecinos C, Pérez-Alenda S, Casaña J, Carrasco JJ, Andersen LL, López-Bueno R, Nuñez-Cortés R, Bonanad S, Querol F, Calatayud J. Effectiveness of progressive moderate-vigorous intensity elastic resistance training on quality of life and perceived functional abilities in people with hemophilia: Secondary analysis of a randomized controlled trial. Eur J Haematol 2023; 110:253-261. [PMID: 36396600 PMCID: PMC10107706 DOI: 10.1111/ejh.13900] [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: 09/29/2022] [Revised: 11/10/2022] [Accepted: 11/14/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION AND AIM Strength exercise training is advised for people with hemophilia (PWH); however, few studies have been published and have methodological limitations. The purpose of this study was to evaluate the effectiveness of progressive elastic resistance training on quality of life and perceived functional abilities in PWH. METHODS Participants were randomly allocated to the intervention (n = 10) or control (n = 10) group. The intervention group performed progressive moderate-vigorous elastic resistance training (2 days/week, a total of 8 weeks), focusing on the muscles of the knee, elbow, and ankle joints. The control group continued its usual daily activities for 8 weeks. Quality of life (A36 Hemofilia-QoL®) and perceived functional abilities (Haemophilia Activities List) were assessed at baseline and an 8-week follow-up. RESULTS The intervention group improved the quality-of-life dimension of joint damage perception in comparison to the control group (p = .015, large effect size). Regarding perceived functional abilities, the intervention group improved lying, sitting, kneeling, and standing (p = .006, small effect size), and complex lower extremities activities (i.e., walking short and long-distance, and up-down stairs) (p = .006, small effect size) compared to the control group. No other significant differences were observed. CONCLUSIONS Eight weeks of progressive moderate-vigorous elastic resistance training in PWH improve the quality-of-life dimension of joint damage perception and perceived functional abilities (lying/sitting/kneeling/standing, and complex lower extremities activities). Our results suggest a limited effect of the program on the other items of quality of life measured by the questionnaire as emotional functioning, mental health, and social relationships. Importantly, no serious adverse effects occurred.
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Affiliation(s)
- Carlos Cruz-Montecinos
- Physiotherapy in Motion, Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain.,Laboratory of Clinical Biomechanics, Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Sofía Pérez-Alenda
- Physiotherapy in Motion, Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain.,Haemostasis and Thrombosis Unit, Universitary and Polytechnic Hospital La Fe, Valencia, Spain
| | - José Casaña
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Juan J Carrasco
- Physiotherapy in Motion, Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain.,Intelligent Data Analysis Laboratory, University of Valencia, Valencia, Spain
| | - Lars L Andersen
- National Research Centre for the Working Environment, Copenhagen, Denmark.,Sport Sciences, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Rubén López-Bueno
- National Research Centre for the Working Environment, Copenhagen, Denmark.,Department of Physical Medicine and Nursing, University of Zaragoza, Zaragoza, Spain
| | - Rodrigo Nuñez-Cortés
- Physiotherapy in Motion, Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain.,Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile.,Service of Physical Therapy, Hospital Clínico Florida, Santiago, Chile
| | - Santiago Bonanad
- Haemostasis and Thrombosis Unit, Universitary and Polytechnic Hospital La Fe, Valencia, Spain
| | - Felipe Querol
- Physiotherapy in Motion, Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain.,Haemostasis and Thrombosis Unit, Universitary and Polytechnic Hospital La Fe, Valencia, Spain
| | - Joaquín Calatayud
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain.,National Research Centre for the Working Environment, Copenhagen, Denmark
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Herranz R, Oto J, Hueso M, Plana E, Cana F, Aleman I, Bonanad S, Perez Ardavin J, Martínez-Sarmiento M, Vera-Donoso C, Medina P. Patients with bladder cancer have an increased NETosis and impaired DNaseI-mediated NET degradation, which can be therapeutically restored in vitro. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01218-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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8
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Núñez R, Álvarez-Román MT, Bonanad S, González-Porras JR, De La Corte-Rodriguez H, Berrueco R, Jiménez-Yuste V. The Limitations and Unmet Needs of the Five Cornerstones to Guarantee Lifelong Optimization of Prophylaxis in Hemophilia Patients. TH Open 2022; 6:e365-e377. [DOI: 10.1055/s-0042-1757745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
AbstractProphylaxis to prevent bleeding is highly recommended for hemophilia patients. The development of new drugs and tools for modeling personalized prophylaxis provides the means for people with hemophilia to lead active lives with a quality of life comparable to that of nonhemophilic individuals. The choice of regimens must be made on a highly individual basis. Unfortunately, reference guides neither always concur in their recommendations nor provide directions to cover all possible scenarios. In this review, a group of experts identify the significant limitations and unmet needs of prophylaxis, taking advantage of their clinical experience in the disease, and supported by a rigorous literature update. To perform a more systematic and comprehensive search for gaps, the main cornerstones that influence decisions regarding prophylactic patterns were first identified.Bleeding phenotype, joint status, physical activity, pharmacokinetics/medication properties, and adherence to treatment were considered as the primary mainstays that should allow physicians guiding prophylaxis to secure the best outcomes. Several challenges identified within each of these topics require urgent attention and agreement. The scores to assess severity of bleeding are not reliable, and lead to no consensus definition of severe bleeding phenotype. The joint status is to be redefined in light of new, more efficient treatments with an agreement to establish one scale as the unique reference for joint health. Further discussion is needed to establish the appropriateness of high-intensity physical activities according to patient profiles, especially because sustaining trough factor levels within the safe range is not always warranted for long periods. Importantly, many physicians do not benefit from the advantages provided by the programs based on population pharmacokinetic models to guide individualized prophylaxis through more efficient and cost-saving strategies. Finally, ensuring correct adherence to long-term treatments may be time-consuming for practitioners, who often have to encourage patients and review complex questionnaires.In summary, we identify five cornerstones that influence prophylaxis and discuss the main conflicting concerns that challenge the proper long-term management of hemophilia. A consensus exercise is warranted to provide reliable guidelines and maximize benefit from recently developed tools that should notably improve patients' quality of life.
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Affiliation(s)
- Ramiro Núñez
- Hemophilia Unit, Hospital Universitario Virgen del Rocío, Sevilla, Andalucía, Spain
| | | | - Santiago Bonanad
- Haemostasis and Thrombosis Unit, Hospital Universitari i Politècnic La Fe, València, Spain
| | - José Ramón González-Porras
- Hematology Department, Hospital Universitario de Salamanca, Instituto Biosanitario de Salamanca (Ibsal), Salamanca, Spain
| | | | - Rubén Berrueco
- Pediatric Hematology Department, Hospital Sant Joan de Déu Barcelona, Esplugues de Llobregat, Barcelona, Spain
- Institut de Recerca, Pediàtrica Hospital Sant Joan de Déu de Barcelona (IRP-HSJD0), Barcelona, Spain
- Instituto Nacional de Investigación Biomédica en Enfermedades Raras (CIBER ER), Instituto de Salud Carlos III, Madrid, Spain
| | - Víctor Jiménez-Yuste
- Department of Hematology and Hemotherapy, La Paz University Hospital-IdiPaz, Madrid, Spain
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Montalvá E, Rodríguez-Perálvarez M, Blasi A, Bonanad S, Gavín O, Hierro L, Lladó L, Llop E, Pozo-Laderas JC, Colmenero J. Consensus Statement on Hemostatic Management, Anticoagulation, and Antiplatelet Therapy in Liver Transplantation. Transplantation 2022; 106:1123-1131. [PMID: 34999660 PMCID: PMC9128618 DOI: 10.1097/tp.0000000000004014] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Anticoagulation and antiplatelet therapies are increasingly used in liver transplant (LT) candidates and recipients due to cardiovascular comorbidities, portal vein thrombosis, or to manage posttransplant complications. The implementation of the new direct-acting oral anticoagulants and the recently developed antiplatelet drugs is a great challenge for transplant teams worldwide, as their activity must be monitored and their complications managed, in the absence of robust scientific evidence. In this changing and clinically heterogeneous scenario, the Spanish Society of Liver Transplantation and the Spanish Society of Thrombosis and Haemostasis aimed to achieve consensus regarding the indications, drugs, dosing, and timing of anticoagulation and antiplatelet therapies initiated from the inclusion of the patient on the waiting list to post-LT surveillance. A multidisciplinary group of experts composed by transplant hepatologists, surgeons, hematologists, transplant-specialized anesthesiologists, and intensivists performed a comprehensive review of the literature and identified 21 clinically relevant questions using the patient-intervention-comparison-outcome format. A preliminary list of recommendations was drafted and further validated using a modified Delphi approach by a panel of 24 transplant delegates, each representing a LT institution in Spain. The present consensus statement contains the key recommendations together with the core supporting scientific evidence, which will provide guidance for improved and more homogeneous clinical decision making.
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Affiliation(s)
- Eva Montalvá
- Department of HPB Surgery and Transplantation, La Fe University Hospital and University of Valencia, Instituto de Investigación Sanitaria de La Fe, Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Manuel Rodríguez-Perálvarez
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
- Department of Hepatology and Liver Transplantation, Reina Sofía University Hospital, IMIBIC, University of Córdoba, Córdoba, Spain
| | - Annabel Blasi
- Department of Anesthesiology, Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
| | - Santiago Bonanad
- Unidad de Hemostasia y Trombosis, Servicio de Hematología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Olga Gavín
- Departamento de Hematología y Hemoterapia, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Loreto Hierro
- Department of Liver Transplantation, Hospital Universitario La Paz, Madrid, Spain
| | - Laura Lladó
- Liver Transplant Unit, Department of Surgery, Bellvitge University Hospital, IDIBELL, University of Barcelona, Barcelona, Spain
| | - Elba Llop
- Department of Hepatology and Liver Transplantation, Reina Sofía University Hospital, IMIBIC, University of Córdoba, Córdoba, Spain
- Servicio de Aparato Digestivo, Instituto de Investigación Puerta de Hierro-Segovia Arana (IDIPHISA), Madrid, Spain
| | | | - Jordi Colmenero
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
- Department of Hepatology and Liver Transplantation, Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
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Ferré-Vallverdú M, Latorre AM, Fuset MP, Sánchez E, Madrid I, Ten F, Vallés J, Santos MT, Bonanad S, Moscardó A. Neutrophil extracellular traps (NETs) in patients with STEMI. Association with percutaneous coronary intervention and antithrombotic treatments. Thromb Res 2022; 213:78-83. [DOI: 10.1016/j.thromres.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 02/15/2022] [Accepted: 03/01/2022] [Indexed: 11/28/2022]
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11
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Piñana JL, Vázquez L, Martino R, de la Cámara R, Sureda A, Rodríguez-Veiga R, Garrido A, Sierra J, Ribera JM, Torrent A, Mateos MV, de la Rubia J, Tormo M, Díez-Campelo M, García-Gutiérrez V, Álvarez-Larrán A, Sancho JM, MartínGarcía-Sancho A, Yañez L, Pérez Simón JA, Barba P, Abrisqueta P, Álvarez-Twose I, Bonanad S, Lecumberri R, Ruiz-Camps I, Navarro D, Hernández-Rivas JÁ, Cedillo Á, García-Sanz R, Bosch F. Spanish Society of Hematology and Hemotherapy expert consensus opinion for SARS-CoV-2 vaccination in onco-hematological patients. Leuk Lymphoma 2021; 63:538-550. [PMID: 34668835 PMCID: PMC8544670 DOI: 10.1080/10428194.2021.1992619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
In the midst of the COVID-19 pandemic, different vaccines in front of SARS-CoV-2 have been approved and administered in different vulnerable populations. As patients with cancer were excluded from pivotal trials of vaccination, little is known on their immunogenic response to these vaccines, particularly in patients with severely impaired immune system. In response to that uncertainty, the Spanish Society of Hematology and Hemotherapy launched an initiative aimed to provide recommendations for vaccination of the main hematological conditions. This document is based on the available information on COVID-19 outcomes, prior knowledge on vaccination in hematological patients, recent published data on serological response in oncohematological patients and expert opinions. New information about SARS-CoV-2 vaccination will be gathered in the near future, providing new scientific grounds to delineate the most adequate management of vaccination in patients with hematological diseases. The current limited data on SARS-CoV-2 vaccines in hematological patients represents a major limitation of this expert consensus opinion. In fact, the speed in which this field evolves may reduce their validity in the near future.
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Affiliation(s)
- José Luis Piñana
- Hematology Department, Hospital Clínico Universitario de Valencia, Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Lourdes Vázquez
- Hematology Department, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Rodrigo Martino
- Hematology Department, Hosptital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Anna Sureda
- Hematology Department, Hematology Department, Institut Català d'Oncologia-Hospitalret, IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | | | - Ana Garrido
- Hematology Department, Hosptital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jorge Sierra
- Hematology Department, Hosptital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - José-María Ribera
- Clinical Hematology Department, ICO-Hospital Germans Trias i Pujol. Josep Carreras Research Institute, Badalona, Spain
| | - Anna Torrent
- Clinical Hematology Department, ICO-Hospital Germans Trias i Pujol. Josep Carreras Research Institute, Badalona, Spain
| | | | - Javier de la Rubia
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Mar Tormo
- Hematology Department, Hospital Clínico Universitario de Valencia, Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - María Díez-Campelo
- Hematology Department, Hospital Universitario de Salamanca, Salamanca, Spain
| | | | | | - Juan-Manuel Sancho
- Hematology Department, Hospital Universitario Ramón y Cajal. IRYCIS, Madrid, Spain
| | | | - Lucrecia Yañez
- Hematology Department, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| | | | - Pere Barba
- Hematology Department, Hospital Universitario Vall d´Hebron, Barcelona, Spain
| | - Pau Abrisqueta
- Hematology Department, Hospital Universitario Vall d´Hebron, Barcelona, Spain
| | - Iván Álvarez-Twose
- Instituto de Estudios de Mastocitosis de Castilla La Mancha (CLMast) and CIBERONC, Hospital Virgen del Valle, Toledo, Spain
| | - Santiago Bonanad
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Ramón Lecumberri
- Hematology Service, Clínica Universidad de Navarra, Pamplona, Spain.,CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain
| | - Isabel Ruiz-Camps
- Infectious disease department, Hospital Universitario Vall d´Hebron, Barcelona, Spain
| | - David Navarro
- Department of Medicine, School of Medicine, Microbiology Service, Hospital Clínico Universitario, University of Valencia, Valencia, Spain
| | | | - Ángel Cedillo
- Hematology Department, Hospital Clínico Universitario de Valencia, Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Ramón García-Sanz
- Hematology Department, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Francesc Bosch
- Hematology Department, Hospital Universitario Vall d´Hebron, Barcelona, Spain
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12
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Pérez-Rodríguez A, Batlle J, Pinto JC, Corrales I, Borràs N, Garcia-Martínez I, Cid AR, Bonanad S, Parra R, Mingot-Castellano ME, Navarro N, Altisent C, Pérez-Montes R, Moretó A, Herrero S, Soto I, Mosteirín NF, Jiménez-Yuste V, Jacob ADA, Fontanes E, Mateo J, Quismondo NC, Batlle F, Vidal F, López-Fernández MF. Type 2N VWD: Conclusions from the Spanish PCM-EVW-ES project. Haemophilia 2021; 27:1007-1021. [PMID: 34494337 DOI: 10.1111/hae.14405] [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: 05/13/2021] [Revised: 08/17/2021] [Accepted: 08/22/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Type 2N von Willebrand disease (VWD) is characterized by a decreased affinity of von Willebrand factor (VWF) for factor VIII (FVIII). Abnormal binding of FVIII to VWF (VWF:FVIIIB), results in low FVIII plasma levels, which can lead to a misdiagnosis of mild haemophilia A. Accurate diagnosis of type 2N VWD is essential for appropriate genetic counselling and therapy. This disease can be distinguished from haemophilia A by in vitro assays (measurement VWF:FVIIIB activity) and/or genetic analysis. AIM To identify the current challenges in the diagnosis and treatment of this type of VWD and provide an in-depth description of the phenotypes and mutations identified. RESULTS Twenty-eight patients had at least one type 2N mutation, and 13 of these had a type 2N mutation combined with other variations. Three type 2N mutations were detected: p.Arg816Trp, p.Arg854Gln, and p.Arg763Ser. Two of these are the most frequently described mutations worldwide. This mutational spectrum differs from the broad spectrum seen in neighbouring France, where at least eight distinct 2N mutations have been found. In the PCM-EVW-ES cohort, 11 asymptomatic type 2N carriers with borderline FVIII plasma levels would probably have been excluded if the evaluation had been based on clinical and laboratory data only. Likewise, three patients with a severe phenotype would have been classified as homozygous for a 2N mutation if only the phenotype study had been performed. CONCLUSION The high detection yield and affordability of next-generation sequencing support the use of this technology as a first-line diagnostic tool in this setting.
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Affiliation(s)
| | - Javier Batlle
- Complexo Hospitalario Universitario A Coruña, INIBIC, A Coruña, Spain
| | - Joana Costa Pinto
- Complexo Hospitalario Universitario A Coruña, INIBIC, A Coruña, Spain
| | - Irene Corrales
- Haematology Service, Banc de Sang i Teixits (BST), Barcelona, Spain.,Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona (VHIR-UAB), Barcelona, Spain
| | - Nina Borràs
- Haematology Service, Banc de Sang i Teixits (BST), Barcelona, Spain.,Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona (VHIR-UAB), Barcelona, Spain
| | - Iris Garcia-Martínez
- Haematology Service, Banc de Sang i Teixits (BST), Barcelona, Spain.,Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona (VHIR-UAB), Barcelona, Spain
| | - Ana Rosa Cid
- Haematology Service, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Santiago Bonanad
- Haematology Service, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Rafael Parra
- Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona (VHIR-UAB), Barcelona, Spain.,Haematology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Nira Navarro
- Haematology Service, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - Carmen Altisent
- Haematology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Rocío Pérez-Montes
- Haematology Service, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Ana Moretó
- Haematology Service, Hospital Universitario Cruces, Barakaldo, Spain
| | - Sonia Herrero
- Haematology Service, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - Inmaculada Soto
- Haematology Service, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | | | - Aurora de Andrés Jacob
- Haematology Service, Complexo Hospitalario Universitario Santiago de Compostela, Santiago, Spain
| | - Emilia Fontanes
- Haematology Service, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - José Mateo
- Haematology Service, Hospital Sta Creu i St Pau, Barcelona, Spain
| | | | - Fernando Batlle
- Haematology Service, Lapisoft Projects S.A., A Coruña, Spain
| | - Francisco Vidal
- Haematology Service, Banc de Sang i Teixits (BST), Barcelona, Spain.,Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona (VHIR-UAB), Barcelona, Spain.,Haematology Service, CIBER de Enfermedades Cardiovasculares (CIBERCV)
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- Complexo Hospitalario Universitario A Coruña, INIBIC, A Coruña, Spain
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Bonanad S, Núñez R, Poveda JL, Kurnik K, Goldmann G, Andreozzi V, Vandewalle B, Santos S. Matching-Adjusted Indirect Comparison of Efficacy and Consumption of rVIII-SingleChain Versus Two Recombinant FVIII Products Used for Prophylactic Treatment of Adults/Adolescents with Severe Haemophilia A. Adv Ther 2021; 38:4872-4884. [PMID: 34368918 PMCID: PMC8408075 DOI: 10.1007/s12325-021-01853-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 06/30/2021] [Indexed: 12/03/2022]
Abstract
Introduction Given the relatively small number of patients with haemophilia A, head-to-head comparisons between recombinant FVIII (rFVIII) products are difficult to conduct. This study compared the efficacy and consumption of rVIII-SingleChain (lonoctocog alfa, AFSTYLA®) with rAHF-PFM (octocog alfa, Advate®) and rFVIIIFc (efmoroctocog alfa, Elocta®), for the prophylaxis and treatment of bleeding episodes in previously treated adolescents/adults with severe haemophilia A, through a matching-adjusted indirect comparison (MAIC). Methods A systematic literature review identified published clinical trials for rAHF-PFM and rFVIIIFc. Individual patient data for rVIII-SingleChain were used to match baseline patient characteristics to those from published trials, using an approach similar to propensity score weighting. After matching, annualized bleeding rates (ABR), percentage of patients with zero bleeds, and rFVIII consumption were compared across trial populations. Results Published data were identified from two rAHF-PFM trials and one rFVIIIFc trial. rVIII-SingleChain had similar ABR (risk ratio [RR]: 0.74 [0.16; 3.48]; RR: 1.18 [0.85; 1.65]) and percentage of patients with zero bleeds (odds ratio [OR]: 1.34 [0.56; 3.22]; OR: 0.78 [0.47; 1.31]) versus rAHF-PFM and rFVIIIFc, respectively. Annual rVIII-SingleChain consumption was significantly lower than rAHF-PFM (mean difference: − 1507.66 IU/kg/year [− 2011.71; − 1003.61]) and equivalent to rFVIIIFc (RR: 0.96 [0.62; 1.49]). Conclusion Although limited to published information for comparator trials, these results suggest that with an annualized rFVIII consumption comparable to rFVIIIFc, but significantly lower than rAHF-PFM, routine prophylaxis with rVIII-SingleChain is able to maintain a similar ABR and percentage of patients with zero bleeds, attesting to the long-acting nature of rVIII-SingleChain. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-021-01853-0. It is difficult to directly compare different recombinant FVIII products in head-to-head studies because there are few patients with haemophilia A. This study aimed to indirectly compare the efficacy and consumption of different recombinant FVIII products in the prophylactic treatment of haemophilia A using published clinical data. A proven method for performing indirect comparisons of products is referred to as a matching-adjusted indirect comparison. Using this approach, we were able to compare rVIII-SingleChain with two other recombinant FVIII products (rAHF-PFM and rFVIIIFc). Our results suggest that annual FVIII consumption with rVIII-SingleChain is comparable to rFVIIIFc, but is significantly lower than rAHF-PFM, while maintaining a similar bleeding rate. These results highlight the long-acting nature of the product.
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Megías-Vericat JE, Bonanad S, Haya S, Cid AR, Marqués MR, Ferrada A, Monte-Boquet E, Pérez-Alenda S, Bosch P, Querol-Giner F, Poveda JL. Clinical benefits of a Bayesian model for plasma-derived factor VIII/VWF after one year of pharmacokinetic-guided prophylaxis in severe/moderate hemophilia A patients. Thromb Res 2021; 205:99-105. [PMID: 34293540 DOI: 10.1016/j.thromres.2021.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 05/05/2021] [Accepted: 07/12/2021] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Individual pharmacokinetic (PK) profiling in hemophilia A (HA) helps to individualize prophylaxis using population PK models (popPK). A specific popPK model for plasma-derived factor VIII containing von-Willebrand Factor (pdFVIII/VWF) was developed. AIM To compare standard versus PK-driven prophylaxis, using a generic or a specific popPK model for pdFVIII/VWF. MATERIALS AND METHODS A prospective study conducted in HA patients in prophylaxis with pdFVIII/VWF (Fanhdi®) comparing three one-year study periods: (1) standard prophylaxis, (2) PK-guided prophylaxis using a generic pdFVIII popPK model which described FVIII activity irrespective of FVIII concentrate, and (3) PK-guided prophylaxis with specific pdFVIII/VWF popPK model. PK parameters analyzed were half-life, trough levels (TL) at 24, 48 and 72 h, and time to reach FVIII levels of 1, 2, 5% (T5%). Clinical outcomes were dose/kg, FVIII consumption, annualized bleeding rate (ABR), annualized joint bleeding rate (AJBR), spontaneous and traumatic bleeds. RESULTS Of the 30 analyzed patients, 28 had severe HA and the median age was 31.2. Fifteen patient's prophylaxis doses were PK-adjusted. After the generic PK-guided prophylaxis period, younger patients showed more joint bleeds, a shorter half-life, and lower TL48, TL72 and T5%. Using the specific pdFVIII/VWF popPK model compared with standard prophylaxis, a lower spontaneous AJBR was observed in the entire cohort and in patients aged >15 years. Additionally, lower spontaneous ABR was reported in patients aged ≤15 years comparing specific and generic models. CONCLUSIONS PK-guided prophylaxis with a specific pdFVIII/VWF popPK model allowed treatment individualization and improved bleeding control in routine clinical practice, especially in younger patients with short pdFVIII/VWF half-lives.
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Affiliation(s)
- Juan Eduardo Megías-Vericat
- Hospital Universitari i Politècnic La Fe, Pharmacy Department, Valencia, Spain; Hospital Universitari i Politècnic La Fe, Haemostasis and Thrombosis Unit, Valencia, Spain.
| | - Santiago Bonanad
- Hospital Universitari i Politècnic La Fe, Haemostasis and Thrombosis Unit, Valencia, Spain
| | - Saturnino Haya
- Hospital Universitari i Politècnic La Fe, Haemostasis and Thrombosis Unit, Valencia, Spain
| | - Ana Rosa Cid
- Hospital Universitari i Politècnic La Fe, Haemostasis and Thrombosis Unit, Valencia, Spain
| | | | - Alejandra Ferrada
- Hospital Universitari i Politècnic La Fe, Pharmacy Department, Valencia, Spain
| | - Emilio Monte-Boquet
- Hospital Universitari i Politècnic La Fe, Pharmacy Department, Valencia, Spain
| | - Sofía Pérez-Alenda
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia
| | - Pau Bosch
- Hospital Universitari i Politècnic La Fe, Haemostasis and Thrombosis Unit, Valencia, Spain
| | - Felipe Querol-Giner
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia
| | - Jose Luis Poveda
- Hospital Universitari i Politècnic La Fe, Pharmacy Department, Valencia, Spain
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Iftimi AA, Rodríguez-Bernal CL, Peiró S, Bonanad S, Ferrero-Gregori A, Hurtado I, García-Sempere A, Sanfélix-Gimeno G. Association of Vitamin K and Non-Vitamin K Oral Anticoagulant Use and Cancer Incidence in Atrial Fibrillation Patients. Clin Pharmacol Ther 2021; 111:200-208. [PMID: 34242404 PMCID: PMC9291805 DOI: 10.1002/cpt.2362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 04/21/2021] [Accepted: 06/27/2021] [Indexed: 12/01/2022]
Abstract
The association between the use of vitamin K antagonists (VKAs) and cancer risk reduction remains unclear. We aimed to assess the association between the use of VKAs or direct oral anticoagulants (DOACs) and the incidence of cancer in a large cohort of patients with atrial fibrillation (AF) by means of a population‐based, propensity‐weighted cohort study using population‐wide databases including patients diagnosed with nonvalvular AF (NVAF) followed for up of 5 years (median 2.94 years). We created two cohorts based on the initiation therapy (VKA or DOAC). Initiation with VKA or DOAC was defined as filling a prescription with no previous exposure in the preceding 12 months. Cancer diagnoses of any type and for specific tumors (lung, colon, prostate, bladder, and breast). We included 39,989 patients, 31,200 (78.0%) in the VKA cohort. Incidence rate for any cancer was 12.45 per 1,000 person‐year in the DOAC cohort vs. 14.55 in the VKA cohort (adjusted hazard ratio (HR): 1.16, 95% confidence interval (CI): 1.02–1.32). In secondary outcomes, no differences were found for specific types of cancer, such as lung (HR: 1.28, CI: 0.89–1.83), colon (HR: 0.84, CI: 0.62–1.13), prostate (HR: 1.40, CI: 0.94–2.10), bladder (HR: 1.07, CI: 0.76–1.52), and breast (HR: 1.05, CI: 0.66–1.69). Sensitivity analyses yielded similar results. Subgroup analyses also produced consistent findings, except for men, for whom VKA was associated with a lower risk of colon cancer (HR: 0.68, 95% CI: 0.48–0.96). Our results do not confirm a chemoprotective effect of VKA when compared with DOAC in a large, real‐world cohort of patients with NVAF followed for up to 5 years.
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Affiliation(s)
- Adina A Iftimi
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain.,Department of Statistics and Operations Research, Universidad de Valencia, València, Spain
| | - Clara L Rodríguez-Bernal
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain
| | - Salvador Peiró
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain
| | - Santiago Bonanad
- Haemostasis and Thrombosis Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain.,Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Andreu Ferrero-Gregori
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain
| | - Isabel Hurtado
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain
| | - Aníbal García-Sempere
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain
| | - Gabriel Sanfélix-Gimeno
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain
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16
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Chelle P, Yeung CHT, Croteau SE, Lissick J, Balasa V, Ashburner C, Park YS, Bonanad S, Megías-Vericat JE, Nagao A, Wynn T, Corrales-Medina F, Tran H, Sharathkumar A, Chitlur M, Sarmiento S, Edginton A, Iorio A. Development and Validation of a Population-Pharmacokinetic Model for Rurioctacog Alfa Pegol (Adynovate ®): A Report on Behalf of the WAPPS-Hemo Investigators Ad Hoc Subgroup. Clin Pharmacokinet 2021; 59:245-256. [PMID: 31435896 DOI: 10.1007/s40262-019-00809-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND OBJECTIVE Rurioctacog alfa pegol (Adynovate) is a modified recombinant factor VIII concentrate used for treating hemophilia A. Aiming to improve treatment tailoring on the Web-Accessible Population Pharmacokinetic Service-Hemophilia (WAPPS-Hemo) platform for patients of all ages treated with Adynovate, we have developed and evaluated a population pharmacokinetic (PopPK) model. On the platform, PopPK models are used as priors for Bayesian forecasting that derive individual PK of hemophilia patients and are subsequently used for personalized dose regimen design. METHODS Factor activity measurements and demographic covariate data from patients infused with Adynovate were extracted from the WAPPS-Hemo database. Evaluations testing the appropriateness of Bayesian forecasting included 10-fold cross validation, a limited sampling analysis (LSA), and an external evaluation using additional independent data extracted from the WAPPS-Hemo database at a later date. RESULTS The model was constructed using 650 plasma factor activity observations (555 one stage assay and 95 chromogenic assay - 4.6% below limit of quantification) measured in 154 patients from 36 hemophilia centres. A two-compartment model including between subject variability on clearance and central volume was selected as the base model. Covariates were fat free mass on clearance and central volume, age on clearance and assay type on activity. The final model was well-suited to predict PK parameters of new individuals (n = 26) from sparse observations. CONCLUSIONS The development of a PopPK model for Adynovate using real-world data increases the covariate space (e.g. age) beyond what is possible from clinical trial data. This model is available on the WAPPS-Hemo platform for tailoring treatment in hemophilia A patients.
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Affiliation(s)
- Pierre Chelle
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
| | - Cindy H T Yeung
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Stacy E Croteau
- Boston Children's Hospital/Harvard Medical School, Boston, MA, USA
| | | | | | | | - Young Shil Park
- Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | | | | | | | - Tung Wynn
- University of Florida, Gainesville, FL, USA
| | | | - Huyen Tran
- Ronald Sawers Haemophilia Treatment Centre, Melbourne, VIC, Australia
| | - Anjali Sharathkumar
- University of Iowa Carver College of Medicine, Stead Family Department of Pediatrics, University of Iowa Children's Hospital, Iowa City, IA, USA
| | | | | | - Andrea Edginton
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
| | - Alfonso Iorio
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada. .,McMaster Bayer Endowed Chair for Clinical Epidemiology of Congenital Bleeding Disorders, Department of Medicine, McMaster University, Hamilton, ON, Canada.
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17
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García-Dasí M, Pérez-Alenda S, Carrasco JJ, Marques-Sule E, Aguilar-Rodríguez M, Moreno-Segura N, Gómez-Tomás C, Querol F, Bonanad S. Effects of a non-pharmacological approach for chronic pain management in patients with haemophilia: efficacy of cognitive-behavioural therapy associated with physiotherapy. Haemophilia 2021; 27:e357-e367. [PMID: 33650767 DOI: 10.1111/hae.14284] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 02/20/2019] [Revised: 02/10/2021] [Accepted: 02/12/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION More than half of adult patients with severe haemophilia (PWH) suffer pain daily, with chronic pain (CP) in more than 15% of cases, thereby reducing their quality of life (QoL). However, there are no evidence-based therapeutic guidelines for pain management. AIM To evaluate the effectiveness of a combined protocol based on psychology and physiotherapy in the improvement of CP self-efficacy in PWH with CP. Secondary outcomes are changes in QoL, emotional status, pain and kinesiophobia. METHODS In this prospective controlled trial study, recruited patients were allocated either to an experimental group (EG, n = 10) or to a control group (CG, n = 9). EG received interventions over four months: one cognitive-behavioural therapy (CBT) session per month and three home exercise sessions per week. Self-efficacy (Chronic Pain Self-Efficacy Scale), QoL (A36 Hemophilia-QoL), emotional status (Hospital Anxiety and Depression Scale and Rosenberg's Self-esteem Scale), pain (Visual Analogue Scale) and kinesiophobia (Tampa Scale for Kinesiophobia) were assessed at three time points (Week 0, Month 4 and Month 7). The intervention effects were determined with mixed 2-factor ANOVAs. RESULTS The EG showed a significant improvement (p < .05) in the control of symptoms and pain management scores on the Self-Efficacy Scale, QoL, self-esteem emotional status, pain and kinesiophobia. The intervention effects remained significant (p < .05) over time for pain management, QoL, pain and kinesiophobia. CONCLUSION The non-pharmacological treatment applied based on CBT and physiotherapy showed to be effective in improving CP self-efficacy, QoL and emotional status, while reducing pain and kinesiophobia in PWH with CP.
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Affiliation(s)
- María García-Dasí
- Instituto de Investigaciones Sanitarias La Fe, University and Polytechnic Hospital La Fe, Valencia, Spain.,Haemostasis and Thrombosis Unit, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Sofía Pérez-Alenda
- Haemostasis and Thrombosis Unit, University and Polytechnic Hospital La Fe, Valencia, Spain.,Physiotherapy in Motion, Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Juan J Carrasco
- Physiotherapy in Motion, Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain.,Intelligent Data Analysis Laboratory, University of Valencia, Valencia, Spain
| | - Elena Marques-Sule
- Physiotherapy in Motion, Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Marta Aguilar-Rodríguez
- Haemostasis and Thrombosis Unit, University and Polytechnic Hospital La Fe, Valencia, Spain.,Research unit in Clinical biomechanics (UBIC), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | | | - Cinta Gómez-Tomás
- Grupo de Investigación en Fisioterapia y Readaptación al Deporte, Universidad Católica San Antonio de Murcia, Murcia, España
| | - Felipe Querol
- Haemostasis and Thrombosis Unit, University and Polytechnic Hospital La Fe, Valencia, Spain.,Physiotherapy in Motion, Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Santiago Bonanad
- Haemostasis and Thrombosis Unit, University and Polytechnic Hospital La Fe, Valencia, Spain
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Jiménez-Yuste V, de la Corte-Rodríguez H, Álvarez-Román MT, Martín-Salces M, Querol F, Bonanad S, Mingot-Castellano ME, Fernández-Mosteirín N, Canaro M, Santamaría A, Núñez R, García-Frade LJ, Martinoli C, Kim HK. Ultrasound evaluation of joint damage and disease activity in adult patients with severe haemophilia A using the HEAD-US system. Haemophilia 2021; 27:479-487. [PMID: 33620134 DOI: 10.1111/hae.14280] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/25/2021] [Accepted: 02/05/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The Haemophilia Early Arthropathy Detection with Ultrasound (HEAD-US) system and scoring scale has proven to be an accurate and time-efficient imaging method for identifying joint damage in patients with haemophilia. AIM Observational, multicentre, cross-sectional study conducted in 8 centres in Spain that assessed the joint status of adult patients with severe haemophilia A (SHA) using HEAD-US. METHODS Joint status of the elbow, knee and ankle was evaluated in adults with SHA receiving on-demand (OD) treatment, or primary (PP), secondary (SP), tertiary (TP) or intermittent (IP) prophylaxis. RESULTS Of the 95 patients enrolled, 87 received prophylaxis (6.3% PP, 38.9% SP, 43.2% TP and 3.2% IP). Mean age was 35.2 years, and 59% of patients had not undergone image testing in the last year. The HEAD-US score was 0 in all joints in 6.3% of patients. The ankle was the most affected joint, regardless of treatment regimen. Patients receiving OD treatment, TP or IP had the overall worst scores, mainly in the ankles and elbows; a similar but milder profile was observed in patients on SP; and patients on PP had the best score in all joints. CONCLUSION Joint function may be effectively preserved in patients with SHA on PP, but OD treatment or later initiation of prophylaxis does not seem to prevent progression of arthropathy. Disease worsening was observed in patients OD, TP or IP, most often affecting ankles and elbows. Closer ultrasound imaging monitoring may improve management of these patients.
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Affiliation(s)
- Víctor Jiménez-Yuste
- Department of Haematology, Hospital Universitario La Paz, Autonoma University, Madrid, Spain
| | | | | | | | - Felipe Querol
- University of Valencia and Haemostasis and Thrombosis Unit, Department of Haematology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Santiago Bonanad
- Haemostasis and Thrombosis Unit. Department of Haematology, Hospital Universitari i Politècnic La Fe, University of Valencia, Valencia, Spain
| | - María Eva Mingot-Castellano
- Department of Haematology, Hospital Regional Universitario de Málaga, Malaga, Spain.,Department of Haematology, Hospital Universitario Virgen del Rocío, Seville, Spain
| | | | - Mariana Canaro
- Department of Haemostasis and Thrombosis, Hospital Universitario Son Espases, Mallorca, Spain
| | - Amparo Santamaría
- Department of Thrombosis and Haemostasis, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Ramiro Núñez
- Department of Haematology, Hospital Universitario Virgen del Rocío, Seville, Spain
| | | | - Carlo Martinoli
- Dipartimento di Scienze della Salute Department of Health Sciences (DISSAL) and IRCCS Ospedale Policlinico San Martino, Genova, University of Genoa, Genoa, Italy
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19
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Tiede A, Bonanad S, Santamaria A, Goldmann G, Canaro M, Palomero A, Frade LJG, Eduardo Megias‐Vericat J, Martinez F, Garcia Candel F, Jimenez Yuste V, Sparber‐Sauer M, Halimeh S, Adolf D, Hukauf M, Reichmann J, Oldenburg J. Quality of electronic treatment records and adherence to prophylaxis in haemophilia and von Willebrand disease: Systematic assessments from an electronic diary. Haemophilia 2020; 26:999-1008. [DOI: 10.1111/hae.14178] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 09/07/2020] [Accepted: 09/22/2020] [Indexed: 01/19/2023]
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20
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Calatayud J, Pérez-Alenda S, Carrasco JJ, Cruz-Montecinos C, Andersen LL, Bonanad S, Querol F, Casaña J. Feasibility, safety and muscle activity during flywheel vs traditional strength training in adult patients with severe haemophilia. Haemophilia 2020; 27:e102-e109. [PMID: 33012084 DOI: 10.1111/hae.14170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Eccentric training has been associated with several specific physiological adaptations. The flywheel machine is one of the easiest ways of performing eccentric overload training. However, no studies evaluated its feasibility, safety and muscle activity in patients with haemophilia (PWH). AIM To evaluate feasibility and safety and compare muscle activity during flywheel vs weight machine knee extension exercise in severe PWH. METHODS Eleven severe PWH [mean age of 33.5 (8.1) years] participated in this cross-sectional study after receiving prophylactic treatment. Surface electromyography (EMG) signals were recorded for the rectus femoris during the knee extension exercise performed with 2 different conditions (flywheel and weight machine) with matched intensity (6 on the Borg CR10 scale). Kinesiophobia was assessed before and after the experimental session. Participants were asked to rate tolerability of each condition. Adverse effects were evaluated 24 and 48 hours after the session. RESULTS Kinesophobia did not increase after the experimental session, and no adverse effects were reported. At 60%-70% of the contraction cycle, the flywheel exercise showed higher (P = .024) eccentric rectus femoris muscle activity than the weight machine. In contrast, during the last 90%-100% of the contraction cycle, the traditional weight machine showed higher (P = .004) rectus femoris activity than the flywheel. CONCLUSION The knee extension exercise performed with the flywheel at moderate intensity is safe and well tolerated among severe PWH under adequate factor coverage. Importantly, the flywheel variation provides higher eccentric rectus femoris activity at the breaking force moment, while it provides lower eccentric muscle activity at the end of the cycle.
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Affiliation(s)
- Joaquín Calatayud
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain.,National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Sofía Pérez-Alenda
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain.,Haemostasis and Thrombosis Unit, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Juan J Carrasco
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain.,Intelligent Data Analysis Laboratory, University of Valencia, Valencia, Spain
| | - Carlos Cruz-Montecinos
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain.,Laboratory of Clinical Biomechanics, Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Lars L Andersen
- National Research Centre for the Working Environment, Copenhagen, Denmark.,Sport Sciences, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Santiago Bonanad
- Haemostasis and Thrombosis Unit, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Felipe Querol
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain.,Haemostasis and Thrombosis Unit, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - José Casaña
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
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21
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Rodríguez López M, Megías Vericat JE, Albo López C, Bonanad S. Clinical, pharmacokinetic and economic analysis of the first switch to an extended half-life factor IX (albutrepenonacog alfa, rFIX-FP) in Spain. BMJ Case Rep 2020; 13:13/10/e234142. [DOI: 10.1136/bcr-2019-234142] [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] [Indexed: 01/19/2023] Open
Abstract
Extended half-life of factor IX (FIX) demonstrated clinical benefit and lower treatment burden than standard half-life FIX products in clinical trials. We analysed the impact in efficacy, pharmacokinetics (PKs) and costs of the switch from nonacog alfa (rFIX) to albutrepenonacog alfa (rFIX-FP) in the first patient with haemophilia B (HB) treated in Spain outside clinical trials. A 7-year-old boy presented with HB with poor venous access and repetition infections using rFIX, which was switched to rFIX-FP. Prophylaxis was adjusted by PKs using WAPPS-Hemo tailoring from 100 IU/kg/week of rFIX to 80 IU/kg/3 weeks of rFIX-FP. Comparing 6 months before, rFIX-FP reduced 68.5% FIX consumption/kg and 58.3% infusion frequency, but total costs/weight showed a slight increase. Ratio of half-life between rFIX and rFIX-FP was 3.4–3.7. This case report revealed that switch to rFIX-FP decreased frequency and FIX consumption, without adverse events and bleeds.
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22
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Calatayud J, Pérez-Alenda S, Carrasco JJ, Cruz-Montecinos C, Andersen LL, Bonanad S, Querol F, Megías-Vericat JE, Casaña J. Safety and Effectiveness of Progressive Moderate-to-Vigorous Intensity Elastic Resistance Training on Physical Function and Pain in People With Hemophilia. Phys Ther 2020; 100:1632-1644. [PMID: 32525975 DOI: 10.1093/ptj/pzaa106] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 10/24/2019] [Accepted: 04/16/2020] [Indexed: 02/09/2023]
Abstract
OBJECTIVE Strength training is recommended for people with hemophilia; however, published data are anecdotal and have methodological limitations. The purpose of this study was to evaluate the safety and effectiveness of progressive moderate-to-vigorous intensity elastic resistance training on physical function and pain in this patient population. METHODS A randomized controlled trial was conducted in a university laboratory setting where 20 patients (17 with severe, 1 with moderate, and 2 with mild hemophilia) aged 21 to 53 years received evaluations at baseline and 8-week follow-up. Participants were allocated to intervention (progressive strength training) or control (usual daily activities) groups. The intervention group trained 2 days per week during 8 weeks with elastic resistance. Intensity during the first 2 weeks was a 20-repetition maximum and increased progressively toward 15, 12, and finally 10 repetition maximum. The primary outcome was muscle strength. Secondary outcomes were the Timed "Up and Go" Test score, sit-to-stand, range of motion, Haemophilia Joint Health Score, kinesiophobia score, global impression of pain change, general self-rated health status, and desire to exercise. RESULTS The intervention group showed greater strength improvements than the control group in almost all of the joints, with moderate to high effect sizes. The intervention group also showed better Timed "Up and Go" and sit-to-stand scores than the control group (moderate effect size), greater range of motion at the knee flexion with the right leg (trivial effect size), and better Haemophilia Joint Health Score at the left knee (small effect size). The intervention group showed greater overall pain reduction, self-rated overall status, and desire to exercise than the control group. CONCLUSIONS Progressive strength training with elastic resistance performed twice a week during 8 weeks is safe and effective in people with hemophilia to improve muscle strength and functional capacity, reduce general pain, and improve self-rated health status and desire to exercise. IMPACT This study provides evidence for the use of a specific strength training regimen for people with hemophilia. LAY SUMMARY People with hemophilia of differing levels of severity, with adequate coverage with clotting factor, can safely engage in progressive strength training and can improve their functioning.
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Affiliation(s)
- Joaquín Calatayud
- Department of Physiotherapy, Exercise Intervention for Health Research Group, University of Valencia, Valencia, Spain; and National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Sofía Pérez-Alenda
- Department of Physiotherapy, Multispeciality Research Group, Physiotherapy in Motion, University of Valencia, Gascó Oliag 5, Valencia CP 46100 Spain; and Haemostasis and Thrombosis Unit, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Juan J Carrasco
- Department of Physiotherapy, Multispeciality Research Group, Physiotherapy in Motion and Intelligent Data Analysis Laboratory, University of Valencia
| | - Carlos Cruz-Montecinos
- Department of Physiotherapy, Multispeciality Research Group, Physiotherapy in Motion, University of Valencia and Department of Physical Therapy, Faculty of Medicine, Laboratory of Clinical Biomechanics, University of Chile, Santiago, Chile
| | - Lars L Andersen
- National Research Centre for the Working Environment and Department of Health Science and Technology, Sport Sciences, Aalborg University, Aalborg, Denmark
| | - Santiago Bonanad
- Haemostasis and Thrombosis Unit, University and Polytechnic Hospital La Fe
| | - Felipe Querol
- Department of Physiotherapy, Multispeciality Research Group, Physiotherapy in Motion, University of Valencia and Haemostasis and Thrombosis Unit, University and Polytechnic Hospital La Fe
| | - Juan E Megías-Vericat
- Haemostasis and Thrombosis Unit, University and Polytechnic Hospital La Fe and Pharmacy Department, Drug Clinical Area, University and Polytechnic Hospital La Fe
| | - José Casaña
- Department of Physiotherapy, Exercise Intervention for Health Research Group, University of Valencia
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23
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Bonanad S, García-Dasí M, Aznar JA, Mingot-Castellano ME, Jiménez-Yuste V, Calle M, Palma A, López-Fernández MF, Marco P, Paloma MJ, Fernández-Mosteirin N, Galmés B, Sanabria M, Álvarez M. Adherence to prophylaxis in adult patients with severe haemophilia A. Haemophilia 2020; 26:800-808. [PMID: 32700426 DOI: 10.1111/hae.14039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 04/03/2020] [Accepted: 04/28/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Adherence is a cornerstone of factor VIII prophylactic treatment. Information regarding the factors with potential influence on adherence is limited, particularly in adult patients. AIM To assess adherence in adult patients with severe haemophilia A receiving prophylactic treatment in a real-life setting, and investigate the factors influencing adherence. METHODS Observational, prospective study including adult patients receiving factor VIII therapy in 15 Spanish centres. Patients recorded infusion doses on a logbook and answered various questionnaires to assess their health beliefs. Adherence rate was the percentage of infused doses over the prescribed ones. Self-perceived adherence was assessed using the VERITAS-Pro questionnaire, the psychometric properties of which were validated in the Spanish population. The relationship between adherence rate and treatment, clinical and demographic characteristics, health beliefs and perceived self-efficacy was investigated. RESULTS A total of 66 patients were followed up for 12 months. Mean adherence rate at the end of follow-up was 82.5%. Most of the study patients (n = 53, 80.3%) showed a moderate-to-high adherence rate (>70%). The VERITAS-Pro revealed a high perception of adherence. Multivariate analyses to predict treatment adherence identified the knee as a target joint and longer treatment duration as variables with significant (negative) influence on adherence. Adherence rate was not influenced by the patient's health beliefs or perceived self-efficacy. CONCLUSION Most adult patients receiving factor VIII prophylactic treatment in Spain have moderate-to-high treatment adherence. Treatment duration and the knee as a target joint are factors with a moderate negative influence on treatment adherence.
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Affiliation(s)
| | - María García-Dasí
- Instituto de Investigaciones Sanitarias La Fe, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - José A Aznar
- Instituto de Investigaciones Sanitarias La Fe, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | | | | | | | | | | | | | | | | | - Martín Sanabria
- Medical Department Hematology, Bayer Hispania S.L., Barcelona, Spain
| | - MªPilar Álvarez
- Medical Department Hematology, Bayer Hispania S.L., Barcelona, Spain
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24
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Borràs N, Garcia-Martínez I, Batlle J, Pérez-Rodríguez A, Parra R, Altisent C, López-Fernández MF, Costa Pinto J, Batlle-López F, Cid AR, Bonanad S, Cabrera N, Moret A, Mingot-Castellano ME, Navarro N, Pérez-Montes R, Marcellini S, Moreto A, Herrero S, Soto I, Fernández-Mosteirín N, Jiménez-Yuste V, Alonso N, de Andrés-Jacob A, Fontanes E, Campos R, Paloma MJ, Bermejo N, Berrueco R, Mateo J, Arribalzaga K, Marco P, Palomo Á, Castro Quismondo N, Iñigo B, Del Mar Nieto M, Vidal R, Martínez MP, Aguinaco R, Tenorio M, Ferreiro M, García-Frade J, Rodríguez-Huerta AM, Cuesta J, Rodríguez-González R, García-Candel F, Dobón M, Aguilar C, Corrales I, Vidal F. Unraveling the Influence of Common von Willebrand factor variants on von Willebrand Disease Phenotype: An Exploratory Study on the Molecular and Clinical Profile of von Willebrand Disease in Spain Cohort. Thromb Haemost 2020; 120:437-448. [PMID: 32135566 DOI: 10.1055/s-0040-1702227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The clinical diagnosis of von Willebrand disease (VWD), particularly type 1, can be complex because several genetic and environmental factors affect von Willebrand factor (VWF) plasma levels. An estimated 60% of the phenotypic variation is attributable to hereditary factors, with the ABO blood group locus being the most influential. However, recent studies provide strong evidence that nonsynonymous single nucleotide variants (SNVs) contribute to VWF and factor VIII phenotypic variability in healthy individuals. This study aims to investigate the role of common VWF SNVs on VWD phenotype by analyzing data from 219 unrelated patients included in the "Molecular and Clinical Profile of von Willebrand Disease in Spain project." To that end, generalized linear mixed-effects regression models were fitted, and additive and epistatic analyses, and haplotype studies were performed, considering five VWD-related measures (bleeding score, VWF:Ag, VWF:RCo, factor VIII:C, and VWF:CB). According to these analyses, homozygotes: for p.Thr789Ala(C) would be expected to show 39% higher VWF:Ag levels; p.Thr1381Ala(C), 27% lower VWF:Ag levels; and p.Gln852Arg(C), 52% lower VWF:RCo levels. Homozygotes for both p.Thr789Ala(C) and p.Gln852Arg(T) were predicted to show 185% higher VWF:CB activity, and carriers of two copies of the p.Thr1381Ala(T)/p.Gln852Arg(T) haplotype would present a 100% increase in VWF:RCo activity. These results indicate a substantial effect of common VWF variation on VWD phenotype. Although additional studies are needed to determine the true magnitude of the effects of SNVs on VWF, these findings provide new evidence regarding the contribution of common variants to VWD, which should be taken into account to enhance the accuracy of the diagnosis and classification of this condition. ClinicalTrials.gov identifier: NCT02869074.
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Affiliation(s)
- Nina Borràs
- Congenital Coagulopathies, Banc de Sang i Teixits, Barcelona, Spain.,Transfusional Medicine, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona (VHIR-UAB), Barcelona, Spain
| | - Iris Garcia-Martínez
- Congenital Coagulopathies, Banc de Sang i Teixits, Barcelona, Spain.,Transfusional Medicine, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona (VHIR-UAB), Barcelona, Spain
| | - Javier Batlle
- Department of Hematology, Complexo Hospitalario Universitario A Coruña, INIBIC, A Coruña, Spain
| | | | - Rafael Parra
- Congenital Coagulopathies, Banc de Sang i Teixits, Barcelona, Spain.,Transfusional Medicine, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona (VHIR-UAB), Barcelona, Spain
| | - Carme Altisent
- Transfusional Medicine, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona (VHIR-UAB), Barcelona, Spain
| | | | - Joana Costa Pinto
- Department of Hematology, Complexo Hospitalario Universitario A Coruña, INIBIC, A Coruña, Spain
| | | | - Ana Rosa Cid
- Department of Hematology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Santiago Bonanad
- Department of Hematology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Noelia Cabrera
- Department of Hematology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Andrés Moret
- Department of Hematology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - María Eva Mingot-Castellano
- Department of Hematology, Hospital Regional Universitario de Málaga, Málaga, Spain.,Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | - Nira Navarro
- Department of Hematology, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - Rocío Pérez-Montes
- Department of Hematology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - Ana Moreto
- Department of Hematology, Hospital Universitario Cruces, Barakaldo, Spain
| | - Sonia Herrero
- Department of Hematology, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - Inmaculada Soto
- Department of Hematology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | | | - Nieves Alonso
- Department of Hematology, Hospital Infanta Cristina, Badajoz, Spain
| | - Aurora de Andrés-Jacob
- Department of Hematology, Complexo Hospitalario Universitario Santiago de Compostela, Spain
| | - Emilia Fontanes
- Department of Hematology, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Rosa Campos
- Department of Hematology, Hospital Jerez de la Frontera, Cádiz, Spain
| | - María José Paloma
- Department of Hematology, Hospital Virgen del Camino, Pamplona, Spain
| | - Nuria Bermejo
- Department of Hematology, Hospital San Pedro de Alcántara, Cáceres, Spain
| | - Rubén Berrueco
- Department of Hematology, Hospital Sant Joan de Deu, Barcelona, Spain
| | - José Mateo
- Department of Hematology, Hospital Sta Creu i St Pau, Barcelona, Spain
| | - Karmele Arribalzaga
- Department of Hematology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Pascual Marco
- Department of Hematology, Hospital General de Alicante, Alicante, Spain
| | - Ángeles Palomo
- Department of Hematology, Hospital Regional Universitario de Málaga, Málaga, Spain
| | | | - Belén Iñigo
- Department of Hematology, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Rosa Vidal
- Department of Hematology, Fundación Jiménez Díaz, Madrid, Spain
| | - María Paz Martínez
- Department of Hematology, Hospital Nuestra Sra. de Sonsoles, Ávila, Spain
| | - Reyes Aguinaco
- Department of Hematology, Hospital Joan XXIII, Tarragona, Spain
| | - Maria Tenorio
- Department of Hematology, Hospital Ramón y Cajal, Madrid, Spain
| | - María Ferreiro
- Department of Hematology, Hospital Montecelo, Pontevedra, Spain
| | | | | | - Jorge Cuesta
- Department of Hematology, Hospital Virgen de la Salud, Toledo, Spain
| | | | | | - Manuela Dobón
- Department of Hematology, Hospital Lozano Blesa, Zaragoza, Spain
| | - Carlos Aguilar
- Department of Hematology, Hospital Santa Bárbara, Soria, Spain
| | - Irene Corrales
- Congenital Coagulopathies, Banc de Sang i Teixits, Barcelona, Spain.,Transfusional Medicine, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona (VHIR-UAB), Barcelona, Spain
| | - Francisco Vidal
- Congenital Coagulopathies, Banc de Sang i Teixits, Barcelona, Spain.,Transfusional Medicine, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona (VHIR-UAB), Barcelona, Spain.,CIBER de Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain
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Calatayud J, Pérez-Alenda S, Carrasco JJ, Escriche-Escuder A, Cruz-Montecinos C, Andersen LL, Bonanad S, Querol F, Casaña J. Electromyographic and Safety Comparisons of Common Lower Limb Rehabilitation Exercises for People With Hemophilia. Phys Ther 2020; 100:116-126. [PMID: 31584672 DOI: 10.1093/ptj/pzz146] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 04/19/2019] [Indexed: 11/14/2022]
Abstract
BACKGROUND Ankles and knees are commonly affected in people with hemophilia and thus are targets for prevention or rehabilitation. However, to our knowledge, no studies have evaluated muscle activity and safety during exercises targeting the lower limbs in people with hemophilia; this lack of information hinders clinical decision-making. OBJECTIVE The aim of this study was to compare the tolerability of, safety of, and muscle activity levels obtained with external resistance (elastic or machine)-based and non-external resistance-based lower limb exercises in people with hemophilia. DESIGN This was a cross-sectional study. METHODS Eleven people who had severe hemophilia and were undergoing prophylactic treatment participated. In a single experimental session, participants performed knee extension and ankle plantar flexion during 3 exercise conditions in random order: elastic band-based resistance (elastic resistance), machine-based resistance (machine resistance), and no external resistance. Exercise intensities for the 2 external resistance-based conditions were matched for perceived exertion. Muscle activity was determined using surface electromyography (EMG) for the rectus femoris, biceps femoris, gastrocnemius lateralis, and tibialis anterior muscles. Participants were asked to rate exercise tolerability according to a scale ranging from "very well tolerated" to "not tolerated" and to report possible adverse effects 24 and 48 hours after the session. RESULTS No adverse effects were reported, and exercise tolerability was generally high. In the knee extension exercise, the rectus femoris normalized EMG values during the elastic resistance and machine resistance conditions were similar; 29% to 30% higher activity was obtained during these conditions than during the non-external resistance condition. In the ankle plantar flexion exercise, the gastrocnemius lateralis normalized EMG value was 34% higher during the machine resistance condition than without external resistance, and the normalized EMG values during the elastic resistance and other conditions were similar. LIMITATIONS The small sample size and single training session were the primary limitations of this study. CONCLUSIONS Exercises performed both with elastic bands and with machines at moderate intensity are safe, feasible, and efficient in people with severe hemophilia, providing comparable activity levels in the agonist muscles.
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Affiliation(s)
- Joaquín Calatayud
- Department of Physiotherapy, Exercise Intervention for Health Research Group (EXINH-RG), University of Valencia, Valencia, Spain; and National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Sofía Pérez-Alenda
- Haemostasis and Thrombosis Unit, University and Polytechnic Hospital La Fe, Valencia, Spain; and Department of Physiotherapy, Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), University of Valencia, c/Gascó Oliag 5, CP 46010, Valencia, Spain
| | - Juan J Carrasco
- Department of Physiotherapy, Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), University of Valencia; and Intelligent Data Analysis Laboratory, University of Valencia
| | | | - Carlos Cruz-Montecinos
- Department of Physiotherapy, Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), University of Valencia; Laboratory of Clinical Biomechanics, Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile; and Laboratory of Biomechanics and Kinesiology, San José Hospital, Santiago, Chile
| | - Lars L Andersen
- National Research Centre for the Working Environment; and Sport Sciences, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Santiago Bonanad
- Haemostasis and Thrombosis Unit, University and Polytechnic Hospital La Fe
| | - Felipe Querol
- Haemostasis and Thrombosis Unit, University and Polytechnic Hospital La Fe; and Department of Physiotherapy, Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), University of Valencia
| | - José Casaña
- Department of Physiotherapy, Exercise Intervention for Health Research Group (EXINH-RG), University of Valencia
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Latorre AM, Santos MT, Vallés J, Bonanad S, Moscardó A. Signal transducer and activator of transcription 3 (STAT3) phosphorylation regulates thromboxane A 2 receptor activity in human platelets. Br J Haematol 2019; 188:e39-e42. [PMID: 31858582 DOI: 10.1111/bjh.16309] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 09/13/2019] [Accepted: 09/13/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Ana María Latorre
- Haemostasis and Thrombosis Unit, Health Research Institute La Fe, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - María Teresa Santos
- Haemostasis and Thrombosis Unit, Health Research Institute La Fe, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Juana Vallés
- Haemostasis and Thrombosis Unit, Health Research Institute La Fe, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Santiago Bonanad
- Haemostasis and Thrombosis Unit, Health Research Institute La Fe, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Antonio Moscardó
- Haemostasis and Thrombosis Unit, Health Research Institute La Fe, University and Polytechnic Hospital La Fe, Valencia, Spain
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27
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Carrasco JJ, Pérez-Alenda S, Casaña J, Soria-Olivas E, Bonanad S, Querol F. Physical Activity Monitoring and Acceptance of a Commercial Activity Tracker in Adult Patients with Haemophilia. Int J Environ Res Public Health 2019; 16:E3851. [PMID: 31614706 PMCID: PMC6843269 DOI: 10.3390/ijerph16203851] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 10/01/2019] [Accepted: 10/09/2019] [Indexed: 12/27/2022]
Abstract
Physical activity (PA) is highly beneficial for people with haemophilia (PWH), however, studies that objectively monitor the PA in this population are scarce. This study aimed to monitor the daily PA and analyse its evolution over time in a cohort of PWH using a commercial activity tracker. In addition, this work analyses the relationship between PA levels, demographics, and joint health status, as well as the acceptance and adherence to the activity tracker. Twenty-six PWH were asked to wear a Fitbit Charge HR for 13 weeks. According to the steps/day in the first week, data were divided into two groups: Active Group (AG; ≥10,000 steps/day) and Non-Active Group (NAG; <10,000 steps/day). Correlations between PA and patient characteristics were studied using the Pearson coefficient. Participants' user experience was analysed with a questionnaire. The 10,000 steps/day was reached by 57.7% of participants, with 12,603 (1525) and 7495 (1626) being the mean steps/day of the AG and NAG, respectively. In general, no significant variations (p > 0.05) in PA levels or adherence to wristband were produced. Only the correlation between very active minutes and arthropathy was significant (r = -0.40, p = 0.045). Results of the questionnaire showed a high level of satisfaction. In summary, PWH are able to comply with the PA recommendations, and the Fitbit wristband is a valid tool for a continuous and long-term monitoring of PA. However, by itself, the use of a wristband is not enough motivation to increase PA levels.
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Affiliation(s)
- Juan J Carrasco
- Physiotherapy in Motion, Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Carrer de Gascó Oliag, 5, 46010 Valencia, Spain.
- Intelligent Data Analysis Laboratory, Department of Electronics Engineering, University of Valencia, Avda. Universitat, 46100 Burjassot, Spain.
| | - Sofía Pérez-Alenda
- Physiotherapy in Motion, Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Carrer de Gascó Oliag, 5, 46010 Valencia, Spain.
- Haemostasis and Thrombosis Unit, University and Polytechnic Hospital La Fe, Avinguda de Fernando Abril Martorell, 106, 46026 Valencia, Spain.
| | - José Casaña
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Carrer de Gascó Oliag, 5, 46010 Valencia, Spain.
| | - Emilio Soria-Olivas
- Intelligent Data Analysis Laboratory, Department of Electronics Engineering, University of Valencia, Avda. Universitat, 46100 Burjassot, Spain.
| | - Santiago Bonanad
- Haemostasis and Thrombosis Unit, University and Polytechnic Hospital La Fe, Avinguda de Fernando Abril Martorell, 106, 46026 Valencia, Spain.
| | - Felipe Querol
- Physiotherapy in Motion, Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Carrer de Gascó Oliag, 5, 46010 Valencia, Spain.
- Haemostasis and Thrombosis Unit, University and Polytechnic Hospital La Fe, Avinguda de Fernando Abril Martorell, 106, 46026 Valencia, Spain.
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28
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Chelle P, Yeung CHT, Bonanad S, Morales Muñoz JC, Ozelo MC, Megías Vericat JE, Iorio A, Spears J, Mir R, Edginton A. Correction to: Routine clinical care data for population pharmacokinetic modeling: the case for Fanhdi/Alphanate in hemophilia A patients. J Pharmacokinet Pharmacodyn 2019; 46:439. [PMID: 31302829 PMCID: PMC6820592 DOI: 10.1007/s10928-019-09647-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Pierre Chelle
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
| | - Cindy H T Yeung
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | | | | | - Margareth C Ozelo
- Unidade de Hemofilia IHTC 'Claudio L. P. Correa', Instituto Nacional de Tecnologia do Sangue, Hemocentro UNICAMP, University of Campinas, Campinas, Brazil
| | | | - Alfonso Iorio
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.,Department of Medicine, McMaster University, Hamilton, ON, Canada
| | | | | | - Andrea Edginton
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada.
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29
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Martos L, Fernández-Pardo Á, López-Fernández MF, Ibáñez F, Herrero S, Tàssies D, González-Porras JR, Solmoirago MJ, Costa MJ, Reverter JC, Marco P, Roldán V, Lecumberri R, Velasco F, Oto J, Iruin G, Alonso MN, Vayá A, Bonanad S, Ferrando F, Martí E, Cid AR, Plana E, Oña F, Cuesta I, González-López TJ, España F, Medina P, Navarro S. Identification of 58 Mutations (26 Novel) in 94 of 109 Symptomatic Spanish Probands with Protein C Deficiency. Thromb Haemost 2019; 119:1409-1418. [PMID: 31254973 DOI: 10.1055/s-0039-1692440] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Presently, no data on the molecular basis of hereditary protein C (PC) deficiency in Spain is available. We analyzed the PC gene (PROC) in 109 patients with symptomatic PC deficiency and in 342 relatives by sequencing the 9 PROC exons and their flanking intron regions. In 93 probands, we found 58 different mutations (26 novel). Thirty-seven consisted of a nucleotide change, mainly missense mutations, 1 was a 6-nucleotide insertion causing the duplication of 2 amino acids, and 4 were deletions of 1, 3, 4, and 16 nucleotides. Nine mutations caused type II deficiencies, with the presence of normal antigen levels but reduced anticoagulant activity. Using a PC level of 70% as lowest normal limit, we found no mutations in 16 probands and 25 relatives with PC levels ≤ 70%. On the contrary, 4 probands and 12 relatives with PC levels > 70% carried the mutation identified in the proband. The spectrum of recurrent mutations in Spain is different from that found in the Netherlands, where the most frequent mutations were p.Gln174* and p.Arg272Cys, and is more similar to that found in France, where the most frequent were p.Arg220Gln and p.Pro210Leu. In our study, p.Val339Met (9 families), p.Tyr166Cys (7), p.Arg220Gln (6), and p.Glu58Lys (5) were the most prevalent. This study confirms the considerable heterogeneity of the genetic abnormality in PC deficiencies, and allowed genetic counseling to those individuals whose PC levels were close to the lower limit of the normal reference range.
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Affiliation(s)
- Laura Martos
- Grupo de Investigación en Hemostasia, Trombosis, Arteriosclerosis y Biología Vascular, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Álvaro Fernández-Pardo
- Grupo de Investigación en Hemostasia, Trombosis, Arteriosclerosis y Biología Vascular, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | | | - Sonia Herrero
- Hospital Universitario de Guadalajara, Guadalajara, Spain
| | | | | | - María J Solmoirago
- Grupo de Investigación en Hemostasia, Trombosis, Arteriosclerosis y Biología Vascular, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - María J Costa
- Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | | | - Pascual Marco
- Hospital General Universitario de Alicante, Alicante, Spain
| | - Vanessa Roldán
- Hospital General Universitario Morales Meseguer, Murcia, Spain
| | | | - Francisco Velasco
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Julia Oto
- Grupo de Investigación en Hemostasia, Trombosis, Arteriosclerosis y Biología Vascular, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Gemma Iruin
- Hospital de Cruces, Baracaldo, Bilbao, Spain
| | | | - Amparo Vayá
- Grupo de Investigación en Hemostasia, Trombosis, Arteriosclerosis y Biología Vascular, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Santiago Bonanad
- Grupo de Investigación en Hemostasia, Trombosis, Arteriosclerosis y Biología Vascular, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Hospital Universitario y Politécnico La Fe, Valencia, Spain.,Unidad de Trombosis y Hemostasia, Servicio de Hematología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Fernando Ferrando
- Grupo de Investigación en Hemostasia, Trombosis, Arteriosclerosis y Biología Vascular, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Hospital Universitario y Politécnico La Fe, Valencia, Spain.,Unidad de Trombosis y Hemostasia, Servicio de Hematología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | - Ana R Cid
- Grupo de Investigación en Hemostasia, Trombosis, Arteriosclerosis y Biología Vascular, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Hospital Universitario y Politécnico La Fe, Valencia, Spain.,Unidad de Trombosis y Hemostasia, Servicio de Hematología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Emma Plana
- Grupo de Investigación en Hemostasia, Trombosis, Arteriosclerosis y Biología Vascular, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Francisca Oña
- Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | | | - Tomás J González-López
- Hospital Universitario de Burgos y Departamento de Ciencias de la Salud, Universidad de Burgos, Burgos, Spain
| | - Francisco España
- Grupo de Investigación en Hemostasia, Trombosis, Arteriosclerosis y Biología Vascular, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Pilar Medina
- Grupo de Investigación en Hemostasia, Trombosis, Arteriosclerosis y Biología Vascular, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Silvia Navarro
- Grupo de Investigación en Hemostasia, Trombosis, Arteriosclerosis y Biología Vascular, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Hospital Universitario y Politécnico La Fe, Valencia, Spain
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30
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Chelle P, Yeung CHT, Bonanad S, Morales Muñoz JC, Ozelo MC, Megías Vericat JE, Iorio A, Spears J, Mir R, Edginton A. Routine clinical care data for population pharmacokinetic modeling: the case for Fanhdi/Alphanate in hemophilia A patients. J Pharmacokinet Pharmacodyn 2019; 46:427-438. [PMID: 31115857 PMCID: PMC6820598 DOI: 10.1007/s10928-019-09637-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 04/11/2019] [Indexed: 12/15/2022]
Abstract
Fanhdi/Alphanate is a plasma derived factor VIII concentrate used for treating hemophilia A, for which there has not been any dedicated model describing its pharmacokinetics (PK). A population PK model was developed using data extracted from the Web-Accessible Population Pharmacokinetic Service-Hemophilia (WAPPS-Hemo) project. WAPPS-Hemo provided individual PK profiles for hemophilia patients using sparse observations as provided in routine clinical care by hemophilia centers. Plasma factor activity measurements and covariate data from hemophilia A patients on Fanhdi/Alphanate were extracted from the WAPPS-Hemo database. A population PK model was developed using NONMEM and evaluated for suitability for Bayesian forecasting using prediction-corrected visual predictive check (pcVPC), cross validation, limited sampling analysis and external evaluation against a population PK model developed on rich sampling data. Plasma factor activity measurements from 92 patients from 12 centers were used to derive the model. The PK was best described by a 2-compartment model including between subject variability on clearance and central volume, fat free mass as a covariate on clearance, central and peripheral volumes, and age as covariate on clearance. Evaluations showed that the developed population PK model could predict the PK parameters of new individuals based on limited sampling analysis and cross and external evaluations with acceptable precision and bias. This study shows the feasibility of using real-world data for the development of a population PK model. Evaluation and comparison of the model for Bayesian forecasting resulted in similar results as a model developed using rich sampling data.
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Affiliation(s)
- Pierre Chelle
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
| | - Cindy H T Yeung
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | | | | | - Margareth C Ozelo
- Unidade de Hemofilia IHTC 'Claudio L. P. Correa', Instituto Nacional de Tecnologia do Sangue, Hemocentro UNICAMP, University of Campinas, Campinas, Brazil
| | | | - Alfonso Iorio
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | | | | | - Andrea Edginton
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada.
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31
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Mateo F, Carrasco JJ, Aguilar‐Rodríguez M, Soria‐Olivas E, Bonanad S, Querol F, Pérez‐Alenda S. Assessment of Kinect V2 for elbow range of motion estimation in people with haemophilia using an angle correction model. Haemophilia 2019; 25:e165-e173. [DOI: 10.1111/hae.13744] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 03/05/2019] [Accepted: 03/07/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Fernando Mateo
- Department of Electronics Engineering University of Valencia Valencia Spain
- Intelligent Data Analysis Laboratory University of Valencia Valencia Spain
| | - Juan J. Carrasco
- Intelligent Data Analysis Laboratory University of Valencia Valencia Spain
- Department of Physiotherapy University of Valencia Valencia Spain
| | - Marta Aguilar‐Rodríguez
- Department of Physiotherapy University of Valencia Valencia Spain
- Rehabilitation Service University and Polytechnic Hospital La Fe Valencia Spain
| | - Emilio Soria‐Olivas
- Department of Electronics Engineering University of Valencia Valencia Spain
- Intelligent Data Analysis Laboratory University of Valencia Valencia Spain
| | - Santiago Bonanad
- Haemostasis and Thrombosis Unit University and Polytechnic Hospital La Fe Valencia Spain
| | - Felipe Querol
- Department of Physiotherapy University of Valencia Valencia Spain
- Haemostasis and Thrombosis Unit University and Polytechnic Hospital La Fe Valencia Spain
| | - Sofía Pérez‐Alenda
- Department of Physiotherapy University of Valencia Valencia Spain
- Haemostasis and Thrombosis Unit University and Polytechnic Hospital La Fe Valencia Spain
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32
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Calatayud J, Pérez-Alenda S, Carrasco JJ, Escriche A, Cruz-Montecinos C, Andersen LL, Bonanad S, Querol F, Casaña J. Upper-Body Exercises With External Resistance Are Well Tolerated and Enhance Muscle Activity in People With Hemophilia. Phys Ther 2019; 99:411-419. [PMID: 30690577 DOI: 10.1093/ptj/pzy136] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 09/18/2018] [Indexed: 02/09/2023]
Abstract
BACKGROUND Conventional nonresisted therapeutic exercises for people with hemophilia involve a careful, low-intensity approach to avoid injuries. Externally resisted exercise is highly efficient for increasing muscle strength in healthy adults but its feasibility for people with hemophilia remains unknown. OBJECTIVE The purpose of this study was to evaluate muscle activity during upper-body rehabilitation exercises with 2 types of external resistance and without external resistance (conventional) and to examine tolerability, kinesiophobia, and possible adverse effects derived from the session. DESIGN This was a cross-sectional study. METHODS Twelve people with hemophilia A/B (11 with severe hemophilia undergoing prophylactic treatment, 1 with mild hemophilia) participated. During the experimental session, participants completed the Tampa Scale of Kinesiophobia and performed 2 exercises-elbow flexion and shoulder abduction-with 3 conditions for each exercise: elastic resistance (externally resisted), free weights (externally resisted), and conventional nonresisted. Surface electromyography signals were recorded for the biceps brachii, triceps brachii, upper trapezius, and middle deltoid muscles. After the session, exercise tolerability and kinesiophobia were assessed. Adverse effects were evaluated 24 and 48 hours after the session. RESULTS Externally resisted exercises provided greater muscle activity than conventional nonresisted therapeutic exercises. The exercises were generally well tolerated and there was no change in kinesiophobia following the session. No adverse effects were observed in the following days. LIMITATIONS Small sample size was the main limitation. CONCLUSIONS In people with severe hemophilia undergoing prophylactic treatment, elbow flexion and shoulder abduction exercises with external resistance at moderate intensities are feasible and provide greater muscle activity than nonresisted conventional exercises.
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Affiliation(s)
- Joaquín Calatayud
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain; and National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Sofía Pérez-Alenda
- Department of Physiotherapy, University of Valencia, C/Gascó Oliag, 5 Valencia 46010, Valencia, Spain; and Haemostasis and Thrombosis Unit, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Juan J Carrasco
- Department of Physiotherapy and Intelligent Data Analysis Laboratory, University of Valencia
| | - Adrián Escriche
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia
| | - Carlos Cruz-Montecinos
- Department of Physiotherapy, University of Valencia; and Laboratory of Clinical Biomechanics, Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Lars L Andersen
- National Research Centre for the Working Environment; and Sport Sciences, Department of Health Science and Technology, Aalborg University, Denmark
| | - Santiago Bonanad
- Haemostasis and Thrombosis Unit, University and Polytechnic Hospital La Fe
| | - Felipe Querol
- Department of Physiotherapy, University of Valencia; and Haemostasis and Thrombosis Unit, University and Polytechnic Hospital La Fe
| | - José Casaña
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia
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33
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Megías‐Vericat JE, Bonanad S, Haya S, Cid AR, Marqués MR, Monte‐Boquet E, Pérez‐Alenda S, Bosch P, Querol F, Poveda JL. Cross‐sectional comparative study of pharmacokinetics and efficacy between sucrose‐formulated recombinant factor VIII (Kogenate
®
) and BAY 81‐8973 (Kovaltry
®
) in patients with severe or moderate haemophilia A in prophylaxis. Haemophilia 2019; 25:e215-e218. [DOI: 10.1111/hae.13733] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 02/19/2019] [Accepted: 02/19/2019] [Indexed: 01/19/2023]
Affiliation(s)
- Juan Eduardo Megías‐Vericat
- Pharmacy Department, Drug Clinical Area Hospital Universitari i Politècnic La Fe Valencia Spain
- Haemostasis and Thrombosis Unit Hospital Universitari i Politècnic La Fe Valencia Spain
| | - Santiago Bonanad
- Haemostasis and Thrombosis Unit Hospital Universitari i Politècnic La Fe Valencia Spain
| | - Saturnino Haya
- Haemostasis and Thrombosis Unit Hospital Universitari i Politècnic La Fe Valencia Spain
| | - Ana Rosa Cid
- Haemostasis and Thrombosis Unit Hospital Universitari i Politècnic La Fe Valencia Spain
| | - María Remedios Marqués
- Pharmacy Department, Drug Clinical Area Hospital Universitari i Politècnic La Fe Valencia Spain
| | - Emilio Monte‐Boquet
- Pharmacy Department, Drug Clinical Area Hospital Universitari i Politècnic La Fe Valencia Spain
| | - Sofía Pérez‐Alenda
- Haemostasis and Thrombosis Unit Hospital Universitari i Politècnic La Fe Valencia Spain
- Department of Physiotherapy University of Valencia Valencia Spain
| | - Pau Bosch
- Haemostasis and Thrombosis Unit Hospital Universitari i Politècnic La Fe Valencia Spain
| | - Felipe Querol
- Haemostasis and Thrombosis Unit Hospital Universitari i Politècnic La Fe Valencia Spain
- Department of Physiotherapy University of Valencia Valencia Spain
| | - José Luis Poveda
- Pharmacy Department, Drug Clinical Area Hospital Universitari i Politècnic La Fe Valencia Spain
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34
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Haya S, Solano C, Cid AR, Argilés B, Hervás D, Querol F, Bonanad S, Casaña P. Predictive factors of immune tolerance treatment response in severe haemophilia A patients with inhibitors: A real‐world report from a single centre, mixed retrospective‐prospective long‐term study. Haemophilia 2019; 25:e97-e100. [PMID: 30604912 PMCID: PMC7078961 DOI: 10.1111/hae.13660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Saturnino Haya
- Hemostasis and Thrombosis Unit, Hematology Service Hospital Universitari i Politècnic La Fe Valencia Spain
| | - Carlos Solano
- Hematology Service Hospital Clínico de Valencia Valencia Spain
- Department of Medicine Universidad de Valencia Valencia Spain
| | - Ana Rosa Cid
- Hemostasis and Thrombosis Unit, Hematology Service Hospital Universitari i Politècnic La Fe Valencia Spain
| | - Bienvenida Argilés
- Pediatric Hematology Unit Hospital Universitari i Politècnic La Fe Valencia Spain
| | - David Hervás
- Unit of Data Science, Biostatistics and Bioinformatics Instituto de Investigación Sanitaria La Fe Valencia Spain
| | - Felipe Querol
- Hemostasis and Thrombosis Unit, Hematology Service Hospital Universitari i Politècnic La Fe Valencia Spain
- Departament of Physiotherapy Universidad de Valencia Valencia Spain
| | - Santiago Bonanad
- Hemostasis and Thrombosis Unit, Hematology Service Hospital Universitari i Politècnic La Fe Valencia Spain
| | - Pilar Casaña
- Hemostasis and Thrombosis Unit, Hematology Service Hospital Universitari i Politècnic La Fe Valencia Spain
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35
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Megías-Vericat J, Bonanad S, Haya S, Cid A, Marqués M, Monte E, Pérez-Alenda S, Bosch P, Querol F, Poveda J. Bayesian pharmacokinetic-guided prophylaxis with recombinant factor VIII in severe or moderate haemophilia A. Thromb Res 2019; 174:151-162. [DOI: 10.1016/j.thromres.2018.12.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 12/17/2018] [Accepted: 12/31/2018] [Indexed: 01/19/2023]
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36
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Jiménez-Yuste V, Álvarez-Román MT, Martín-Salces M, De la Corte-Rodríguez H, Altisent C, Parra R, Núñez R, Pérez R, García-Candel F, Bonanad S, Querol F, Alonso N, Fernández-Mosteirín N, López-Ansoar E, García-Frade LJ, Bermejo N, Pérez-González N, Gutiérrez-Pimentel MJ, Martinoli C, Fernández-Arias I, Kim HK. Joint status in Spanish haemophilia B patients assessed using the Haemophilia Early Arthropathy Detection with Ultrasound (HEAD-US) score. Haemophilia 2018; 25:144-153. [DOI: 10.1111/hae.13628] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 10/05/2018] [Accepted: 10/10/2018] [Indexed: 01/05/2023]
Affiliation(s)
| | | | | | | | | | - Rafael Parra
- Hospital Universitario Vall d’Hebron; Barcelona Spain
| | - Ramiro Núñez
- Hospital Universitario Virgen del Rocio; Seville Spain
| | - Rosario Pérez
- Hospital Universitario Virgen del Rocio; Seville Spain
| | | | | | - Felipe Querol
- Hospital Universitario y Politécnico La Fe; Valencia Spain
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Borràs N, Orriols G, Batlle J, Pérez-Rodríguez A, Fidalgo T, Martinho P, López-Fernández MF, Rodríguez-Trillo Á, Lourés E, Parra R, Altisent C, Cid AR, Bonanad S, Cabrera N, Moret A, Mingot-Castellano ME, Navarro N, Pérez-Montes R, Marcellin S, Moreto A, Herrero S, Soto I, Fernández-Mosteirín N, Jiménez-Yuste V, Alonso N, de Andrés-Jacob A, Fontanes E, Campos R, Paloma MJ, Bermejo N, Berrueco R, Mateo J, Arribalzaga K, Marco P, Palomo Á, Quismondo NC, Iñigo B, Nieto MDM, Vidal R, Martínez MP, Aguinaco R, Tenorio JM, Ferreiro M, García-Frade J, Rodríguez-Huerta AM, Cuesta J, Rodríguez-González R, García-Candel F, Dobón M, Aguilar C, Vidal F, Corrales I. Unraveling the effect of silent, intronic and missense mutations on VWF splicing: contribution of next generation sequencing in the study of mRNA. Haematologica 2018; 104:587-598. [PMID: 30361419 PMCID: PMC6395343 DOI: 10.3324/haematol.2018.203166] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 08/03/2018] [Accepted: 10/19/2018] [Indexed: 12/12/2022] Open
Abstract
Large studies in von Willebrand disease patients, including Spanish and Portuguese registries, led to the identification of >250 different mutations. It is a challenge to determine the pathogenic effect of potential splice site mutations on VWF mRNA. This study aimed to elucidate the true effects of 18 mutations on VWF mRNA processing, investigate the contribution of next-generation sequencing to in vivo mRNA study in von Willebrand disease, and compare the findings with in silico prediction. RNA extracted from patient platelets and leukocytes was amplified by RT-PCR and sequenced using Sanger and next generation sequencing techniques. Eight mutations affected VWF splicing: c.1533+1G>A, c.5664+2T>C and c.546G>A (p.=) prompted exon skipping; c.3223-7_3236dup and c.7082-2A>G resulted in activation of cryptic sites; c.3379+1G>A and c.7437G>A) demonstrated both molecular pathogenic mechanisms simultaneously; and the p.Cys370Tyr missense mutation generated two aberrant transcripts. Of note, the complete effect of three mutations was provided by next generation sequencing alone because of low expression of the aberrant transcripts. In the remaining 10 mutations, no effect was elucidated in the experiments. However, the differential findings obtained in platelets and leukocytes provided substantial evidence that four of these would have an effect on VWF levels. In this first report using next generation sequencing technology to unravel the effects of VWF mutations on splicing, the technique yielded valuable information. Our data bring to light the importance of studying the effect of synonymous and missense mutations on VWF splicing to improve the current knowledge of the molecular mechanisms behind von Willebrand disease. clinicaltrials.gov identifier:02869074.
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Affiliation(s)
- Nina Borràs
- Banc de Sang i Teixits, Barcelona, Spain.,Institut de Recerca Vall d'Hebron -Universitat Autònoma de Barcelona (VHIR-UAB), Spain
| | | | - Javier Batlle
- Complexo Hospitalario Universitario A Coruña, INIBIC, Spain
| | | | | | | | | | | | - Esther Lourés
- Complexo Hospitalario Universitario A Coruña, INIBIC, Spain
| | - Rafael Parra
- Banc de Sang i Teixits, Barcelona, Spain.,Institut de Recerca Vall d'Hebron -Universitat Autònoma de Barcelona (VHIR-UAB), Spain
| | - Carme Altisent
- Institut de Recerca Vall d'Hebron -Universitat Autònoma de Barcelona (VHIR-UAB), Spain
| | - Ana Rosa Cid
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | - Noelia Cabrera
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Andrés Moret
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | - Nira Navarro
- Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | | | | | - Ana Moreto
- Hospital Universitario Cruces, Barakaldo, Spain
| | | | | | | | | | | | | | | | | | | | | | | | - José Mateo
- Hospital Sta Creu i St Pau, Barcelona, Spain
| | | | | | - Ángeles Palomo
- Hospital Regional Universitario Carlos Haya, Málaga, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Francisco Vidal
- Banc de Sang i Teixits, Barcelona, Spain .,Institut de Recerca Vall d'Hebron -Universitat Autònoma de Barcelona (VHIR-UAB), Spain.,CIBER de Enfermedades Cardiovasculares, Madrid, Spain
| | - Irene Corrales
- Banc de Sang i Teixits, Barcelona, Spain .,Institut de Recerca Vall d'Hebron -Universitat Autònoma de Barcelona (VHIR-UAB), Spain
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Romero S, Sempere A, Gómez-Seguí I, Román E, Moret A, Jannone R, Moreno I, Mendizábal S, Espí J, Peris A, Carbonell R, Cervera J, Pemán J, Bonanad S, de la Rubia J, Jarque I. Guía práctica de tratamiento urgente de la microangiopatía trombótica. Med Clin (Barc) 2018. [DOI: 10.1016/j.medcli.2018.01.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mateo F, Soria-Olivas E, Carrasco JJ, Bonanad S, Querol F, Pérez-Alenda S. HemoKinect: A Microsoft Kinect V2 Based Exergaming Software to Supervise Physical Exercise of Patients with Hemophilia. Sensors (Basel) 2018; 18:E2439. [PMID: 30050026 PMCID: PMC6111835 DOI: 10.3390/s18082439] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 07/06/2018] [Accepted: 07/24/2018] [Indexed: 12/19/2022]
Abstract
Patients with hemophilia need to strictly follow exercise routines to minimize their risk of suffering bleeding in joints, known as hemarthrosis. This paper introduces and validates a new exergaming software tool called HemoKinect that intends to keep track of exercises using Microsoft Kinect V2's body tracking capabilities. The software has been developed in C++ and MATLAB. The Kinect SDK V2.0 libraries have been used to obtain 3D joint positions from the Kinect color and depth sensors. Performing angle calculations and center-of-mass (COM) estimations using these joint positions, HemoKinect can evaluate the following exercises: elbow flexion/extension, knee flexion/extension (squat), step climb (ankle exercise) and multi-directional balance based on COM. The software generates reports and progress graphs and is able to directly send the results to the physician via email. Exercises have been validated with 10 controls and eight patients. HemoKinect successfully registered elbow and knee exercises, while displaying real-time joint angle measurements. Additionally, steps were successfully counted in up to 78% of the cases. Regarding balance, differences were found in the scores according to the difficulty level and direction. HemoKinect supposes a significant leap forward in terms of exergaming applicability to rehabilitation of patients with hemophilia, allowing remote supervision.
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Affiliation(s)
- Fernando Mateo
- Department of Electronic Engineering, University of Valencia, Avda. Universitat, 46100-Burjassot, Spain.
- Intelligent Data Analysis Laboratory, University of Valencia, Avda. Universitat, 46100-Burjassot, Spain.
| | - Emilio Soria-Olivas
- Department of Electronic Engineering, University of Valencia, Avda. Universitat, 46100-Burjassot, Spain.
- Intelligent Data Analysis Laboratory, University of Valencia, Avda. Universitat, 46100-Burjassot, Spain.
| | - Juan J Carrasco
- Intelligent Data Analysis Laboratory, University of Valencia, Avda. Universitat, 46100-Burjassot, Spain.
- Department of Physiotherapy, University of Valencia, Carrer de Gascó Oliag, 5, 46010-Valencia, Spain.
| | - Santiago Bonanad
- Haemostasis and Thrombosis Unit, University and Polytechnic Hospital La Fe, Avinguda de Fernando Abril Martorell, 106, 46026-Valencia, Spain.
| | - Felipe Querol
- Department of Physiotherapy, University of Valencia, Carrer de Gascó Oliag, 5, 46010-Valencia, Spain.
- Haemostasis and Thrombosis Unit, University and Polytechnic Hospital La Fe, Avinguda de Fernando Abril Martorell, 106, 46026-Valencia, Spain.
| | - Sofía Pérez-Alenda
- Department of Physiotherapy, University of Valencia, Carrer de Gascó Oliag, 5, 46010-Valencia, Spain.
- Haemostasis and Thrombosis Unit, University and Polytechnic Hospital La Fe, Avinguda de Fernando Abril Martorell, 106, 46026-Valencia, Spain.
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Pérez-Rodríguez A, Batlle J, Corrales I, Borràs N, Rodríguez-Trillo Á, Lourés E, Cid AR, Bonanad S, Cabrera N, Moret A, Parra R, Mingot-Castellano ME, Navarro N, Altisent C, Pérez-Montes R, Marcellini S, Moreto A, Herrero S, Soto I, Fernández Mosteirín N, Jiménez-Yuste V, Alonso N, de Andrés Jacob A, Fontanes E, Campos R, Paloma MJ, Bermejo N, Berrueco R, Mateo J, Arribalzaga K, Marco P, Palomo Á, Castro Quismondo N, Iñigo B, Nieto MDM, Vidal R, Martínez MP, Aguinaco R, Tenorio M, Ferreiro M, García-Frade J, Rodríguez-Huerta AM, Cuesta J, Rodríguez-González R, García-Candel F, Dobón M, Aguilar C, Batlle F, Vidal F, López-Fernández MF. Role of multimeric analysis of von Willebrand factor (VWF) in von Willebrand disease (VWD) diagnosis: Lessons from the PCM-EVW-ES Spanish project. PLoS One 2018; 13:e0197876. [PMID: 29924855 PMCID: PMC6010290 DOI: 10.1371/journal.pone.0197876] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 05/09/2018] [Indexed: 11/19/2022] Open
Abstract
The multimeric analysis (MA) of plasma von Willebrand factor (VWF) evaluates structural integrity and helps in the diagnosis of von Willebrand disease (VWD). This assay is a matter of controversy, being considered by some investigators cumbersome and only slightly informative. The centralised study ‘Molecular and Clinical Profile of von Willebrand Disease in Spain (PCM-EVW-ES)’ has been carried out by including the phenotypic assessment and the genetic analysis by next generation sequencing (NGS) of the VWF gene (VWF). The aim of the present study was to evaluate the role of MA to the diagnosis of these patients and their potential discrepancies. Two hundred and seventy out of 480 patients centrally diagnosed with VWD had normal multimers, 168 had abnormal multimers and 42 a total absence of multimers. VWF MA was of great significance in the diagnosis of 83 patients (17.3%), it was also of help in the diagnosis achieved in 365 additional patients (76%) and was not informative in 32 cases (6.7%). With regard to discrepancies, 110 out of 480 (23%) patients centrally diagnosed with VWD presented some kind of discordance between VWF:RCo/VWF:Ag and/or VWF:CB/VWF:Ag ratios, multimeric study and/or genetic results. The VWF MA was key in the presence of novel mutations as well as in cases with phenotypic discrepancies. A comparison between the contribution of MA and VWF:CB showed a clearly higher contribution of the former in the diagnostic process. These data seem to reinforce the relevance of the VWF MA in VWD diagnosis, despite all its limitations.
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Affiliation(s)
| | - Javier Batlle
- Servicio Hematología, Complexo Hospitalario Universitario A Coruña, INIBIC, A Coruña, Spain
- * E-mail:
| | - Irene Corrales
- Banc de Sang i Teixits, Barcelona, Spain
- Unitat d’Hemofilia, Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona (VHIR-UAB), Barcelona, Spain
| | - Nina Borràs
- Banc de Sang i Teixits, Barcelona, Spain
- Unitat d’Hemofilia, Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona (VHIR-UAB), Barcelona, Spain
| | | | - Esther Lourés
- Servicio Hematología, Complexo Hospitalario Universitario A Coruña, INIBIC, A Coruña, Spain
| | - Ana Rosa Cid
- Servicio Hematología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Santiago Bonanad
- Servicio Hematología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Noelia Cabrera
- Servicio Hematología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Andrés Moret
- Servicio Hematología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Rafael Parra
- Unitat d’Hemofilia, Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona (VHIR-UAB), Barcelona, Spain
- Servicio Hematología, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | | | - Nira Navarro
- Servicio Hematología, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - Carmen Altisent
- Servicio Hematología, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Rocío Pérez-Montes
- Servicio Hematología, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - Ana Moreto
- Servicio Hematología, Hospital Universitario Cruces, Barakaldo, Spain
| | - Sonia Herrero
- Servicio Hematología, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - Inmaculada Soto
- Servicio Hematología, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | | | - Nieves Alonso
- Servicio Hematología, Hospital Infanta Cristina, Badajoz, Spain
| | | | - Emilia Fontanes
- Servicio Hematología, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Rosa Campos
- Servicio Hematología, Hospital Jerez de la Frontera, Cádiz, Spain
| | | | - Nuria Bermejo
- Servicio Hematología, Hospital San Pedro de Alcántara, Cáceres, Spain
| | - Rubén Berrueco
- Servicio Hematología, Hospital Sant Joan de Deu, Barcelona, Spain
| | - José Mateo
- Servicio Hematología, Hospital Sta Creu i St Pau, Barcelona, Spain
| | - Karmele Arribalzaga
- Servicio Hematología, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Pascual Marco
- Servicio Hematología, Hospital General de Alicante, Alicante, Spain
| | - Ángeles Palomo
- Servicio Hematología, Hospital Regional Universitario de Málaga, Málaga, Spain
| | | | - Belén Iñigo
- Servicio Hematología, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Rosa Vidal
- Servicio Hematología, Fundación Jiménez Díaz, Madrid, Spain
| | | | - Reyes Aguinaco
- Servicio Hematología, Hospital Joan XXIII, Tarragona, Spain
| | - Maria Tenorio
- Servicio Hematología, Hospital Ramón y Cajal, Madrid, Spain
| | - María Ferreiro
- Servicio Hematología, Hospital Montecelo, Pontevedra, Spain
| | | | | | - Jorge Cuesta
- Servicio Hematología, Hospital Virgen de la Salud, Toledo, Spain
| | | | | | - Manuela Dobón
- Servicio Hematología, Hospital Lozano Blesa, Zaragoza, Spain
| | - Carlos Aguilar
- Servicio Hematología, Hospital Santa Bárbara, Soria, Spain
| | - Fernando Batlle
- Department of Research, Lapisoft Project S.L., A Coruña, Spain
| | - Francisco Vidal
- Banc de Sang i Teixits, Barcelona, Spain
- Unitat d’Hemofilia, Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona (VHIR-UAB), Barcelona, Spain
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain
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41
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Megías-Vericat JE, Monte-Boquet E, Martín-Cerezuela M, Cuéllar-Monreal MJ, Tarazona-Casany MV, Pérez-Huertas P, Bonanad S, Poveda-Andrés JL. Pilot evaluation of home delivery programme in haemophilia. J Clin Pharm Ther 2018; 43:822-828. [PMID: 29906305 DOI: 10.1111/jcpt.12718] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 05/14/2018] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVES Most of the clotting factor (CF) dispensations to haemophiliac patients are centralized in a few haemophilia treatment centres, necessitating frequent visits and long travel distances. The aim was to evaluate the home delivery programme developed by the Outpatient Pharmaceutical Care Unit (OPCU) through the association of patients (ASHECOVA). METHODS A specific software programme was designed to communicate the individual CF requirements. Dispensations were prepared in advance, and an ASHECOVA member collected and delivered to patients' homes in optimal conditions. Data regarding the programme were analysed from December 2011 to December 2017. An electronic satisfaction survey with 34 questions was conducted, asking about organizational aspects, education and communication, use of apps and satisfaction level. RESULTS AND DISCUSSION Forty-nine patients were included and 2464 home deliveries were made, without any reported incident related to dispensation errors, drug preservation, communication or confidentiality problems. This system avoids 11.4 annual dispensation visits per patient to OCPU, and a mean travel distance, time and cost of 1189.1 km, 945.3 minutes and 373.5 euros, respectively. Overall satisfaction with home delivery was 9.7, without any change suggested in the current system. Ninety-five per cent of individuals believed that the programme improves adherence and all patients would recommend it to other patients. The most common benefits reported were less frequent visits to hospital, reducing time and cost spent on transportation. WHAT IS NEW AND CONCLUSION The home delivery programme guarantees a proper follow-up of treatments with full patient satisfaction. This programme allows OPCU to achieve better pharmaceutical care, traceability of the process and optimization of working times and CF stock management.
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Affiliation(s)
- J E Megías-Vericat
- Pharmacy Department, Drug Clinical Area, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - E Monte-Boquet
- Pharmacy Department, Drug Clinical Area, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - M Martín-Cerezuela
- Pharmacy Department, Drug Clinical Area, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - M J Cuéllar-Monreal
- Pharmacy Department, Drug Clinical Area, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - M V Tarazona-Casany
- Pharmacy Department, Drug Clinical Area, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - P Pérez-Huertas
- Pharmacy Department, Drug Clinical Area, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - S Bonanad
- Haemostasis and Thrombosis Unit, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - J L Poveda-Andrés
- Pharmacy Department, Drug Clinical Area, University and Polytechnic Hospital La Fe, Valencia, Spain
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42
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Martos L, Ramón LA, Oto J, Fernández-Pardo Á, Bonanad S, Cid AR, Gruber A, Griffin JH, España F, Navarro S, Medina P. α2-Macroglobulin Is a Significant In Vivo Inhibitor of Activated Protein C and Low APC:α2M Levels Are Associated with Venous Thromboembolism. Thromb Haemost 2018; 118:630-638. [PMID: 29448296 PMCID: PMC6002867 DOI: 10.1055/s-0038-1629902] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Activated protein C (APC) is a major regulator of thrombin formation. Two major plasma inhibitors form complexes with APC, protein C inhibitor (PCI) and α1-antitrypsin (α1AT), and these complexes have been quantified by specific enzyme-linked immunosorbent assays (ELISAs). Also, complexes of APC with α2-macroglobulin (α2M) have been observed by immunoblotting. Here, we report an ELISA for APC:α2M complexes in plasma. METHODS Plasma samples were pre-treated with dithiothreitol and then with iodoacetamide. The detection range of the newly developed APC:α2M assay was 0.031 to 8.0 ng/mL of complexed APC. Following infusions of APC in humans and baboons, complexes of APC with α2M, PCI and α1AT were quantified. These complexes as well as circulating APC were also measured in 121 patients with a history of venous thromboembolism (VTE) and 119 matched controls. RESULTS In all the in vivo experiments, α2M was a significant APC inhibitor. The VTE case-control study showed that VTE patients had significantly lower APC:α2M and APC levels than the controls (p < 0.001). Individuals in the lowest quartile of APC:α2M or the lowest quartile of APC had approximately four times more VTE risk than those in the highest quartile of APC:α2M or of APC. The risk increased for individuals with low levels of both parameters. CONCLUSION The APC:α2M assay reported here may be useful to help monitor the in vivo fate of APC in plasma. In addition, our results show that a low APC:α2M level is associated with increased VTE risk.
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Affiliation(s)
- Laura Martos
- Grupo de Investigación en Hemostasia, Trombosis, Arteriosclerosis y Biología Vascular, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Luis Andrés Ramón
- Grupo de Investigación en Hemostasia, Trombosis, Arteriosclerosis y Biología Vascular, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Julia Oto
- Grupo de Investigación en Hemostasia, Trombosis, Arteriosclerosis y Biología Vascular, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Álvaro Fernández-Pardo
- Grupo de Investigación en Hemostasia, Trombosis, Arteriosclerosis y Biología Vascular, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Santiago Bonanad
- Grupo de Investigación en Hemostasia, Trombosis, Arteriosclerosis y Biología Vascular, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Hospital Universitario y Politécnico La Fe, Valencia, Spain,Unidad de Trombosis y Hemostasia, Servicio de Hematología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Ana Rosa Cid
- Grupo de Investigación en Hemostasia, Trombosis, Arteriosclerosis y Biología Vascular, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Hospital Universitario y Politécnico La Fe, Valencia, Spain,Unidad de Trombosis y Hemostasia, Servicio de Hematología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Andras Gruber
- Department of Biomedical Engineering, Oregon Health and Science University, Portland, Oregon, United States
| | - John H. Griffin
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, California, United States
| | - Francisco España
- Grupo de Investigación en Hemostasia, Trombosis, Arteriosclerosis y Biología Vascular, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Silvia Navarro
- Grupo de Investigación en Hemostasia, Trombosis, Arteriosclerosis y Biología Vascular, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Pilar Medina
- Grupo de Investigación en Hemostasia, Trombosis, Arteriosclerosis y Biología Vascular, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Hospital Universitario y Politécnico La Fe, Valencia, Spain
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43
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Aznar JA, Altisent C, Álvarez-Román MT, Bonanad S, Mingot-Castellano ME, López MF. Moderate and severe haemophilia in Spain: An epidemiological update. Haemophilia 2018; 24:e136-e139. [PMID: 29578308 DOI: 10.1111/hae.13462] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2018] [Indexed: 11/29/2022]
Affiliation(s)
- J A Aznar
- Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - C Altisent
- Hospital Valle de Hebrón, Barcelona, Spain
| | | | - S Bonanad
- Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - M F López
- Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain
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Pérez-Alenda S, Carrasco JJ, Megías-Vericat JE, Poveda JL, Bonanad S, Querol F. Quantification of physical activity in adult patients with haemophilic arthropathy in prophylaxis treatment using a fitness tracker. Haemophilia 2017; 24:e28-e32. [DOI: 10.1111/hae.13388] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2017] [Indexed: 11/28/2022]
Affiliation(s)
- S. Pérez-Alenda
- Department of Physiotherapy; University of Valencia; Valencia Spain
- Haemostasis and Thrombosis Unit; University and Polytechnic Hospital La Fe; Valencia Spain
| | - J. J. Carrasco
- Department of Physiotherapy; University of Valencia; Valencia Spain
- Intelligent Data Analysis Laboratory; University of Valencia; Valencia Spain
| | - J. E. Megías-Vericat
- Pharmacy Department; Drug Clinical Area; University and Polytechnic Hospital La Fe; Valencia Spain
| | - J. L. Poveda
- Pharmacy Department; Drug Clinical Area; University and Polytechnic Hospital La Fe; Valencia Spain
| | - S. Bonanad
- Haemostasis and Thrombosis Unit; University and Polytechnic Hospital La Fe; Valencia Spain
| | - F. Querol
- Department of Physiotherapy; University of Valencia; Valencia Spain
- Haemostasis and Thrombosis Unit; University and Polytechnic Hospital La Fe; Valencia Spain
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Borràs N, Batlle J, Pérez-Rodríguez A, López-Fernández MF, Rodríguez-Trillo Á, Lourés E, Cid AR, Bonanad S, Cabrera N, Moret A, Parra R, Mingot-Castellano ME, Balda I, Altisent C, Pérez-Montes R, Fisac RM, Iruín G, Herrero S, Soto I, de Rueda B, Jiménez-Yuste V, Alonso N, Vilariño D, Arija O, Campos R, Paloma MJ, Bermejo N, Berrueco R, Mateo J, Arribalzaga K, Marco P, Palomo Á, Sarmiento L, Iñigo B, Nieto MDM, Vidal R, Martínez MP, Aguinaco R, César JM, Ferreiro M, García-Frade J, Rodríguez-Huerta AM, Cuesta J, Rodríguez-González R, García-Candel F, Cornudella R, Aguilar C, Vidal F, Corrales I. Molecular and clinical profile of von Willebrand disease in Spain (PCM-EVW-ES): comprehensive genetic analysis by next-generation sequencing of 480 patients. Haematologica 2017; 102:2005-2014. [PMID: 28971901 PMCID: PMC5709099 DOI: 10.3324/haematol.2017.168765] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [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: 03/16/2017] [Accepted: 09/20/2017] [Indexed: 01/10/2023] Open
Abstract
Molecular diagnosis of patients with von Willebrand disease is pending in most populations due to the complexity and high cost of conventional molecular analyses. The need for molecular and clinical characterization of von Willebrand disease in Spain prompted the creation of a multicenter project (PCM-EVW-ES) that resulted in the largest prospective cohort study of patients with all types of von Willebrand disease. Molecular analysis of relevant regions of the VWF, including intronic and promoter regions, was achieved in the 556 individuals recruited via the development of a simple, innovative, relatively low-cost protocol based on microfluidic technology and next-generation sequencing. A total of 704 variants (237 different) were identified along VWF, 155 of which had not been previously recorded in the international mutation database. The potential pathogenic effect of these variants was assessed by in silico analysis. Furthermore, four short tandem repeats were analyzed in order to evaluate the ancestral origin of recurrent mutations. The outcome of genetic analysis allowed for the reclassification of 110 patients, identification of 37 asymptomatic carriers (important for genetic counseling) and re-inclusion of 43 patients previously excluded by phenotyping results. In total, 480 patients were definitively diagnosed. Candidate mutations were identified in all patients except 13 type 1 von Willebrand disease, yielding a high genotype-phenotype correlation. Our data reinforce the capital importance and usefulness of genetics in von Willebrand disease diagnostics. The progressive implementation of molecular study as the first-line test for routine diagnosis of this condition will lead to increasingly more personalized and effective care for this patient population.
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Affiliation(s)
- Nina Borràs
- Banc de Sang i Teixits, Barcelona, Spain
- Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona (VHIR-UAB), Spain
| | - Javier Batlle
- Complexo Hospitalario Universitario A Coruña, INIBIC, Spain
| | | | | | | | - Esther Lourés
- Complexo Hospitalario Universitario A Coruña, INIBIC, Spain
| | - Ana Rosa Cid
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | - Noelia Cabrera
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Andrés Moret
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Rafael Parra
- Banc de Sang i Teixits, Barcelona, Spain
- Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Ignacia Balda
- Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | | | | | | | - Gemma Iruín
- Hospital Universitario Cruces, Barakaldo, Spain
| | | | | | | | | | | | - Dolores Vilariño
- Complejo Hospitalario Universitario Santiago de Compostela, Spain
| | - Olga Arija
- Hospital Universitario Lucus Augusti, Lugo, Spain
| | | | | | | | | | - José Mateo
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Rosa Cornudella
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | | | - Francisco Vidal
- Banc de Sang i Teixits, Barcelona, Spain
- Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona (VHIR-UAB), Spain
- CIBER de Enfermedades Cardiovasculares, Spain
| | - Irene Corrales
- Banc de Sang i Teixits, Barcelona, Spain
- Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona (VHIR-UAB), Spain
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Cid AR, Montesinos P, Sánchez‐Guiu I, Haya S, Lorenzo JI, Sanz J, Moscardo F, Puig N, Planelles D, Bonanad S, Sanz GF, Vicente V, González‐Manchón C, Lozano ML, Rivera J, Sanz MA. Allogeneic hematopoietic cell transplantation in an adult patient with Glanzmann thrombasthenia. Clin Case Rep 2017; 5:1887-1890. [PMID: 29152293 PMCID: PMC5676254 DOI: 10.1002/ccr3.1206] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 07/27/2017] [Accepted: 08/19/2017] [Indexed: 11/17/2022] Open
Abstract
Glanzmann thrombasthenia is a rare bleeding disorder that can present life‐threatening bleeding. Our patients develop antiplatelet antibodies that become refractory to any pharmacological treatment. Allogeneic hematopoietic stem‐cell transplantation is the only currently curative procedure, but has major risks mainly in adult; indeed, our patient died.
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Affiliation(s)
- Ana R. Cid
- Unidad de Hemostasia y TrombosisServicio de HematologíaHospital Universitario y Politécnico La FeValenciaSpain
| | - Pau Montesinos
- Unidad de Trasplante de Células HematopoyéticasServicio de HematologíaHospital Universitario y Politécnico La FeValenciaSpain
| | - Isabel Sánchez‐Guiu
- Servicio de Hematología y Oncología MédicaHospital Universitario Morales MeseguerCentro Regional de HemodonaciónUniversidad de Murcia, IMIB‐Arrixaca, CIBERERMurciaSpain
| | - Saturnino Haya
- Unidad de Hemostasia y TrombosisServicio de HematologíaHospital Universitario y Politécnico La FeValenciaSpain
| | - Jose I. Lorenzo
- Unidad de Trasplante de Células HematopoyéticasServicio de HematologíaHospital Universitario y Politécnico La FeValenciaSpain
| | - Jaime Sanz
- Unidad de Trasplante de Células HematopoyéticasServicio de HematologíaHospital Universitario y Politécnico La FeValenciaSpain
| | - Federico Moscardo
- Unidad de Trasplante de Células HematopoyéticasServicio de HematologíaHospital Universitario y Politécnico La FeValenciaSpain
| | - Nieves Puig
- Centro de Transfusión de la Comunidad ValencianaValenciaSpain
| | | | - Santiago Bonanad
- Unidad de Hemostasia y TrombosisServicio de HematologíaHospital Universitario y Politécnico La FeValenciaSpain
| | - Guillermo F. Sanz
- Unidad de Trasplante de Células HematopoyéticasServicio de HematologíaHospital Universitario y Politécnico La FeValenciaSpain
| | - Vicente Vicente
- Servicio de Hematología y Oncología MédicaHospital Universitario Morales MeseguerCentro Regional de HemodonaciónUniversidad de Murcia, IMIB‐Arrixaca, CIBERERMurciaSpain
| | - Consuelo González‐Manchón
- Departament Cellular and Molecular MedicineCentro de Investigaciones Biológicas (C.S.I.C.)MadridSpain
| | - María L. Lozano
- Servicio de Hematología y Oncología MédicaHospital Universitario Morales MeseguerCentro Regional de HemodonaciónUniversidad de Murcia, IMIB‐Arrixaca, CIBERERMurciaSpain
| | - José Rivera
- Servicio de Hematología y Oncología MédicaHospital Universitario Morales MeseguerCentro Regional de HemodonaciónUniversidad de Murcia, IMIB‐Arrixaca, CIBERERMurciaSpain
| | - Miguel A. Sanz
- Unidad de Hemostasia y TrombosisServicio de HematologíaHospital Universitario y Politécnico La FeValenciaSpain
- Unidad de Trasplante de Células HematopoyéticasServicio de HematologíaHospital Universitario y Politécnico La FeValenciaSpain
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Bonanad S, Schulz M, Gordo A, Spurden D, Cicchetti M, Cappelleri JC, Tolley C, Staunton H, Brohan E. HaemoPREF: Further evaluation of patient perception and preference for treatment in a real world setting. Haemophilia 2017; 23:884-893. [PMID: 28925586 DOI: 10.1111/hae.13321] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2017] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Adherence to haemophilia A (HA) treatment may be influenced by patients' beliefs about their condition and treatment. Furthermore, difficulties administering treatment may lead to poor adherence. New treatment strategies aim to reduce the burden associated with administration and to improve patient perception of treatment, which, in turn, increase adherence levels. AIMS This study aimed to examine patient perception of HA treatment and related factors using patient-reported outcome (PRO) questionnaires and to confirm the psychometric properties of a recently developed questionnaire, the HaemoPREF. METHODS A non-interventional, cross-sectional, questionnaire study was conducted with adult HA patients in Spain (n=31), Germany (n=10) and Italy (n=48), who were using ReFacto AF with the FuseNGo administration device. Patients completed the HaemoPREF and other questionnaires measuring related constructs: treatment adherence, satisfaction and well-being, online at two time points. Correlational, regression and psychometric analyses were conducted. RESULTS PRO scores indicated that patients are satisfied with and adherent to their treatment. Multivariate regression of the HaemoPREF global score identified a number of significant predictors (P≤.05). The HaemoPREF Global Score had a moderate relationship with subscales on the related questionnaires (mean correlation=0.43; range=0.39-0.48). The HaemoPREF demonstrated good test-retest reliability (intraclass correlation coefficient=0.82), internal consistency reliability (Cronbach's alpha range=0.69-0.82) and convergent validity with measures of treatment satisfaction (Spearman correlation coefficient, r=.48) and well-being (r=.41). CONCLUSION The findings suggest that patients using ReFacto AF with FuseNGo were satisfied with and adherent to their treatment. The HaemoPREF can identify important concepts relating to patient treatment experience in HA.
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Affiliation(s)
- S Bonanad
- Haematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - M Schulz
- Pfizer Pharma GmbH, Berlin, Germany
| | - A Gordo
- Lab.Pfizer, Lda, Porto Salvo, Portugal
| | | | - M Cicchetti
- A Parexel Company, Execupharm, Groton, CT, USA
| | | | - C Tolley
- Adelphi Values, Bollington, Cheshire, UK
| | - H Staunton
- Adelphi Values, Bollington, Cheshire, UK
| | - E Brohan
- Adelphi Values, Bollington, Cheshire, UK
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48
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Querol-Giner M, Pérez-Alenda S, Aguilar-Rodríguez M, Carrasco JJ, Bonanad S, Querol F. Effect of radiosynoviorthesis on the progression of arthropathy and haemarthrosis reduction in haemophilic patients. Haemophilia 2017; 23:e497-e503. [PMID: 28891593 DOI: 10.1111/hae.13326] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2017] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Repeated haemarthrosis is widely accepted as the triggering cause of synovitis and haemophilic arthropathy. A first-line treatment of chronic synovitis is radiosynoviorthesis (RS). The aim of this study was to evaluate the RS effects on the progression of arthropathy and on a reduction in bleeding in patients with haemophilia. METHODS An observational-retrospective study was performed. Bleeding episodes in the 12 months following and in the 12 months preceding RS was compared. The arthropathy was clinically and radiologically analysed by age range, joint and subject, comparing those undergoing RS (Radiosynoviorthesis Group, RSG) against those not undergoing this treatment (Non-Radiosynoviorthesis Group, Non-RSG). RESULTS One hundred and seventy-four RS were performed in 71 patients (90 Y in Knees and 186 Re in elbows/ankles/shoulder). RS resulted in significant reduction in bleeding (582 preintervention and 168 postintervention, P < .001). In general, the level of arthropathy measured clinically and radiologically was greater with age increase in both groups (RSG and Non-RSG), especially in the 25-40 age range. A significant increase (P < .05) in the progression of arthropathy was also observed, both globally by patient and specifically for each joint, in non-RSG and RSG group. CONCLUSION RS is an effective method to reduce the number of haemarthrosis episodes in chronic synovitis. Moreover, RS can positively affect arthropathy by slowing down its progression. However, the results obtained suggest that arthropathy may be conditioned by the subject's age, regardless of whether or not the joint has undergone RS.
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Affiliation(s)
- M Querol-Giner
- Servicio de Rehabilitación, Hospital de Sagunto, Valencia, Spain.,Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - S Pérez-Alenda
- Department of Physiotherapy, University of Valencia, Valencia, Spain.,Haemostasis and Thrombosis Unit, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - M Aguilar-Rodríguez
- Department of Physiotherapy, University of Valencia, Valencia, Spain.,Rehabilitation Service, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - J J Carrasco
- Department of Physiotherapy, University of Valencia, Valencia, Spain.,Intelligent Data Analysis Laboratory, University of Valencia, Valencia, Spain
| | - S Bonanad
- Haemostasis and Thrombosis Unit, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - F Querol
- Department of Physiotherapy, University of Valencia, Valencia, Spain.,Haemostasis and Thrombosis Unit, University and Polytechnic Hospital La Fe, Valencia, Spain
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Calvo X, Arenillas L, Luño E, Senent L, Arnan M, Ramos F, Pedro C, Tormo M, Montoro J, Díez-Campelo M, Blanco ML, Arrizabalaga B, Xicoy B, Bonanad S, Jerez A, Nomdedeu M, Ferrer A, Sanz GF, Florensa L. Enumerating bone marrow blasts from nonerythroid cellularity improves outcome prediction in myelodysplastic syndromes and permits a better definition of the intermediate risk category of the Revised International Prognostic Scoring System (IPSS-R). Am J Hematol 2017; 92:614-621. [PMID: 28370234 DOI: 10.1002/ajh.24732] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 03/16/2017] [Accepted: 03/20/2017] [Indexed: 01/21/2023]
Abstract
The Revised International Prognostic Scoring System (IPSS-R) has been recognized as the score with the best outcome prediction capability in MDS, but this brought new concerns about the accurate prognostication of patients classified into the intermediate risk category. The correct enumeration of blasts is essential in prognostication of MDS. Recent data evidenced that considering blasts from nonerythroid cellularity (NECs) improves outcome prediction in the context of IPSS and WHO classification. We assessed the percentage of blasts from total nucleated cells (TNCs) and NECs in 3924 MDS patients from the GESMD, 498 of whom were MDS with erythroid predominance (MDS-E). We assessed if calculating IPSS-R by enumerating blasts from NECs improves prognostication of MDS. Twenty-four percent of patients classified into the intermediate category were reclassified into higher-risk categories and showed shorter overall survival (OS) and time to AML evolution than those who remained into the intermediate one. Likewise, a better distribution of patients was observed, since lower-risk patients showed longer survivals than previously whereas higher-risk ones maintained the outcome expected in this poor prognostic group (median OS < 20 months). Furthermore, our approach was particularly useful for detecting patients at risk of dying with AML. Regarding MDS-E, 51% patients classified into the intermediate category were reclassified into higher-risk ones and showed shorter OS and time to AML. In this subgroup of MDS, IPSS-R was capable of splitting our series in five groups with significant differences in OS only when blasts were assessed from NECs. In conclusion, our easy-applicable approach improves prognostic assessment of MDS patients.
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Affiliation(s)
- Xavier Calvo
- Laboratorio Citología Hematológica. Servicio Patología, GRETNHE, IMIM Hospital del Mar Research Institute, Barcelona, Spain
| | - Leonor Arenillas
- Laboratorio Citología Hematológica. Servicio Patología, GRETNHE, IMIM Hospital del Mar Research Institute, Barcelona, Spain
| | - Elisa Luño
- Servicio Hematología, Hospital Universitario Central Asturias, Oviedo, Spain
| | - Leonor Senent
- Servicio Hematología, Hospital Universitario La Fe, Valencia, Spain
| | | | - Fernando Ramos
- Servicio Hematología, Hospital Universitario de León, León, Spain
| | - Carme Pedro
- Servicio Hematología, IMIM Hospital del Mar Research Institute, Barcelona, Spain
| | - Mar Tormo
- Servicio Hematología, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Julia Montoro
- Servicio Hematología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - María Díez-Campelo
- Servicio Hematología, Hospital Universitario de Salamanca, Salamanca, Spain
| | - María Laura Blanco
- Servicio Hematología, Hospital de la Santa Creu i Sant Pau, Univeristat Autònoma de Barcelona, Barcelona, Spain
| | | | - Blanca Xicoy
- Servicio Hematología, ICO-Badalona, Badalona, Spain
| | - Santiago Bonanad
- Servicio Hematología, Hospital Universitario La Fe, Valencia, Spain
| | - Andrés Jerez
- Servicio Hematología y Oncología Médica, Hospital Morales Meseguer, IMIB-Arrixaca, Murcia, Spain
| | | | - Ana Ferrer
- Laboratorio Citología Hematológica. Servicio Patología, GRETNHE, IMIM Hospital del Mar Research Institute, Barcelona, Spain
| | - Guillermo F Sanz
- Servicio Hematología, Hospital Universitario La Fe, Valencia, Spain
| | - Lourdes Florensa
- Laboratorio Citología Hematológica. Servicio Patología, GRETNHE, IMIM Hospital del Mar Research Institute, Barcelona, Spain
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50
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Cruz-Jentoft AJ, González B, de la Rubia J, Hernández Rivas JÁ, Soler JA, Fernández Lago C, Arnao M, Gironella M, Pérez Persona E, Zudaire MT, Olivier C, Altés A, García Guiñón A, Nomdedeu B, Arnan M, Ramírez Payer Á, Sánchez-Godoy P, Pajuelo N, Vilanova D, Monjil DF, Bonanad S. Further psychometric validation of the GAH scale: Responsiveness and effect size. J Geriatr Oncol 2017; 8:211-215. [DOI: 10.1016/j.jgo.2016.12.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 11/03/2016] [Accepted: 12/06/2016] [Indexed: 10/20/2022]
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