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白 心, 何 金, 陆 松, 李 春, 王 依, 熊 建. [Vertebral fractures combined with prolonged activated partial prothrombin time: A case report]. Beijing Da Xue Xue Bao Yi Xue Ban 2024; 56:371-374. [PMID: 38595261 PMCID: PMC11004961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Indexed: 04/11/2024]
Abstract
With the development of modern medical standards, autoimmune diseases and their associated successive osteoporosis have received increasing attention in recent years. Patients with autoimmune diseases, due to the characteristics of the disease and the prolonged use of glucocorticoid hormone therapy, may affect the bone formation and bone absorption of the patient, followed by severe successive osteoporosis, thereby increasing the risk of osteoporotic vertebral fractures. Vertebral compression fractures of the spine are common fracture types in patients with osteoporotic fractures. Osteoporosis is a common complication after glucocorticoid therapy in patients with autoimmune diseases. Percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) are minimally invasive operation and are commonly used surgical methods for the treatment of osteoporotic vertebral compression fractures. However, due to the operation of spinal puncture during the operation, there are serious surgical risks such as bone cement leakage, spinal epidural hemorrhage, subdural hemorrhage, and subarachnoid hemorrhage in both PVP and PKP. As a result, it is necessary to evaluate the patient' s body before surgery carefully, especially in the case of blood coagulation. This article reports a case of autoimmune disease patient admitted to Peking University People' s Hospital due to lumbar 4 vertebral compression fracture combined with Sjögren' s syndrome. The patient' s preoperative examination showed that the activated partial thromboplastin time (APTT) was significantly prolonged. After completing the APTT extended screening experiment and lupus anticoagulant factor testing, the multi-disciplinary team (MDT) of Peking University People' s Hospital jointly discussed the conclusion that the patient' s test results were caused by an abnormal self-immunity anti-copulant lupus (LAC). Based on the results of the laboratory examination, the patient was considered to be diagnosed with combined antiphospholipid syndrome (APS). For such patients, compared with the patient' s tendency to bleed, we should pay more attention to the risk of high blood clotting in the lower limbs of the patient, pulmonary clots and so on. With timely anti-coagulation treatment, the patient safely passed the peripheral period and was successfully discharged from the hospital. Therefore, for patients with autoimmune diseases with prolonged APTT in the perioperative period, doctors need to carefully identify the actual cause and carry out targeted treatment in order to minimize the risk of surgical and perioperative complications and bring satisfactory treatment results to the patients.
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Affiliation(s)
- 心竹 白
- 北京大学人民医院创伤骨科, 国家创伤医学中心, 北京 100044Department of Trauma and Orthopaedics, Peking University People's Hospital; National Center for Trauma Medicine, Beijing 100044, China
| | - 金徽 何
- 浙江省人民医院毕节医院创伤科, 贵州毕节 551799Department of Trauma, Zhejiang Provincial People's Hospital Bijie Hospital, Bijie 551799, Guizhou, China
| | - 松松 陆
- 北京大学人民医院检验科, 北京 100044Department of Clinical Laboratory, Peking University People's Hospital, Beijing 100044, China
| | - 春 李
- 北京大学人民医院风湿免疫科, 北京 100044Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing 100044, China
| | - 依林 王
- 北京大学人民医院创伤骨科, 国家创伤医学中心, 北京 100044Department of Trauma and Orthopaedics, Peking University People's Hospital; National Center for Trauma Medicine, Beijing 100044, China
| | - 建 熊
- 北京大学人民医院创伤骨科, 国家创伤医学中心, 北京 100044Department of Trauma and Orthopaedics, Peking University People's Hospital; National Center for Trauma Medicine, Beijing 100044, China
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Fadraersada J, Alva-Gallegos R, Skořepa P, Musil F, Javorská L, Matoušová K, Krčmová LK, Paclíková M, Carazo A, Blaha V, Mladěnka P. Head-to-head ex vivo comparison of clinically used direct anticoagulant drugs. Naunyn Schmiedebergs Arch Pharmacol 2023:10.1007/s00210-023-02891-x. [PMID: 38112731 DOI: 10.1007/s00210-023-02891-x] [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] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 12/04/2023] [Indexed: 12/21/2023]
Abstract
An imbalance in coagulation is associated with cardiovascular events. For prevention and treatment, anticoagulants, currently mainly xabans and gatrans, are used. The purpose of the present study was to provide a head-to-head comparison since there are no studies directly evaluating these novel anticoagulants. An additional aim was to find whether selected anthropological and biochemical factors can affect their anticoagulant properties as they are used in fixed doses. In this cross-sectional study, blood from 50 generally healthy donors was collected, and coagulation responses to dabigatran, argatroban, rivaroxaban, and apixaban, at a concentration of 1 μM, were analyzed. Heparin was used as a positive control. Prothrombin time (PT) expressed as international normalized ratio (INR) and activated partial thromboplastin time (aPTT) were measured and compared. Rivaroxaban was the most active according to PT/INR while argatroban according to aPTT. The ex vivo anticoagulant effect measured by INR correlated inversely with body mass index (BMI) in all four anticoagulants tested. Shortening of aPTT was associated with higher cholesterol and triglyceride levels. No sex-related differences were observed in response to the anticoagulant treatments. As this was an ex vivo study and pharmacokinetic factors were not included, the influence of BMI is of high therapeutic importance.
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Affiliation(s)
- Jaka Fadraersada
- Department of Pharmacology and Toxicology, Faculty of Pharmacy in Hradec Králové, Charles University, Hradec Králové, Czech Republic
| | - Raúl Alva-Gallegos
- Department of Pharmacology and Toxicology, Faculty of Pharmacy in Hradec Králové, Charles University, Hradec Králové, Czech Republic
| | - Pavel Skořepa
- 3rd Department of Internal Medicine-Metabolic Care and Gerontology, University Hospital and Faculty of Medicine in Hradec Králové, Charles University, Sokolská 581, 50005, Hradec Králové, Czech Republic
- Department of Military Internal Medicine and Military Hygiene, Faculty of Military Health Sciences, University of Defence, Hradec Králové, Czech Republic
| | - František Musil
- Department of Occupational Medicine, University Hospital and Faculty of Medicine in Hradec Králové, Charles University, Sokolská 581, 50005, Hradec Králové, Czech Republic
| | - Lenka Javorská
- Department of Clinical Biochemistry and Diagnostics, University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Kateřina Matoušová
- Department of Clinical Biochemistry and Diagnostics, University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Lenka Kujovská Krčmová
- Department of Clinical Biochemistry and Diagnostics, University Hospital Hradec Králové, Hradec Králové, Czech Republic
- Department of Analytical Chemistry, Faculty of Pharmacy in Hradec Králové, Charles University, Hradec Králové, Czech Republic
| | - Markéta Paclíková
- 3rd Department of Internal Medicine-Metabolic Care and Gerontology, University Hospital and Faculty of Medicine in Hradec Králové, Charles University, Sokolská 581, 50005, Hradec Králové, Czech Republic
| | - Alejandro Carazo
- Department of Pharmacology and Toxicology, Faculty of Pharmacy in Hradec Králové, Charles University, Hradec Králové, Czech Republic
| | - Vladimír Blaha
- 3rd Department of Internal Medicine-Metabolic Care and Gerontology, University Hospital and Faculty of Medicine in Hradec Králové, Charles University, Sokolská 581, 50005, Hradec Králové, Czech Republic
| | - Přemysl Mladěnka
- Department of Pharmacology and Toxicology, Faculty of Pharmacy in Hradec Králové, Charles University, Hradec Králové, Czech Republic.
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Kumano O, Moore GW. Validation of mixing test-specific cut-off in lupus anticoagulant mixing test interpretation for multiple reagents. Thromb Res 2023; 231:39-43. [PMID: 37801773 DOI: 10.1016/j.thromres.2023.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 08/30/2023] [Accepted: 09/26/2023] [Indexed: 10/08/2023]
Affiliation(s)
- Osamu Kumano
- Research Department, Hyphen BioMed, Neuville sur Oise, France; Sysmex Corporation, Kobe, Japan; Health and Medical Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Takamatsu, Japan.
| | - Gary W Moore
- Department of Haematology, Specialist Haemostasis Unit, Addenbrooke's Hospital, Cambridge, UK; Department of Natural Sciences, Middlesex University, London, UK; Department of Haemostasis and Thrombosis, Viapath Analytics, St. Thomas' Hospital, London, UK
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Fu S, Yu W, Fu Q, Xu Z, Zhang S, Liang TB. Prognostic value of APTT combined with fibrinogen and creatinine in predicting 28-Day mortality in patients with septic shock caused by acute enteric perforation. BMC Surg 2023; 23:274. [PMID: 37700315 PMCID: PMC10498602 DOI: 10.1186/s12893-023-02165-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 08/22/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Septic shock is one of the leading causes of mortality in intensive care units. This retrospective study was carried out to evaluate the association of clinical available factors with 28-day mortality. PATIENTS AND METHOD In this observational study, patients with perioperative septic shocks secondary to intra-abdominal infection caused by enteric perforation were included. A total of 328 sepsis patients were admitted to the surgical intensive care units from January 2012 to December 2016. A total of 138 patients met the enrolment criteria and were included in the study. The data of demographic, clinical and laboratory were all recorded. RESULT All these 138 patients received abdominal surgery prior to surgical intensive care units caused by acute enteric perforation. These patients were all met the diagnostic criteria of septic shock according to Sepsis-3. Statistical analysis showed that lactic acid, blood platelet, fibrinogen, creatinine and activated partial thromboplastin time were found to be associated with 28-day mortality. A combination of serum activated partial thromboplastin time combined with fibrinogen and creatinine could predict in-hospital 28-day mortality. The area under the curve of serum activated partial thromboplastin time combined with fibrinogen and creatinine is 0.875 (0.806-0.944). CONCLUSION In conclusion, this pilot study demonstrated that these factors can predict the prognosis of septic shock caused by enteric perforation. In order to reduce the mortality, surgeons and intensive care units physician may consider these data in perioperative period.
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Affiliation(s)
- Shuiqiao Fu
- The Department of SICU, The First Affiliated Hospital, Zhejiang University School of Medicine, Qingchun street 79th, Hangzhou, 310003, Zhejiang Province, China
| | - Wenqiao Yu
- The Department of SICU, The First Affiliated Hospital, Zhejiang University School of Medicine, Qingchun street 79th, Hangzhou, 310003, Zhejiang Province, China
| | - Qinghui Fu
- The Department of SICU, The First Affiliated Hospital, Zhejiang University School of Medicine, Qingchun street 79th, Hangzhou, 310003, Zhejiang Province, China
| | - Zhipeng Xu
- The Department of SICU, The First Affiliated Hospital, Zhejiang University School of Medicine, Qingchun street 79th, Hangzhou, 310003, Zhejiang Province, China
| | - Shaoyang Zhang
- The Department of Emergency, The First Affiliated Hospital, Zhejiang University School of Medicine, Qingchun street 79th, Hangzhou, 310003, Zhejiang Province, China
| | - Ting-Bo Liang
- The Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Qingchun street 79th, Hangzhou, 310003, Zhejiang Province, China.
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Luo J, Yang T, Ding L, Xiong JH, Ying T, Xu F. Relevant detection indicator of prethrombotic state in patients with primary hypertension. World J Clin Cases 2023; 11:5678-5691. [PMID: 37727711 PMCID: PMC10506004 DOI: 10.12998/wjcc.v11.i24.5678] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/02/2023] [Accepted: 08/03/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Hypertension is a common chronic disease that affects many people worldwide. Only a few reports related to the exploration of relevant indicators of the prethrombotic state in patients with primary hypertension (PH) in clinical settings were available. AIM To detect prethrombotic state-related indicators in patients with PH and analyze their differences in different patient populations to provide a laboratory basis for the clinical prevention and control of hypertensive thrombotic diseases. METHODS The general data of patients with PH who attended the Department of Cardiovascular Medicine, The First Affiliated Hospital of Jiangxi Medical College, from January 2022 to December 2022 were collected retrospectively. The patients were divided into three groups of 40 patients each according to the Grade of PH: Grade 1, Grade 2, and Grade 3 hypertension experimental group. The baseline data of 40 volunteers, who underwent physical examination in our hospital but were not diagnosed with PH during the same period, were included in the control group. The relevant indicators of prethrombotic state of the participants were compared, and mainly included inflammation-related indicators, hemorheology-related indicators, and coagulation function related indicators. The relationship between the aforementioned indicators and the progression of PH was analyzed. RESULTS No significant differences were observed in age, sex, diabetes mellitus, smoking history, drinking history, body mass index, New York Heart Association functional classification, or the course of hypertension among the four groups (P > 0.05). The expressions of high-sensitivity C-reactive protein (hs-CRP), thrombomodulin (TM), hematocrit (Hct), erythrocyte sedimentation rate (ESR), P-selectin on platelet surface (CD62P), and fibrinogen (FIB) in the control group were < Grade 1 hypertension group < Grade 2 hypertension group < Grade 3 hypertension group, and the expressions of platelet (PLT), activated partial thromboplastin time (APTT), prothrombin (PT), and plasma thrombin time (TT) in the control group was > Grade 1 hypertension group > Grade 2 hypertension group > Grade 3 hypertension group, and the difference was statistically significant (P < 0.05). The results of the multivariate logistic regression model showed that the expression of hs-CRP, TM, Hct, ESR, CD62P, PLT, APTT, PT, TT, and FIB in the included participants was related to the progression of PH. Among these, high expression of hs-CRP, TM, Hct, ESR, CD62P, APTT, PT, and TT, and low expression of PLT and FIB were risk factors for PH (OR > 1, P < 0.05). The results of the receiver operating characteristic curve analysis showed that the area under the curve of hs-CRP, TM, ESR, CD62P, APTT, PT, TT, and FIB for the prediction of PH were > 0.80, and the prediction value was ideal. Linear correlation analysis with bivariate Spearman showed that hs-CRP, TM, Hct, ESR, CD62P, APTT, PT, and TT were positively correlated with each other (r > 0, P < 0.05); PLT and FIB were negatively correlated with hs-CRP, TM, Hct, ESR, CD62P, APTT, PT, and TT (r < 0, P < 0.05); and PLT and FIB were positively correlated (r > 0, P < 0.05). Linear correlation analysis using bivariate Spearman showed that hs-CRP, TM, Hct, ESR, CD62P, and FIB were positively correlated with each other (r > 0, P < 0.05), whereas PLT, APTT, PT, and TT were negatively correlated with hs-CRP, TM, Hct, ESR, CD62P, and FIB (r < 0, P < 0.05). There was a positive correlation between PLT, APTT, PT, and TT (r > 0, P < 0.05). CONCLUSION The relevant indicators of the prethrombotic state in patients with PH, such as hs-CRP, TM, Hct, ESR, CD62P, PLT, APTT, PT, TT, and FIB, showed differences. High expression of hs-CRP, TM, Hct, ESR, CD62P, and FIB, and low expression of PLT, APTT, PT, and TT are the keys to the occurrence, progression, and thrombotic state of PH. Based on the above serum indicators' expression in patients, targeted interventions can be administered to patients with abnormal expression levels to control the progression of their disease and reduce the risk of developing a prethrombotic state.
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Affiliation(s)
- Jie Luo
- Medical Technology Department, Jiangxi Medical College, Shangrao 334000, Jiangxi Province, China
| | - Tuo Yang
- Inspection Department, Guangdong Zhanjiang Health School Labor Union, Zhanjiang 524094, Guangzhou Province, China
| | - Lan Ding
- Department of Medical Technology, Jiangxi Medical College, Shangrao 334000, Jiangxi Province, China
| | - Jian-Hui Xiong
- Department of Cardiology, The First Affiliated Hospital of Jiangxi Medical College, Shangrao 334000, Jiangxi Province, China
| | - Teng Ying
- Department of Cardiology, The First Affiliated Hospital of Jiangxi Medical College, Shangrao 334000, Jiangxi Province, China
| | - Fen Xu
- Department of Medical Technology, Jiangxi Medical College, Shangrao 334000, Jiangxi Province, China
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Larabee SM, Hollinger LE, Vogel AM. Systemic anticoagulation in ECMO. Semin Pediatr Surg 2023; 32:151333. [PMID: 37967498 DOI: 10.1016/j.sempedsurg.2023.151333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
While unfractionated heparin (UFH) remains the mainstay of anticoagulation during pediatric extracorporeal life support, direct thrombin inhibitors (DTIs) are increasingly used. In this article, we will review most recent evidence regarding utilization of both UFH and DTIs and compare their known advantages and disadvantages. We will present anticoagulation monitoring strategies during ECMO and outline the most recent Extracorporeal Life Support Organization's anticoagulation guidelines, however with the caveat that there are no true consensus recommendations for anticoagulation management in pediatric ECMO. With these updates, we will serve as the bedside clinician's refresher on common practices for anticoagulation during "routine" ECMO. We will additionally highlight special circumstances, including high risk surgical procedures during ECMO, in which adjustments in anticoagulation and/or addition of antifibrinolytic therapy might mitigate risk.
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Affiliation(s)
- Shannon M Larabee
- Texas Children's Hospital and Baylor College of Medicine, United States
| | | | - Adam M Vogel
- Texas Children's Hospital and Baylor College of Medicine, United States
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Wang X, Wang JY, Chen M, Ren J, Zhang X. Clinical association between coagulation indicators and bone metastasis in patients with gastric cancer. World J Gastrointest Oncol 2023; 15:1253-1261. [PMID: 37546561 PMCID: PMC10401464 DOI: 10.4251/wjgo.v15.i7.1253] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/16/2023] [Accepted: 05/06/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Bones are one of the most common target organs for cancer metastasis. Early evaluation of bone metastasis (BM) status is clinically significant. Cancer patients often experience a hypercoagulable state.
AIM To evaluate the correlation between coagulation indicators and the burden of BM in gastric cancer (GC).
METHODS We conducted a single-center retrospective study and enrolled 454 patients. Clinical information including routine blood examination and coagulation markers were collected before any treatment. Patients were grouped according to the status of BM. Receiver operating characteristic curves were used to assess diagnostic performance and determine the optimal cutoff values of the above indicators. Cutoff values, sensitivity and specificity were based on the maximum Youden index. Univariate and multivariate logistic regression analyses were used to evaluate the relationships between biomarkers and BM.
RESULTS Of the 454 enrolled patients, 191 patients were diagnosed with BM. The receiver operating characteristic curve analysis suggested that prothrombin time (PT) [cutoff: 13.25; sensitivity: 0.651; specificity: 0.709; area under receiver operating characteristic curve (AUC) = 0.738], activated partial thromboplastin time (aPTT) (cutoff: 35.15; sensitivity: 0.640; specificity: 0.640; AUC = 0.678) and fibrin degradation products (FDP) (cutoff: 2.75; sensitivity: 0.668; specificity: 0.801; AUC = 0.768) act as novel predictors for BM. Based on multivariate logistic regression analysis, the results showed the independent correlation between PT [odds ratio (OR): 3.16; 95% confidence interval (CI): 1.612-6.194; P = 0.001], aPTT (OR: 2.234; 95%CI: 1.157-4.313; P = 0.017) and FDP (OR: 3.17; 95%CI: 1.637-6.139; P = 0.001) and BM in patients with GC. Moreover, age, carcinoembryonic antigen, erythrocyte and globulin were found to be significantly associated with BM.
CONCLUSION Coagulation markers, namely PT, aPTT and FDP, might be potential predictors for screening BM in patients with GC.
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Affiliation(s)
- Xuan Wang
- Department of Radiotherapy and Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
| | - Jing-Ya Wang
- Department of Gastroenterology, Xi'an Children's Hospital, Shaanxi Research Institute for Pediatric Diseases, The Affiliated Children's Hospital of Xi'an Jiaotong University and National Regional Medical Center for Children (Northwest), Xi'an 710003, Shaanxi Province, China
| | - Min Chen
- Department of Radiotherapy and Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
| | - Juan Ren
- Department of Radiotherapy and Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
| | - Xin Zhang
- Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
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Rajsic S, Treml B, Jadzic D, Breitkopf R, Oberleitner C, Bachler M, Bösch J, Bukumiric Z. aPTT-guided anticoagulation monitoring during ECMO support: A systematic review and meta-analysis. J Crit Care 2023; 77:154332. [PMID: 37244207 DOI: 10.1016/j.jcrc.2023.154332] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 05/03/2023] [Accepted: 05/08/2023] [Indexed: 05/29/2023]
Abstract
INTRODUCTION The initiation of the extracorporeal membrane oxygenation (ECMO) is associated with complex coagulatory and inflammatory processes and consequently needed anticoagulation. Systemic anticoagulation bears an additional risk of serious bleeding, and its monitoring is of immense importance. Therefore, our work aims to analyze the association of anticoagulation monitoring with bleeding during ECMO support. MATERIAL AND METHODS Systematic literature review and meta-analysis, complying with the PRISMA guidelines (PROSPERO-CRD42022359465). RESULTS Seventeen studies comprising 3249 patients were included in the final analysis. Patients experiencing hemorrhage had a longer activated partial thromboplastin time (aPTT), a longer ECMO duration, and higher mortality. We could not find strong evidence of any aPTT threshold association with the bleeding occurrence, as less than half of authors reported a potential relationship. Finally, we identified the acute kidney injury (66%, 233/356) and hemorrhage (46%, 469/1046) to be the most frequent adverse events, while almost one-half of patients did not survive to discharge (47%, 1192/2490). CONCLUSION The aPTT-guided anticoagulation is still the standard of care in ECMO patients. We did not find strong evidence supporting the aPTT-guided monitoring during ECMO. Based on the weight of the available evidence, further randomized trials are crucial to clarify the best monitoring strategy.
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Affiliation(s)
- Sasa Rajsic
- Department of Anesthesiology and Intensive Care Medicine, Medical University Innsbruck, Innsbruck 6020, Austria.
| | - Benedikt Treml
- Department of Anesthesiology and Intensive Care Medicine, Medical University Innsbruck, Innsbruck 6020, Austria.
| | - Dragana Jadzic
- Anesthesia and Intensive Care Department, Pain Therapy Service, Cagliari University, Cagliari, Italy
| | - Robert Breitkopf
- Department of Anesthesiology and Intensive Care Medicine, Medical University Innsbruck, Innsbruck 6020, Austria
| | - Christoph Oberleitner
- Department of Anesthesiology and Intensive Care Medicine, Medical University Innsbruck, Innsbruck 6020, Austria
| | - Mirjam Bachler
- Department of Anesthesiology and Intensive Care Medicine, Medical University Innsbruck, Innsbruck 6020, Austria
| | - Johannes Bösch
- Department of Anesthesiology and Intensive Care Medicine, Medical University Innsbruck, Innsbruck 6020, Austria
| | - Zoran Bukumiric
- Institute of Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade 11000, Serbia
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Zhang L, Xie S, Lyu F, Liu C, Li C, Liu W, Ma X, Zhou J, Qian X, Lu Y, Qian Z. Predictive value of immunoglobulin G, activated partial thromboplastin time, platelet, and indirect bilirubin for delayed viral clearance in patients infected with the Omicron variant. PeerJ 2023; 11:e15443. [PMID: 37223120 PMCID: PMC10202103 DOI: 10.7717/peerj.15443] [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: 01/17/2023] [Accepted: 05/01/2023] [Indexed: 05/25/2023] Open
Abstract
Background Omicron is the recently emerged highly transmissible severe acute respiratory syndrome coronavirus 2 variant that has caused a dramatic increase in coronavirus disease-2019 infection cases worldwide. This study was to investigate the association between demographic and laboratory findings, and the duration of Omicron viral clearance. Methods Approximately 278 Omicron cases at the Ruijin Hospital Luwan Branch, Shanghai Jiaotong University School of Medicine were retrospectively analyzed between August 11 and August 31, 2022. Demographic and laboratory data were also collected. The association between demographics, laboratory findings, and duration of Omicron viral clearance was analyzed using Pearson correlation analysis and univariate and multivariate logistic regression. Results Univariate logistic regression analyses showed that a prolonged viral clearance time was significantly associated with older age and lower immunoglobulin (Ig) G and platelet (PLT) levels. Using multinomial logistic regression analyses, direct bilirubin, IgG, activated partial thromboplastin time (APTT), and PLT were independent factors for longer viral shedding duration. The model combining direct bilirubin, IgG, APTT, and PLT identifies patients infected with Omicron whose viral clearance time was ≥7 days with 62.7% sensitivity and 83.4% specificity. Conclusion These findings suggest that direct bilirubin, IgG, PLT, and APTT are significant risk factors for a longer viral shedding duration in patients infected with Omicron. Measuring levels of direct bilirubin, IgG, PLT, and APTT is advantageous to identify patients infected with Omicron with longer viral shedding duration.
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Affiliation(s)
- Lina Zhang
- Department of Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Provincial Clinical Research Center for Critical Care Medicine, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Shucai Xie
- Department of Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Provincial Clinical Research Center for Critical Care Medicine, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Feng Lyu
- School of Computer Science and Engineering, Central South University, Changsha, Hunan, China
| | - Chun Liu
- Respiratory and Critical Care Medicine Department, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Chunhui Li
- National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Xiangya Hospital, Central South University, Changsha, Hunan, China
- Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Wei Liu
- Department of Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Provincial Clinical Research Center for Critical Care Medicine, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xinhua Ma
- Department of Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Provincial Clinical Research Center for Critical Care Medicine, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jieyu Zhou
- School of Computer Science and Engineering, Central South University, Changsha, Hunan, China
| | - Xinyu Qian
- School of Computer Science and Engineering, Central South University, Changsha, Hunan, China
| | - Yong Lu
- Department of Radiology, Ruijin Hospital Luwan Branch, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Zhaoxin Qian
- Department of Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Provincial Clinical Research Center for Critical Care Medicine, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Xiangya Hospital, Central South University, Changsha, Hunan, China
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10
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Kanie T, Futamura A, Mizuno T, Yamada S, Usui M. Effect of fat emulsion administration on blood coagulation in terminal lung cancer patients. Fujita Med J 2023; 9:73-79. [PMID: 37234390 PMCID: PMC10206901 DOI: 10.20407/fmj.2021-012] [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] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 01/26/2022] [Indexed: 05/28/2023]
Abstract
Objectives Patients with cancer, especially those with lung cancer, are at high risk of developing thrombosis. Intralipos® infusion 20% is contraindicated for thrombosis, and there is no consensus on whether it can be safely used in cases of advanced cancer. We conducted a retrospective observational study to elucidate the impact of fat emulsion administration on blood coagulation in patients with terminal lung cancer. Methods The subjects were patients with terminal lung cancer in the Department of Surgery and Palliative Medicine, Fujita Health University Nanakuri Memorial Hospital between January 2016 and December 2019. We compared changes in their blood coagulation profile before hospitalization and one month later. Results There were a total of 213 patients with lung cancer-139 who were administered fat emulsion and 74 who were not-with no significant differences in baseline characteristics. In the fat emulsion administration group (n=27), the prothrombin time-international normalized ratio (PT-INR) and activated partial thromboplastin time (APTT), respectively, were 1.17±0.26 (mean±standard deviation) and 30.5±5.0 s at hospitalization and 1.16±0.12 and 31.2±4.2 s one month later with no significant differences. In the non-administration group (n=6), the PT-INR and APTT, respectively, were 1.44±0.43 and 30.6±5.2 s before hospitalization and 1.28±0.18 and 33.0±7.5 s one month later with no significant differences. Conclusions We did not identify any changes in PT-INR and APTT after fat emulsion administration in patients with terminal lung cancer. There were also no new cases of thrombosis, suggesting that fat emulsions were administered safely in patients with terminal lung cancer.
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Affiliation(s)
- Takaki Kanie
- Department of Pharmacy, Fujita Health University Hospital, Toyoake, Aichi, Japan
| | - Akihiko Futamura
- Department of Pharmacy, Fujita Health University Nanakuri Memorial Hospital, Tsu, Mie, Japan
| | - Tomohiro Mizuno
- Department of Pharmacy, Fujita Health University Hospital, Toyoake, Aichi, Japan
| | - Shigeki Yamada
- Department of Pharmacy, Fujita Health University Hospital, Toyoake, Aichi, Japan
| | - Masanobu Usui
- Department of Palliative Medicine, Fujita Health University Hospital, Toyoake, Aichi, Japan
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11
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Khalil DN, Prieto González-Albo I, Rosen L, Lillie T, Stacey A, Parfitt L, Soff GA. A tumor-selective adenoviral vector platform induces transient antiphospholipid antibodies, without increased risk of thrombosis, in phase 1 clinical studies. Invest New Drugs 2023; 41:317-323. [PMID: 36897458 PMCID: PMC9999314 DOI: 10.1007/s10637-023-01345-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 02/22/2023] [Indexed: 03/11/2023]
Abstract
Tumor-selective viruses are a novel therapeutic approach for treating cancer. Tumor-Specific Immuno Gene Therapy (T-SIGn) vectors are tumor-selective adenoviral vectors designed to express immunomodulatory transgenes. Prolonged activated partial thromboplastin time (aPTT), associated with the presence of antiphospholipid antibodies (aPL), has been observed in patients with viral infections, and following administration of adenovirus-based medicines. aPL may be detected as lupus anticoagulant (LA), anti-cardiolipin (aCL) and/or anti-beta 2 glycoprotein antibodies (aβ2GPI). No subtype alone is definitive for development of clinical sequalae, however, patients who are 'triple positive' have a greater thrombotic risk. Additionally, isolated aCL and aβ2GPI IgM do not appear to add value in thrombotic association to aPL positivity, rather IgG subtypes must also be present to confer an increased risk. Here we report induction of prolonged aPTT and aPL in patients from eight Phase 1 studies who were treated with adenoviral vectors (n = 204). Prolonged aPTT (≥ Grade 2) was observed in 42% of patients, with a peak at 2-3 weeks post-treatment and resolution within ~ 2 months. Among patients with aPTT prolongation, LA, but not aCL IgG nor aβ2GPI IgG, was observed. The transience of the prolongation and discordance between positive LA and negative aCL/aβ2GPI IgG assays is not typical of a prothrombotic state. Among the patients with prolonged aPTT there was no evidence of an increased rate of thrombosis. These findings elucidate the relationship between viral exposure and aPL in the context of clinical trials. They suggest a framework in which hematologic changes can be monitored in patients receiving similar treatments.Clinical trial registration:NCT02028442, NCT02636036, NCT02028117, NCT03852511, NCT04053283, NCT05165433, NCT04830592, NCT05043714.
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Affiliation(s)
- Danny N Khalil
- Memorial Sloan Kettering Cancer Center, 1275 York Ave., New York, NY, 10065, USA. .,Parker Institute for Cancer Immunotherapy, New York, NY, USA. .,Weill Cornell Medicine, New York, NY, USA.
| | | | - Lee Rosen
- UCLA Medical Center, Los Angeles, CA, USA
| | | | | | | | - Gerald A Soff
- University of Miami Health System/Sylvester Comprehensive Cancer Center, Miami, FL, USA
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12
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Davidson S. Assays to Monitor Bivalirudin. Methods Mol Biol 2023; 2663:369-380. [PMID: 37204724 DOI: 10.1007/978-1-0716-3175-1_24] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Bivalirudin (Angiomax, Angiox) is a parenteral direct thrombin inhibitor (DTI) that is used for patients with heparin-induced thrombocytopenia (HIT), where heparin cannot be used due to the risk of thrombosis. Bivalirudin is also licensed for use in cardiology procedures (e.g., percutaneous transluminal coronary angioplasty; PTCA). Bivalirudin is a synthetic analogue of hirudin found in the saliva of the medicinal leech and has a relatively short half-life of ~25 min. Several assays can be used to monitor bivalirudin; these include the activated partial thromboplastin time (APTT), activated clotting time (ACT), ecarin clotting time (ECT), an ecarin-based chromogenic assay, thrombin time (TT), the dilute TT, and the prothrombinase-induced clotting time (PiCT). Drug concentrations can also be measured using liquid chromatography tandem mass spectrometry (LC/MS) and clotting or chromogenic-based assays with specific drug calibrators and controls.
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Affiliation(s)
- Simon Davidson
- Division of Medicine, University College London, London, UK
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13
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Pillay D, Rapiti N. The diagnosis and Management of HIV Associated Acquired Hemophilia A: A Case Series From Durban, South Africa. J Prim Care Community Health 2023; 14:21501319231194970. [PMID: 37646157 PMCID: PMC10467197 DOI: 10.1177/21501319231194970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 09/01/2023] Open
Abstract
INTRODUCTION In acquired hemophilia A (AHA), the body produces auto-antibodies against Factor VIII. Although AHA is rare, with an incidence of 1.5 patients/1 million population/year, there is a strong association with human immunodeficiency virus (HIV) infection. The accurate interpretation of screening coagulation tests is critical to identify patients with AHA, as the mortality rate secondary to bleeding is high. METHODS This was a retrospective case series which included all newly diagnosed AHA patients that were referred to Hemophilia care unit at King Edward VIII Hospital, Durban, South Africa from January 2011 to December 2021. The clinical presentation and laboratory results were documented. RESULTS Five patients were included in this case series. All patients were females aged between 28 and 64 years of age and they were HIV seropositive. They presented with spontaneous cutaneous and intramuscular bleeding. Four patients were virologically suppressed on anti-retroviral therapy, and no patient had a family history of congenital bleeding diathesis. Laboratory investigations confirmed AHA with high Factor VIII inhibitor titers, which ranged from 41 to 900 Bethesda Units (BU). All patients were managed with bypassing agents and oral corticosteroids. The monitoring of patients after the initiation of treatment was difficult as they all defaulted treatment. CONCLUSION In view of the prevalence of HIV in sub-Saharan Africa, there is a possibility that AHA is under-diagnosed in our setting. The clinician and the laboratory have a combined critical role in identifying patients with AHA as the investigation of a prolonged APTT is mandatory. There are challenges in managing AHA patients in a resource-constrained setting.
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Affiliation(s)
- Dashini Pillay
- University of KwaZulu-Natal - Department of Hematology, National Health Laboratory Services, School of laboratory medicine, Durban, South Africa
- Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| | - Nadine Rapiti
- University of KwaZulu-Natal - Department of Hematology, National Health Laboratory Services, School of laboratory medicine, Durban, South Africa
- Inkosi Albert Luthuli Central Hospital, Durban, South Africa
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14
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Safani M, Appleby S, Chiu R, Favaloro EJ, Ferro ET, Johannes J, Sheth M. Application of anti-Xa assay in monitoring unfractionated heparin therapy in contemporary antithrombotic management. Expert Rev Hematol 2023; 16:1-8. [PMID: 36637400 DOI: 10.1080/17474086.2023.2169126] [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] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Unfractionated heparin remains the most widely used agent in the prevention and acute treatment of thrombosis. Pharmacological complexities of this intriguing agent mandate frequent monitoring of its anticoagulant properties to maintain safe and effective hematological outcomes. Although activated partial thromboplastin time has been the standard test to monitor unfractionated heparin therapy for many decades, the anti-Xa assay has emerged as a substitute or adjunct in many institutions. AREAS COVERED This brief report outlines the key features of anti-Xa assay in monitoring unfractionated heparin in acute management of thrombosis in various contemporary settings, with emphasis on evidence for clinical outcomes. PubMed.gov database was utilized to obtain the pertinent literature. EXPERT OPINION The anti-Xa activity is primarily a reflection of UFH concentration and does not account for other hematological variables frequently present in contemporary anticoagulation management. The advantage of the anti-Xa assay in monitoring UFH therapy is predicated upon its limitations to account for global physiological hemostasis. There are significant disease and drug interactions that may potentially result in false in-vitro analysis of anti-Xa activity. Routine application of the anti-Xa assay is not evidence-based at this time.
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Affiliation(s)
- Michael Safani
- MemorialCare Heart & Vascular Institute Long Beach, CA, USA.,University of California, San Francisco, CA, USA
| | - Steve Appleby
- Interventional Cardiology, Memorial Care Heart and Vascular Institute, Long Beach, CA, USA
| | - Ryan Chiu
- Cardiovascular Surgery, MemorialCare Heart & Vascular Institute Long Beach, CA, USA
| | - Emmanuel J Favaloro
- Institute of Clinical Pathology and Medical Research, Westmead Hospital, Australia.,School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,School of Dentistry and Medical Sciences, Faculty of Science and Health, Charles Sturt University, Australia.,Sydney Centres for Thrombosis and Haemostasis, Westmead Hospital, Westmead, NSW, Australia
| | | | - Jimmy Johannes
- Critical Care & Pulmonary Medicine, Memorial Care Long Beach, CA, USA
| | - Milan Sheth
- Hematology, Department of Medicine MemorialCare Long Beach, CA, USA
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15
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Bauça JM, Ajzner É, Cadamuro J, Hillarp A, Kristoffersen AH, Meijer P. An international study on activated partial thromboplastin time prolongation. Part 1: Analytical results. Clin Chim Acta 2022; 535:167-173. [PMID: 36041550 DOI: 10.1016/j.cca.2022.08.024] [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: 05/31/2022] [Revised: 07/28/2022] [Accepted: 08/23/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Unexpected prolongation of first-line coagulation tests, including activated partial thromboplastin time (APTT), should trigger further work-up by performing mixing tests to elucidate the underlying cause, direct further specific testing and clarify their possible clinical impact. The aim of our study was to assess whether methodological diversity has any impact on the APTT mixing test results and their interpretation. MATERIAL AND METHODS Two lyophilized plasma samples (case 1: heparin contamination [0.5 IU/mL]; case 2: factor VIII deficiency [0.13 IU/mL]) and their respective fictional clinical cases were sent to European laboratories for APTT measurement and performance of mixing tests. Participants were surveyed about the methodology (reagents, analytical platform, reference ranges), APTT results, mixing test conditions, their classification (normal, equivocal, prolonged) and categorization of the sample (factor deficiency, presence of inhibitor, anticoagulant, unknown). RESULTS A total of 269 responses were included. For case 1, all participants reported a prolonged APTT, and 91% obtained no correction in the mixing test, without differences among reagents or analytical platforms. Only 15% of them selected the presence of an anticoagulant as the single cause for the prolongation. For case 2, 99% of participants reported a prolonged APTT, while some heterogeneity in the mixing test results was found. Eighty-six percent of participants selected factor deficiency as the cause for APTT prolongation. CONCLUSIONS Most European laboratories obtained valid results for APTT and the subsequent mixing tests, despite using different methodologies. However, their classification could be improved. Therefore, more training and periodic evaluations are recommended to harmonize protocols and ensure proper result classification and categorization.
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Affiliation(s)
- Josep Miquel Bauça
- Department of Laboratory Medicine, Hospital Universitari Son Espases, Palma, Spain.
| | - Éva Ajzner
- Central Laboratory, András Jósa University Hospital, Nyíregyháza, Hungary
| | - Janne Cadamuro
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Andreas Hillarp
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - Ann Helen Kristoffersen
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway; Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Piet Meijer
- ECAT Foundation (External Quality Control for Assays and Tests), Voorschoten, Netherlands
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16
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Wang D, Lin C, Gu C, Wu Y, Wang S. Tigecycline-Associated Coagulopathy: A Single-Center Retrospective Analysis. Pharmacology 2022; 107:524-536. [PMID: 35820375 DOI: 10.1159/000525380] [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: 01/29/2022] [Accepted: 05/30/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The purpose of this study was to assess clinical characteristics and risk factors for tigecycline-associated prothrombin time (PT) and activated partial thromboplastin time (aPTT) prolongation. METHODS We performed a retrospective analysis on coagulation parameters before and during tigecycline treatment in 55 patients in our hospital with severe infections, mainly pneumonia caused by Acinetobacter baumannii. Patients were divided into different groups according to prolongation of PT and aPTT, and clinical features involved were explored. Univariate and multivariable binary logistic regression analyses were used to identify risk factors for tigecycline-associated PT and aPTT increase. RESULTS We found that PT values increased from 12.73 ± 1.87 to 13.86 ± 2.06 during the treatment compared with premedication (p < 0.001), and the aPTT level prolonged significantly from 33.63 ± 11.24 to 38.15 ± 11.81 (p < 0.001). The multivariate analyses identified 2 variables that were associated with tigecycline-induced PT prolongation: albumin level (p = 0.018) and weight-adjusted tigecycline dosage (p = 0.005). In addition, treatment duration was the only risk factor for tigecycline-induced aPTT prolongation (p = 0.043). CONCLUSION Albumin level, weight-adjusted tigecycline dosage, treatment duration may serve as risk indicators for tigecycline-associated coagulation dysfunction. Physicians should be careful with coagulation disorder when prescribing tigecycline in clinical practice, especially in patients with risk factors.
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Affiliation(s)
- Dongmei Wang
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Chuwen Lin
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Chunping Gu
- Department of Pharmacy, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yongming Wu
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shengnan Wang
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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17
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Zhang MH, Wei N, Tian XX, Zhao SZ, Li LH, Wang BL. [Analysis of risk factors for hemorrhage in patients with acute poisoning treated with hemoperfusion]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2022; 40:208-212. [PMID: 35439864 DOI: 10.3760/cma.j.cn121094-20210107-00006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Objective: To explore the clinical characterist ics and risk factors of hemorrhage complicated by hemoperfusion therapy in patients with acute poisoning. Methods: In January 2021, the clinical data of 196 patients with acute poisoning who received hemoperfusion therapy in the Second Affiliated Hospital of Air Force Military Medical University from January 2018 to December 2020 were analyzed, and the patients were divided into bleeding group and non-bleeding group according to whether the patients were complicated with bleeding. Multivariate logistic regression was used to analyze the independent risk factors for hemorrhage in patients treated with hemoperfusion. Results: A total of 21 patients in the bleeding group and 175 patients in the non-bleeding group were included. There was no significant difference in general data such as gender, age, and body mass index between the two groups (P>0.05) . Organophosphorus pesticides (χ(2)= 4.56, P=0.030) , HA230 perfusion device (χ(2)=4.12, P=0.042) , platelet count (t=-2.33, P=0.009) and activated partial thromboplastin time (t=14.53, P<0.001) at 2 h of perfusion were the influencing factors of hemorrhage in patients with acute poisoning treated with hemoperfusion. Among them, organophosphorus pesticides, 2 h perfusion activated partial thromboplastin time ≥35 s and other factors were independent risk factors forcomplicated bleeding (P<0.05) . Conclusion: Patients with acute poisoning, especially organophosphorus pesticide poisoning, are at greater risk of bleeding during hemoperfusion therapy. Monitoring of changes in activated partial thromboplastin time should be strengthened and the dose of anticoagulants should be adjusted in time to reduce the risk of bleeding.
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Affiliation(s)
- M H Zhang
- Department of Emergency, the Second Affiliated Hospital of Air Force Military Medical University, Xi'an 710038, China
| | - N Wei
- Department of Emergency, the Second Affiliated Hospital of Air Force Military Medical University, Xi'an 710038, China
| | - X X Tian
- Department of Emergency, the Second Affiliated Hospital of Air Force Military Medical University, Xi'an 710038, China
| | - S Z Zhao
- Department of Emergency, the Second Affiliated Hospital of Air Force Military Medical University, Xi'an 710038, China
| | - L H Li
- Department of Emergency, the Second Affiliated Hospital of Air Force Military Medical University, Xi'an 710038, China
| | - B L Wang
- Department of Emergency, the Second Affiliated Hospital of Air Force Military Medical University, Xi'an 710038, China
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Ono R, Fukushima K, Yamazaki T, Yamashita D, Takahashi H, Hori Y, Nishimura K. Coagulation markers in patients with venous thromboembolism treated with 10 mg apixaban twice daily. Naunyn Schmiedebergs Arch Pharmacol 2022; 395:159-166. [PMID: 34851448 DOI: 10.1007/s00210-021-02190-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 11/24/2021] [Indexed: 11/28/2022]
Abstract
Apixaban is used to treat venous thromboembolism (VTE) at 10 mg twice daily (BID) for 7 days, followed by 5 mg BID without dose adjustment, and non-valvular atrial fibrillation (NVAF) at 5 mg BID or 2.5 mg BID with dose adjustment criteria (DAC) including age, body weight, and renal function. The anti-factor Xa activity (AXA), prothrombin time (PT), and activated partial thromboplastin time (APTT) in patients with VTE receiving 10 mg BID of apixaban remains unclear. Twenty-six patients (70.8±15.4 years, 10 males) with VTE receiving 10 mg BID of apixaban were enrolled. The patients were divided into two groups based on whether they met the DAC of NVAF: DAC group (n=8) and non-DAC group (n=18). Trough and peak AXA values, PT, and APTT were measured at 10 mg BID dosage and then at 5 mg BID dosage. Coagulation markers in recipients of 10 mg BID therapy were significantly higher than those of 5 mg BID recipients. A significant and strong positive correlation was observed between AXA and PT at trough and peak times. The AXA values and PT in the DAC group were significantly higher than those in the non-DAC group. No significant inter-group differences were seen in APTT. This study provides the first report of AXA distribution in VTE patients receiving 10 mg BID of apixaban. Our findings indicate that coagulation markers may differ in patients with VTE-prescribed higher doses of apixaban and a DAC may be warranted in such patients.
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Affiliation(s)
- Ryohei Ono
- Department of Cardiology, Matsudo City General Hospital, 993-1 Sendabori, Matsudo, Chiba, 247-8533, Japan.
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
| | - Kenichi Fukushima
- Department of Cardiology, Matsudo City General Hospital, 993-1 Sendabori, Matsudo, Chiba, 247-8533, Japan
| | - Tatsuro Yamazaki
- Department of Cardiology, Matsudo City General Hospital, 993-1 Sendabori, Matsudo, Chiba, 247-8533, Japan
| | - Daichi Yamashita
- Department of Cardiology, Matsudo City General Hospital, 993-1 Sendabori, Matsudo, Chiba, 247-8533, Japan
| | - Hidehisa Takahashi
- Department of Cardiology, Matsudo City General Hospital, 993-1 Sendabori, Matsudo, Chiba, 247-8533, Japan
| | - Yasuhiko Hori
- Department of Cardiology, Matsudo City General Hospital, 993-1 Sendabori, Matsudo, Chiba, 247-8533, Japan
| | - Kazutaka Nishimura
- Department of Neurology, Matsudo City General Hospital, 993-1 Sendabori, Matsudo, Chiba, 247-8533, Japan
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Miloš M, Marijančević D, Kozmar A, Anić B, Coen Herak D. Dramatically prolonged coagulation screening tests in a patient with positive lupus anticoagulant and monoclonal immunoglobulin M without bleeding manifestations. Clin Chim Acta 2021; 525:6-11. [PMID: 34896061 DOI: 10.1016/j.cca.2021.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 11/26/2021] [Accepted: 11/27/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Concomitant presence of lupus anticoagulant (LA) and monoclonal immunoglobulin in the same patient is uncommon and the influence of this finding on coagulation results is still unknown. CASE REPORT We present a patient with a diagnosis of systemic lupus erythematosus (SLE) and secondary antiphospholipid syndrome (APS) with permanently positive LA who presented with accidental finding of newly discovered monoclonal IgM in a high concentration and dramatically prolonged prothrombin time (PT) and activated partial thromboplastin time (aPTT), without bleeding manifestations. CONCLUSION Concomitant presence of extremely prolonged PT and aPTT with unusual coagulation reaction kinetics, consistent LA ratio over the follow-up period and normalization of coagulation screening results with decreasing monoclonal IgM concentration elicited suspicion that PT and aPTT prolongation could be attributed to M-protein with antiphospholipid specificity. Low LA-sensitive aPTT reagent Actin FS demonstrated exceptional sensitivity, whereas human placental thromboplastin in contrast to recombinant reagents showed significantly lower sensitivity to monoclonal IgM with antiphospholipid specificity. Changes in the activity of SLE observed during the follow-up period were inversely related to monoclonal IgM concentration, while the presence of secondary APS was consistent. Described analytical interference on PT and aPTT without bleeding manifestation should point towards suspicion of previously unidentified monoclonal IgM with antiphospholipid sensitivity.
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Affiliation(s)
- Marija Miloš
- Department of Laboratory Diagnostics, University Hospital Centre Zagreb, Zagreb, Croatia; Faculty of Pharmacy, University of Mostar, Bosnia & Herzegovina.
| | - Domagoj Marijančević
- Laboratory of Endocrinology, Department of Oncology and Nuclear Medicine, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Ana Kozmar
- Department of Laboratory Diagnostics, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Branimir Anić
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia; University of Zagreb School of Medicine, Zagreb, Croatia
| | - Désirée Coen Herak
- Department of Laboratory Diagnostics, University Hospital Centre Zagreb, Zagreb, Croatia
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20
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Swayngim R, Preslaski C, Burlew CC, Beyer J. Comparison of clinical outcomes using activated partial thromboplastin time versus antifactor-Xa for monitoring therapeutic unfractionated heparin: A systematic review and meta-analysis. Thromb Res 2021; 208:18-25. [PMID: 34678527 DOI: 10.1016/j.thromres.2021.10.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 08/11/2021] [Revised: 09/21/2021] [Accepted: 10/12/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Continuous intravenous unfractionated heparin (UFH) is a mainstay of therapeutic anticoagulation in the acute setting. The two most common laboratory tests for monitoring UFH are the activated partial thromboplastin time (aPTT) and antifactor Xa (anti-Xa) heparin assay. We reviewed the available evidence to evaluate if the choice of monitoring test for UFH therapy is associated with a difference in the clinical outcomes of bleeding, thrombosis, or mortality. MATERIALS AND METHODS MEDLINE, Cochrane database, and conference abstracts from the Society of Critical Care Medicine, the American Society of Hematology, and the American College of Clinical Pharmacy were searched for all studies comparing aPTT and anti-Xa monitoring for therapeutic UFH that evaluated outcomes for bleeding, thrombotic events, or mortality. Risk of bias was assessed with the Cochrane Risk of Bias Tool and Newcastle Ottawa Scale. Pooled relative risk ratios were calculated using an inverse variance-weighted random-effects model. RESULTS Ten studies (n = 6677) were included for analysis. The use of anti-Xa compared to aPTT was not associated with an increased risk of bleeding (RR 1.03; 95% CI 0.8-1.22 I2 = 4%) or an increased risk of thrombotic events (RR 0.99; 95% CI 0.76-1.30, I2 = 3%). There was no difference in mortality within individual studies but the data were not suitable for pooled analysis. CONCLUSIONS Pooled data comparing aPTT vs. anti-Xa for monitoring therapeutic UFH did not suggest differences in the outcomes of bleeding or thrombosis.
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Affiliation(s)
- Rebecca Swayngim
- Department of Pharmacy, Denver Health Medical Center, 777 Bannock St, Denver 80204, CO, USA.
| | - Candice Preslaski
- Department of Surgery, Denver Health Medical Center, 777 Bannock St, Denver 80204, CO, USA.
| | - Clay Cothren Burlew
- Department of Surgery, Denver Health Medical Center, 777 Bannock St, Denver 80204, CO, USA.
| | - Jacob Beyer
- Department of Pharmacy, Denver Health Medical Center, 777 Bannock St, Denver 80204, CO, USA.
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Nyansah WB, Koffuor GA, Ben IO, Gyanfosu L, Ehigiator BE. Antithrombotic property of an aqueous extract from Pseudocedrela kotschyi and Adenia cissampeloides. Res Pharm Sci 2021; 16:436-446. [PMID: 34447451 PMCID: PMC8356714 DOI: 10.4103/1735-5362.319581] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 12/07/2020] [Accepted: 05/25/2021] [Indexed: 11/24/2022] Open
Abstract
Background and purpose: An aqueous extract from the root bark of Pseudocedrela kotschyi and aerial parts of Adenia cissampeloides has been proven in previous research to elicit significant anticoagulant property in vitro. This, therefore, indicates the potential usefulness of this extract in managing thromboembolic disease, a major global health risk. The aim of the present work was to establish the antithrombotic effect of a product made from extracts of the root bark of P. kotschyi and the aerial parts of A. cissampeloides (PAE). Experimental approach: The effect of PAE at 500-2000 mg/kg in inhibiting tail infarction and inflammation, as well as its effect on the microthrombi count, hematological, and coagulation profiles in a carrageenan-induced thrombosis model in Sprague-Dawley rats, was studied. Findings/Results: PAE significantly (P ≤ 0.01-0.001) reduced length of tail infarction and inflammation (redness, swelling, pain, and temperature). Histopathological studies revealed a significant reduction (P ≤ 0.0001) in microthrombi count in the liver and the lungs with PAE treatment. PAE treatment caused a marginal (P ≤ 0.01) increase in prothrombin time but resulted in a significant (P ≤ 0.01-0.0001) dose-dependent increase in activated partial thromboplastin time, with the hematological profile being normal. Conclusion and implications: PAE showed anticoagulant and antithrombotic effects in vivo, indicative of its potential benefit as a natural product, and cost-effective therapeutic option, and hence could be helpful in thromboembolic therapies.
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Affiliation(s)
- Wilson Bright Nyansah
- Department of Pharmacology, Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - George Asumeng Koffuor
- Department of Pharmacology, Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Inemesit Okon Ben
- Department of Pharmacology, School of Pharmacy, University of Health and Allied Science, Ho, Ghana
| | - Linda Gyanfosu
- Department of Pharmacology, Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Ben Enoluomen Ehigiator
- Department of Pharmacology and Toxicology, Faculty of Pharmaceutical Sciences, Madonna University, River State, Nigeria
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Habe K, Wada H, Mizutani K, Matsushima Y, Kondo M, Yamanaka K. The clinical significance of a shortened activated partial thromboplastin time in patients with connective tissue disease. Clin Rheumatol 2021. [PMID: 34136970 DOI: 10.1007/s10067-021-05781-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 04/01/2021] [Accepted: 05/19/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Connective tissue disease (CTD) patients have been reported to have an increased risk of venous thromboembolism (VTE). Deep venous thrombosis represents a potential emergency that may have a fatal outcome. The D-dimer test is the most widely accepted screening marker for VTE; however, elevation of the plasma D-dimer level without demonstrable thrombosis sometimes accompanies CTD activity itself, infection, and other conditions. Thus, the accuracy of a diagnosis of VTE based on a D-dimer test result is lower in CTD patients. The activated partial thromboplastin time (APTT) test is a very common and simple test. METHOD The medical records of 535 CTD patients were retrospectively investigated. The following data were extracted: APTT, D-dimer, thrombotic events, laboratory data, and systemic corticosteroid therapy. RESULTS The rates of thrombotic events and VTE were significantly increased in patients with a shortened APTT (< 26 s) (PSAPTT) in comparison to those without a shortened APTT (p = 0.004, 0.0009, respectively). The number of PSAPTTs was significantly increased in patients with VTE in comparison to those without VTE (p = 0.0009). In the diagnosis of VTE in CTD patients, the specificity and positive predictive value (PPV) of the D-dimer test were 71.6% and 83.8% and 12.7% and 19.4%, respectively. The combination of a shortened APTT and elevated plasma D-dimer level improved the specificity and PPV to 94.7% and 97.3% and to 25.0% and 36.4%, respectively. CONCLUSIONS For the evaluation of possibility of accompanying VTE in CTD patients, APTT shortened was useful and should be evaluated with careful attention. KEY POINTS • Regarding the specificity for diagnosing VTE in CTD patients, a shortened APTT showed a value (84.3%) comparable or superior to that of the D-dimer test. • The combination of a shortened APTT and elevated D-dimer level improved the specificity of the diagnosis of VTE in CTD patients to (94.7% or 97.3%) in comparison to the D-dimer test alone (71.6% or 83.8%). • The positive predictive value of the combination of a shortened APTT and plasma D-dimer elevation for the diagnosis of VTE in CTD patients increased to 25.0% or 36.4%. • In the management of CTD patients, physicians should pay attention when they encounter patients with a shortened APTT, as it may indicate VTE.
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You CY, Lu SW, Fu YQ, Xu F. Relationship between admission coagulopathy and prognosis in children with traumatic brain injury: a retrospective study. Scand J Trauma Resusc Emerg Med 2021; 29:67. [PMID: 34016132 PMCID: PMC8136757 DOI: 10.1186/s13049-021-00884-4] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 05/10/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Coagulopathy in adult patients with traumatic brain injury (TBI) is strongly associated with unfavorable outcomes. However, few reports focus on pediatric TBI-associated coagulopathy. METHODS We retrospectively identified children with Glasgow Coma Scale ≤ 13 in a tertiary pediatric hospital from April 2012 to December 2019 to evaluate the impact of admission coagulopathy on their prognosis. A classification and regression tree (CART) analysis using coagulation parameters was performed to stratify the death risk among patients. The importance of these parameters was examined by multivariate logistic regression analysis. RESULTS A total of 281 children with moderate to severe TBI were enrolled. A receiver operating characteristic curve showed that activated partial thromboplastin time (APTT) and fibrinogen were effective predictors of in-hospital mortality. According to the CART analysis, APTT of 39.2 s was identified as the best discriminator, while 120 mg/dL fibrinogen was the second split in the subgroup of APTT ≤ 39.2 s. Patients were stratified into three groups, in which mortality was as follows: 4.5 % (APTT ≤ 39.2 s, fibrinogen > 120 mg/dL), 20.5 % (APTT ≤ 39.2 s and fibrinogen ≤ 120 mg/dL) and 60.8 % (APTT > 39.2 s). Furthermore, length-of-stay in the ICU and duration of mechanical ventilation were significantly prolonged in patients with deteriorated APTT or fibrinogen values. Multiple logistic regression analysis showed that APTT > 39.2 s and fibrinogen ≤ 120 mg/dL was independently associated with mortality in children with moderate to severe TBI. CONCLUSIONS We concluded that admission APTT > 39.2 s and fibrinogen ≤ 120 mg/dL were independently associated with mortality in children with moderate to severe TBI. Early identification and intervention of abnormal APTT and fibrinogen in pediatric TBI patients may be beneficial to their prognosis.
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Affiliation(s)
- Cheng-yan You
- Department of Critical Care Medicine, Childrens Hospital, Chongqing Medical University, 136# Zhongshan Er Road, Yu Zhong District, 400014 Chongqing, Peoples Republic of China
- Ministry of Education Key Laboratory of Child Development and Disorders, 400014 Chongqing, Peoples Republic of China
- National Clinical Research Center for Child Health and Disorders, 400014 Chongqing, Peoples Republic of China
- China International Science and Technology Cooperation base of Child development and Critical Disorders, 400014 Chongqing, Peoples Republic of China
- Chongqing Key Laboratory of Pediatrics, 400014 Chongqing, Peoples Republic of China
| | - Si-wei Lu
- Department of Critical Care Medicine, Childrens Hospital, Chongqing Medical University, 136# Zhongshan Er Road, Yu Zhong District, 400014 Chongqing, Peoples Republic of China
- Ministry of Education Key Laboratory of Child Development and Disorders, 400014 Chongqing, Peoples Republic of China
- National Clinical Research Center for Child Health and Disorders, 400014 Chongqing, Peoples Republic of China
- China International Science and Technology Cooperation base of Child development and Critical Disorders, 400014 Chongqing, Peoples Republic of China
- Chongqing Key Laboratory of Pediatrics, 400014 Chongqing, Peoples Republic of China
| | - Yue-qiang Fu
- Department of Critical Care Medicine, Childrens Hospital, Chongqing Medical University, 136# Zhongshan Er Road, Yu Zhong District, 400014 Chongqing, Peoples Republic of China
- Ministry of Education Key Laboratory of Child Development and Disorders, 400014 Chongqing, Peoples Republic of China
- National Clinical Research Center for Child Health and Disorders, 400014 Chongqing, Peoples Republic of China
- China International Science and Technology Cooperation base of Child development and Critical Disorders, 400014 Chongqing, Peoples Republic of China
- Chongqing Key Laboratory of Pediatrics, 400014 Chongqing, Peoples Republic of China
| | - Feng Xu
- Department of Critical Care Medicine, Childrens Hospital, Chongqing Medical University, 136# Zhongshan Er Road, Yu Zhong District, 400014 Chongqing, Peoples Republic of China
- Ministry of Education Key Laboratory of Child Development and Disorders, 400014 Chongqing, Peoples Republic of China
- National Clinical Research Center for Child Health and Disorders, 400014 Chongqing, Peoples Republic of China
- China International Science and Technology Cooperation base of Child development and Critical Disorders, 400014 Chongqing, Peoples Republic of China
- Chongqing Key Laboratory of Pediatrics, 400014 Chongqing, Peoples Republic of China
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Li H, Li R, Li LL, Chai W, Xu C, Chen J. The change of coagulation profile in two-staged arthroplasty for periprosthetic joint infection patients: a retrospective cohort study. J Orthop Surg Res 2021; 16:319. [PMID: 34006302 DOI: 10.1186/s13018-021-02477-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 05/11/2021] [Indexed: 11/13/2022] Open
Abstract
Aims Periprosthetic joint infection (PJI) is a serious complication of total joint arthroplasty. We performed a retrospective cohort study to evaluate (1) the change of coagulation profile in two-staged arthroplasty patients and (2) the relationship between coagulation profile and the outcomes of reimplantation. Method Between January 2011 and December 2018, a total of 202 PJI patients who were operated on with two-staged arthroplasty were included in this study initially. This study continued for 2 years and the corresponding medical records were scrutinized to establish the diagnosis of PJI based on the 2014 MSIS criteria. The coagulation profile was recorded at two designed points, (1) preresection and (2) preimplantation. The difference of coagulation profile between preresection and preimplantation was evaluated. Receiver operating characteristic curves (ROC) were used to evaluate the diagnostic efficiency of the coagulation profile and change of coagulation profile for predicting persistent infection before reimplantation. Results The levels of APTT, INR, platelet count, PT, TT, and plasma fibrinogen before spacer implantation were significantly higher than before reimplantation. No significant difference was detected in the levels of D-dimer, ACT, and AT3 between the two groups. The AUC of the combined coagulation profile and the change of combined coagulation profile for predicting persistent infection before reimplantation was 0.667 (95% CI 0.511, 0.823) and 0.667 (95% CI 0.526, 0.808), respectively. Conclusion The coagulation profile before preresection is different from before preimplantation in two-staged arthroplasty and the coagulation markers may play a role in predicting infection eradication before reimplantation when two-stage arthroplasty is performed. Level of evidence Level III, diagnostic study. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-021-02477-4.
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Nykänen AI, Selby R, McRae KM, Zhao Y, Asghar UM, Donahoe L, Granton J, de Perrot M. Pseudo Heparin Resistance After Pulmonary Endarterectomy: Role of Thrombus Production of Factor VIII. Semin Thorac Cardiovasc Surg 2021; 34:315-323. [PMID: 33984481 DOI: 10.1053/j.semtcvs.2021.03.042] [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: 03/04/2021] [Accepted: 03/11/2021] [Indexed: 11/11/2022]
Abstract
Pulmonary endarterectomy (PEA) is the main treatment for chronic thromboembolic pulmonary hypertension (CTEPH). Postoperative unfractionated heparin dosing can be monitored by activated partial thromboplastin time (APTT) or by anti-factor Xa activity (anti-Xa). In pseudo heparin resistance, APTT response to heparin is blunted due to elevated Factor VIII (FVIII) which can underestimate anticoagulation. We examined possible pseudo heparin resistance after PEA and assessed the impact of FVIII. APTT response to heparin before and after operation was determined in 13 PEA patients anticoagulated with unfractionated heparin. APTT and anti-Xa concordance was analyzed from paired postoperative samples, and antithrombin, fibrinogen and FVIII levels were measured. Single-cell RNA sequencing was used to characterize FVIII gene expression in PEA specimens of 5 patients. APTT response to heparin was blunted after PEA. APTT and anti-Xa were discordant in 36% of postoperative samples and most common discordant patterns were subtherapeutic APTT with therapeutic (16%) or supratherapeutic (11%) anti-Xa. Overall, APTT underestimated anticoagulation relative to anti-Xa in one-third of the samples. FVIII levels were elevated before surgery, increased substantially 1 and 3 days (median 4.32 IU/mL) after PEA, and were higher in discordant than concordant samples. Single-cell RNA sequencing showed FVIII gene expression in PEA specimen endothelial cells. Pseudo heparin resistance is common after PEA likely due to highly elevated postoperative FVIII levels indicating that anti-Xa reflects postoperative heparinization better than APTT in these patients. FVIII production by the pulmonary artery endothelium may participate in local prothrombotic processes important for CTEPH pathogenesis.
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Affiliation(s)
- Antti I Nykänen
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; Latner Thoracic Surgery Research Laboratories, Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Rita Selby
- Coagulation Laboratory, University Health Network, Toronto, Ontario, Canada
| | - Karen M McRae
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Yidan Zhao
- Latner Thoracic Surgery Research Laboratories, Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Usman M Asghar
- Latner Thoracic Surgery Research Laboratories, Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Laura Donahoe
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - John Granton
- Division of Respirology, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Marc de Perrot
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; Latner Thoracic Surgery Research Laboratories, Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada.
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Munsanje MM, Kaile T, Kowa S, Sinkala M, Simakando M, Ndhlovu J, Chiluba BC. von Willebrand factor activity and activated partial thromboplastin time as proxy biomarkers for coagulopathies in women with menorrhagia in Zambia: a case-control study. Pan Afr Med J 2021; 39:13. [PMID: 34394804 PMCID: PMC8348282 DOI: 10.11604/pamj.2021.39.13.13742] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 04/21/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction von Willebrand Disease (vWD) is the most prevalent bleeding disorder. Women are more likely to manifest abnormal bleeding symptoms due to physiologic events and menorrhagia is the most common presenting symptom. Methods this case-control study included 168 women aged between 18 and 45. The cases had menorrhagia whilst the controls did not. Blood grouping, activated partial thromboplastin time and von Willebrand factor activity tests were performed on samples collected from consenting study participants. Results the mean age was 29.96 ± 7.37. Mean vWF activity of cases was 66.6% and of controls 97.8%. The mean activated Partial ThromboplastinTime (aPTT) of cases was 31.09s and of controls was 30.40s. There was no difference in the vWF activity between blood group O (86.3%) and non-blood group O (88.0%) participants. Eight women were diagnosed with von Willebrand disease, 6 cases and 2 controls. Higher odds of von Willebrand disease were seen in the cases (OR = 6.6). Epistaxis, von Willebrand and factor activity levels and family history of menorrhagia were associated with an increased risk for menorrhagia. Conclusion von Willebrand factor activity levels were associated with menorrhagia while activated partial thromboplastin time was not. vWF activity levels did not depend on any specific blood group. The prevalence of von Willebrand disease was significantly higher in participants with menorrhagia and repeated epistaxis and family history of menorrhagia pointed to a higher risk of menorrhagia.
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Affiliation(s)
- Miyoba Melinda Munsanje
- Lusaka Apex Medical University, Faculty of Medicine, Department of Pathology, Lusaka, Zambia.,University of Zambia, School of Medicine, Department of Biomedical Sciences, Lusaka, Zambia
| | - Trevor Kaile
- University of Zambia, School of Medicine, Lusaka, Zambia
| | - Sumbukeni Kowa
- University Teaching Hospital, Foods and Drugs Laboratory, Lusaka, Zambia
| | - Musalula Sinkala
- University of Zambia, School of Medicine, Department of Biomedical Sciences, Lusaka, Zambia
| | - Marah Simakando
- University of Zambia, School of Medicine, Department of Biomedical Sciences, Lusaka, Zambia
| | - Jacob Ndhlovu
- Eden University, Faculty of Medicine, Lusaka, Zambia
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Nayak AG, Kumar N, Shenoy S, Roche M. Evaluation of the merit of the methanolic extract of Andrographis paniculata to supplement anti-snake venom in reversing secondary hemostatic abnormalities induced by Naja naja venom. 3 Biotech 2021; 11:228. [PMID: 33959471 PMCID: PMC8060375 DOI: 10.1007/s13205-021-02766-z] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 03/29/2021] [Indexed: 12/14/2022] Open
Abstract
Increasing evidence suggests a sizable involvement of hemotoxins in the morbidity associated with envenomation by the Indian spectacled cobra, Naja naja (N.N). This study investigates the ability of Indian polyvalent anti-snake venom (ASV), methanolic extract of Andrographis paniculata (MAP) and their combination in reversing the hemostatic abnormalities, viz. activated partial thromboplastin time(aPTT), prothrombin time(PT) and thrombin time(TT) in citrated plasma. These parameters were assessed in 2 groups of experiments. Group 1: Without the prior incubation of plasma with venom and Group 2: With prior incubation of plasma with venom for 90 min at 37°C. Venom caused significant (p < 0.001) prolongation in aPTT (175%), PT (49%) and TT (34%) in Group 1 and ASV could completely bring them back to normal. MAP showed a concentration-dependent reversal in aPTT, normalization of PT and prolongation of TT. When low concentration of ASV was supplemented with MAP, their combined effect in normalizing aPTT and PT improved by 37% and 26% respectively when compared to ASV alone. In Group 2, venom caused significant (p < 0.001) prolongation in aPTT (231%), PT (312%) and TT (245%). ASV had limited effect in reversing aPTT (52%), TT (31%) but completely normalized PT. MAP was marginally effective in reversing the prolonged aPTT and PT but caused further prolongation of TT. Combination of ASV and MAP was more effective than ASV alone in reversing venom-induced increase in aPTT (52%) and PT (29%). The study proved that, a drastic reduction of ASV by 70%, could be effectively supplemented by MAP in combating hemostatic abnormalities induced by NN venom.
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Affiliation(s)
- Akshatha Ganesh Nayak
- Department of Biochemistry, Melaka Manipal Medical College (Manipal Campus), Manipal Academy of Higher Education, Manipal, Karnataka India
| | - Nitesh Kumar
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Hajipur, Bihar India
| | - Smita Shenoy
- Department of Pharmacology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka India
| | - Maya Roche
- Department of Biochemistry, Melaka Manipal Medical College (Manipal Campus), Manipal Academy of Higher Education, Manipal, Karnataka India
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Idowu OE, Oyeleke SO, Vitowanu JM. Impact of inflammatory cell ratio, biomarkers, activated partial thromboplastin time and prothrombin time on chronic subdural haematoma severity and outcome. Eur J Trauma Emerg Surg 2021. [PMID: 33839805 DOI: 10.1007/s00068-021-01665-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 03/30/2021] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Chronic subdural haematoma (CSH) has multifactorial mechanisms involved in its development and progression. Identifying readily available inflammatory and coagulation indices that can predict the prognosis of CSH will help in clinical care, prognosis, generating objective criteria for assessing efficacy of treatment strategies and comparisons of treatment efficacy between clinical studies. We conducted a study in which we evaluated the impact value of neutrophil to lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), inflammatory biomarkers (erythrocyte sedimentation rate and C-reactive protein), activated partial thromboplastin time (APTT), prothrombin time (PT) and international normalized ratio (INR) at presentation on CSH severity and outcome using Glasgow outcome scale (GOS), Markwalder grading scale (MGS) and Lagos brain disability examination scale (LABDES). METHODS We prospectively studied patients in a single healthcare system with clinical and radiological features of chronic subdural haematoma. Only patients who were managed surgically were recruited. The primary outcome was predictors of severe form CSH (using admission Glasgow coma scale score, MGS grade, inflammatory cells and biomarkers, APTT, PT, and INR) and outcome (using GOS, MGS and LABDES grades 3 months) with secondary outcome being mortality rate, 3 months following surgery. Good outcome was defined as GOS score > 3, LABDES score ≥ 40 at three months and MGS score < 2. Differences in categorical and continuous variables between groups were compared using Fisher's exact test or Chi-square test (χ2) analysis, one-way ANOVA or Kruskal-Wallis test (in case of non-normal distribution). RESULTS We included 61 patients with a male-to-female ratio of 2.6:1 and mean age of 57.5 ± 13.3 years (median 58 years; 27-83 years). The pre-op MGS grade was significantly associated with the LABDES (p = 0.034), GOS (p = 0.011) and post-op MGS (p = 0.007) grade. All the patients that died had elevated APTT and PT with low PLR. A low admission PLR was significantly associated with a poor outcome using the GOS (p = 0.001), MGS (p = 0.011) and LABDES grade (p = 0.006) (Table 3). A high APTT was also significantly associated with a worse outcome using GOS (p = 0.007), MGS (p = 0.007) and LABDES grade (p = 0.003). There were three (4.9%) deaths with post-mortem diagnosis of pulmonary embolism, chronic renal failure and irreversible craniocaudal herniation syndrome. All the patients that died had elevated APTT and PT with low PLR. CONCLUSION Patients' admission APTT, PT, INR and PLR are good predictors of outcome using the GOS. A high admission INR is also associated with a worse outcome using MGS and LABDES grade.
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Baig MA, Swamy KB. Comparative analysis of chromogenic vs clot.based one stage APTT assay for determination of factor VIII level. INDIAN J PATHOL MICR 2021; 64:123-127. [PMID: 33433421 DOI: 10.4103/ijpm.ijpm_900_19] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background In the laboratory, factor VIII can be measured by three different methodologies, such as one-stage clotting assay, two-stage clotting assay, and chromogenic assay. These assays differ in ease of use, variety of reagents available, sensitivity to mild hemophilia A, and interference from lupus anticoagulants (LACs). Certain factor VIII gene mutations can cause discrepancy in results between one-stage activated partial thromboplastin time (APTT) and chromogenic assays. Materials and Methods The coagulometer for factor VIII assay is Sysmex CS-5100. All data were expressed as mean ± standard deviation (SD). Results A total of 135 cases were studied. Of these, 100 cases were of mild hemophilia A diagnosed by molecular genetics and, 15 cases were positive for LAC, which were confirmed by dilute Russell Viper venom test. Clot-based one-stage APTT assay showed 65% sensitivity and 80% specificity in diagnosing mild hemophilia A cases and out of 15 LAC cases, it showed false positivity in five cases. Chromogenic assay showed 85% sensitivity and 90% specificity in diagnosing mild hemophilia cases and was 100% specific in excluding LAC cases. Conclusions One-stage APTT assay is the most commonly used test for determining factor VIII levels but chromogenic assay are considered as the gold standard and recommended as the reference method by European Pharmacopoeia and ISTH subcommittee. Mild hemophilia A patients with missense mutations show discrepancy between the one-stage clot-based APTT assay and chromogenic assays for determination of factor VIII level and this can lead to misdiagnosis or misclassification of mild hemophilia A. Therefore, it is recommended that both the assays should be used in the evaluation of mild hemophilia cases.
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Affiliation(s)
- Mirza Asif Baig
- Department of Anatomy, Faculty of Medicine, Lincoln University College, Malaysia
| | - K B Swamy
- Department of Anatomy, Faculty of Medicine, Lincoln University College, Malaysia
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Xia Y, Zhang Y, Yuan S, Chen J, Zheng W, Xu X, Xie X, Zhang J. A nomogram to early predict isolation length for non-severe COVID-19 patients based on laboratory investigation: A multicenter retrospective study in Zhejiang Province, China. Clin Chim Acta 2021; 512:49-57. [PMID: 33279501 PMCID: PMC7836550 DOI: 10.1016/j.cca.2020.11.019] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 11/11/2020] [Accepted: 11/24/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Majority coronavirus disease 2019 (COVID-19) patients are classified as mild and moderate (non-severe) diseases. We aim to develop a model to predict isolation length for non-severe patients. METHODS Among 188 non-severe patients, 96 patients were enrolled as training cohort to identify factors associated with isolation length via Cox regression model and develop a nomogram. Other 92 patients formed as validation cohort to validate nomogram. Concordance index (C-index), area under the curve (AUC) and calibration curves were used to evaluated nomogram. RESULTS Increasing absolute eosinophil count (AEC) after admission was correlated with shorter isolation length (P = 0.02). Baseline activated partial thromboplastin time (APTT) > 30 s was correlated with longer isolation length (P = 0.03). A nomogram to predict isolation probability at 11-, 16- and 21-day was developed and validated. The C-indices of training and validation cohort were 0.604 and 0.682 respectively. Both cohorts showed a good discriminative ability (AUC, 11-day: 0.646 vs 0.730; 16-day: 0.663 vs 0.750; 21-day: 0.711 vs 0.783; respectively) and calibration power. CONCLUSIONS Baseline APTT and dynamic change of AEC were two significant factors associated with isolation length of non-severe patients. Nomogram could predict isolation probability for each patient to estimate appropriate quarantine length.
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Affiliation(s)
- Yan Xia
- Department of Clinical Laboratory, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yan Zhang
- Department of Clinical Laboratory, Xixi Hospital of Hangzhou, Hangzhou, China
| | - Shijin Yuan
- Department of Clinical Laboratory, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiangnan Chen
- Department of Clinical Laboratory, Affiliated Hospital of Shaoxing University, Shaoxing, China
| | - Wei Zheng
- Department of Clinical Laboratory, The Third People's Hospital of Yueqing, Wenzhou, China
| | - Xiaoping Xu
- Department of Clinical Laboratory, Jinhua Municipal Central Hospital, Jinhua, China
| | - Xinyou Xie
- Department of Clinical Laboratory, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.
| | - Jun Zhang
- Department of Clinical Laboratory, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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31
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Lawlor M, Gupta A, Ranard LS, Madhavan MV, Li J, Eisenberger A, Parikh SA, Sethi SS, Masoumi A. Discordance in activated partial thromboplastin time and anti-factor Xa levels in COVID-19 patients on heparin therapy. Thromb Res 2020; 198:79-82. [PMID: 33302210 PMCID: PMC7698679 DOI: 10.1016/j.thromres.2020.11.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 11/01/2020] [Accepted: 11/23/2020] [Indexed: 01/23/2023]
Affiliation(s)
- Matthew Lawlor
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, 630 W 168th St, New York, NY 10032, United States oF America
| | - Aakriti Gupta
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, 630 W 168th St, New York, NY 10032, United States oF America
| | - Lauren S Ranard
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, 630 W 168th St, New York, NY 10032, United States oF America
| | - Mahesh V Madhavan
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, 630 W 168th St, New York, NY 10032, United States oF America
| | - Jianhua Li
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, 630 W 168th St, New York, NY 10032, United States oF America
| | - Andrew Eisenberger
- Division of Hematology/Oncology, Department of Medicine, Columbia University Irving Medical Center, 630 W 168th St, New York, NY 10032, United States of America
| | - Sahil A Parikh
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, 630 W 168th St, New York, NY 10032, United States oF America
| | - Sanjum S Sethi
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, 630 W 168th St, New York, NY 10032, United States oF America
| | - Amirali Masoumi
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, 630 W 168th St, New York, NY 10032, United States oF America.
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Okamura K, Kodaka M, Ichikawa J, Ando K, Komori M. Left atrial thrombus formation within a few days of hospitalization in semi-acute ischemic heart disease despite no atrial fibrillation and mitral stenosis: a case report. JA Clin Rep 2020; 6:86. [PMID: 33099689 PMCID: PMC7585560 DOI: 10.1186/s40981-020-00390-z] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 10/03/2020] [Accepted: 10/05/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Currently, the occurrence of left atrial thrombus despite the provision of heparinization within a few days of hospitalization without atrial fibrillation (AF) and mitral stenosis (MS) is rarely reported. CASE PRESENTATION A 71-year-old woman presented with chest discomfort and dyspnea. Examination revealed ST elevation with sinus rhythm, congestive heart failure, and moderate mitral regurgitation (MR) by transthoracic echocardiography (TTE). Diuretics, a coronary vasodilator, and unfractionated heparin (15,000 units/day) were administered. Four days after hospitalization, her C-reactive protein level had increased; therefore, TTE was repeated, revealing a thrombus in the left atrial appendage, which was probably affected by heparin resistance because of low antithrombin (49%). On day 5, the patient underwent emergency removal of the thrombus, mitral valve replacement, and coronary artery bypass. CONCLUSION Patients can exhibit low left ventricular contractility, even sinus rhythm without MS. Thus, TTE and subsequent coagulation tests including antithrombin must be performed to prevent thrombus.
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Affiliation(s)
- Keiko Okamura
- Department of Anesthesiology & Intensive Care, Tokyo Women's Medical University Medical Center East, Arakawa-ku, Tokyo, 116-8567, Japan
| | - Mitsuharu Kodaka
- Department of Anesthesiology & Intensive Care, Tokyo Women's Medical University Medical Center East, Arakawa-ku, Tokyo, 116-8567, Japan.
| | - Junko Ichikawa
- Department of Anesthesiology & Intensive Care, Tokyo Women's Medical University Medical Center East, Arakawa-ku, Tokyo, 116-8567, Japan
| | - Kazuyoshi Ando
- Department of Anesthesiology & Intensive Care, Tokyo Women's Medical University Medical Center East, Arakawa-ku, Tokyo, 116-8567, Japan
| | - Makiko Komori
- Department of Anesthesiology & Intensive Care, Tokyo Women's Medical University Medical Center East, Arakawa-ku, Tokyo, 116-8567, Japan
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Shusterman M, Grassl N, Berger K, De Sancho MT. Prolonged activated partial thromboplastin time after prophylactic-dose unfractionated heparin in the post-operative neurosurgical setting: case series and management recommendations. J Thromb Thrombolysis 2020; 49:153-158. [PMID: 31456167 DOI: 10.1007/s11239-019-01936-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Primary brain tumors, both benign and malignant, pose a high risk of perioperative venous thromboembolism (VTE) due to the development of a prothrombotic state. Perioperative pharmacologic thromboprophylaxis with subcutaneous (SC) unfractionated heparin (UFH) has significantly reduced VTE associated morbidity. Recent reports suggest an association between prolonged activated partial thromboplastin time (aPTT) due to prophylactic SC UFH and increased bleeding risk. We present three patients with normal baseline coagulation parameters in whom pharmacologic thromboprophylaxis with SC UFH resulted in a marked prolongation of the aPTT, leading to adverse outcomes in two patients. These cases demonstrate the uncertain kinetics of SC UFH and effect on aPTT, suggesting the significance of routine aPTT monitoring in high-risk settings. Given the wide variation in presentations of therapeutic or supratherapeutic values of aPTT in the perioperative neurosurgical setting, we propose a practical standardized approach to the evaluation and management of aPTT prolongation following prophylactic SC UFH administration.
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Affiliation(s)
- Michael Shusterman
- Division of Hematology - Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA. .,Division of Hematology-Oncology, Department of Medicine, Weill Cornell Medicine, 520 East 70th Street, Starr Pavilion, 3rd Floor, New York, NY, 10021, USA.
| | - Niklas Grassl
- Division of Hematology - Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Karen Berger
- Department of Pharmacy, New York-Presbyterian Hospital - Weill Cornell Medical Center, New York, NY, USA
| | - Maria T De Sancho
- Division of Hematology - Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA. .,Division of Hematology-Oncology, Department of Medicine, Weill Cornell Medicine, 1305 York Avenue 7th Floor, New York, NY, 10021, USA.
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Kim M, Yoo HJ, Lee D, Lee JH. Oxidized LDL induces procoagulant profiles by increasing lysophosphatidylcholine levels, lysophosphatidylethanolamine levels, and Lp-PLA 2 activity in borderline hypercholesterolemia. Nutr Metab Cardiovasc Dis 2020; 30:1137-1146. [PMID: 32456947 DOI: 10.1016/j.numecd.2020.03.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 01/17/2020] [Accepted: 03/20/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS The increased risk of cardiovascular disease under hypercholesterolemia is due to associations between oxidized low-density lipoprotein (ox-LDL) and lipoprotein-associated phospholipase A2 (Lp-PLA2) and between ox-LDL and coagulant profiles. We investigated the impact of different ox-LDL levels on coagulation time and plasma metabolomes in subjects with borderline hypercholesterolemia. METHODS AND RESULTS One hundred thirty-one subjects with borderline hypercholesterolemia (serum cholesterol ≥200 mg/dL) were divided into low ox-LDL (n = 66) and high ox-LDL (n = 65) groups. After adjusting for confounding factors, the high ox-LDL group exhibited a significantly decreased activated partial thromboplastin time (aPTT) and prothrombin time (PT) and increased Lp-PLA2 activity. Compared to the low ox-LDL group, the high ox-LDL group exhibited significantly increased intensities of 17 lysophosphatidylcholines (lysoPCs) and 7 lysophosphatidylethanolamines (lysoPEs). Ox-LDL was inversely correlated with aPTT and PT and positively correlated with Lp-PLA2 activity. Positive correlations were also found among ox-LDL, Lp-PLA2 activity, lysoPCs, and lysoPEs. LysoPCs and lysoPEs were inversely correlated with PT and aPTT. The identified plasma metabolites, including amino acids, fatty acid amides, acylcarnitines, and lysophospholipids, were significantly upregulated in the high ox-LDL group. CONCLUSION High ox-LDL levels may be involved in the development of a procoagulant state in subjects with borderline hypercholesterolemia by increasing Lp-PLA2 activity and lysoPC and lysoPE levels.
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Affiliation(s)
- Minjoo Kim
- Department of Food and Nutrition, College of Life Science and Nano Technology, Hannam University, Daejeon, South Korea
| | - Hye Jin Yoo
- Research Center for Silver Science, Institute of Symbiotic Life-TECH, Yonsei University, Seoul, South Korea; Department of Food and Nutrition, National Leading Research Laboratory of Clinical Nutrigenetics/Nutrigenomics, College of Human Ecology, Yonsei University, Seoul, South Korea
| | - Dahyoung Lee
- Department of Food and Nutrition, National Leading Research Laboratory of Clinical Nutrigenetics/Nutrigenomics, College of Human Ecology, Yonsei University, Seoul, South Korea; Department of Food and Nutrition, Brain Korea 21 PLUS Project, College of Human Ecology, Yonsei University, Seoul, South Korea
| | - Jong Ho Lee
- Research Center for Silver Science, Institute of Symbiotic Life-TECH, Yonsei University, Seoul, South Korea; Department of Food and Nutrition, National Leading Research Laboratory of Clinical Nutrigenetics/Nutrigenomics, College of Human Ecology, Yonsei University, Seoul, South Korea; Department of Food and Nutrition, Brain Korea 21 PLUS Project, College of Human Ecology, Yonsei University, Seoul, South Korea.
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35
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Xing L, Liu SY, Mao HD, Zhou KG, Song Q, Cao QM. The prognostic value of routine coagulation tests for patients with heat stroke. Am J Emerg Med 2021; 44:366-72. [PMID: 32389399 DOI: 10.1016/j.ajem.2020.04.062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 04/16/2020] [Accepted: 04/17/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To evaluate the prognostic value of routine coagulation tests for patients with heat stroke. METHODS This was a multi-center retrospective study. Patients who arrived at the hospital <24 h after the onset of Heat Stroke (HS) were included. The routine coagulation variables were detected within 24 h after the onset, including the lowest platelet count (PLC). RESULTS 60-day mortality rate was 20.9%. The median Prothrombin Time-International Normalized Ratio (PT-INR) of the non-surviving patients was significantly higher than that of the survivors (P < 0.01). The median Activated Partial Thromboplastin Time (APTT) in non-surviving patients was significantly higher than in the surviving patients (P < 0.01). A Cox regression analysis revealed that 60-day mortality was associated with PT-INR (P = 0.032) and APTT (P = 0.004). The optimal PT-INR point for predicting 60-day mortality rate was 1.7. The optimal APTT point for predicting 60-day mortality was 51.45. Patients with increased PT-INR (≥1.7) levels had, overall, a significantly reduced survival time (P < 0.01). Patients with elevated APTT (≥51.45) also had a decrease in survival time (P < 0.01). The prognostic scoring, with increased PT-INR (≥1.7) and prolonged APTT (≥51.45) at one point each, was also demonstrated to be useful in predicting 60-day mortality. Patients whose temperature fell to 38.9 °C within 30 min had significantly lower levels of PT-INR and APTT within 24 h than those who took longer to cool down. CONCLUSIONS A prolonged APTT and elevated PT-INR within 24 h are independent prognostic factors of 60-day mortality in HS.
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Špiljak B, Šimunović L, Lapić I, Rogić D, Špalj S, Vuletić L. Influence of saliva on the results of global laboratory coagulation tests. Aust Dent J 2020; 65:205-209. [PMID: 32072639 DOI: 10.1111/adj.12753] [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] [Accepted: 02/13/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Oral wounds inevitably come into contact with saliva which can affect the time needed for bleeding to stop. The influence of saliva can be non-specific, related to dilution of blood, and/or mediated by salivary factors that affect haemostasis directly. The aim of this study was to assess if mixing blood with an individual's saliva would affect the rate of its coagulation measured by global coagulation tests, prothrombin time (PT) and activated partial thromboplastin time (APTT). METHODS The study included 30 healthy non-smoking volunteers. Paired blood and unstimulated saliva samples were obtained from each participant and PT and APTT were determined in blood, blood + saliva and blood + water mixtures. Coagulation tests were performed using the mechanical clot detection method. RESULTS PT was significantly longer in both blood + saliva and blood + water mixtures compared to blood alone. APTT was significantly longer only in blood + water mixture compared to blood. CONCLUSIONS Similarly prolonged PT in both mixtures suggests that both saliva and water prolong coagulation evenly due to their non-specific effect of blood dilution. The finding that APTT was significantly prolonged only when blood was mixed with water could indicate presence of tissue factor in saliva, however, in a concentration too low to influence the results of PT.
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Affiliation(s)
- B Špiljak
- Dental student, School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - L Šimunović
- Dental student, School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - I Lapić
- Department of Laboratory Diagnostics, University Hospital Center Zagreb, Zagreb, Croatia
| | - D Rogić
- Department of Laboratory Diagnostics, University Hospital Center Zagreb, Zagreb, Croatia
| | - S Špalj
- Department of Orthodontics, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - L Vuletić
- Department of Physiology, School of Dental Medicine, University of Zagreb, Zagreb, Croatia
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37
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Fang T, Corte JR, Gilligan PJ, Jeon Y, Osuna H, Rossi KA, Myers JE Jr, Sheriff S, Lou Z, Zheng JJ, Harper TW, Bozarth JM, Wu Y, Luettgen JM, Seiffert DA, Wexler RR, Lam PYS. Orally bioavailable amine-linked macrocyclic inhibitors of factor XIa. Bioorg Med Chem Lett 2020; 30:126949. [PMID: 31932224 DOI: 10.1016/j.bmcl.2020.126949] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/23/2019] [Accepted: 01/01/2020] [Indexed: 11/20/2022]
Abstract
The discovery of orally bioavailable FXIa inhibitors has been a challenge. Herein, we describe our efforts to address this challenge by optimization of our imidazole-based macrocyclic series. Our optimization strategy focused on modifications to the P2 prime, macrocyclic amide linker, and the imidazole scaffold. Replacing the amide of the macrocyclic linker with amide isosteres led to the discovery of substituted amine linkers which not only maintained FXIa binding affinity but also improved oral exposure in rats. Combining the optimized macrocyclic amine linker with a pyridine scaffold afforded compounds 23 and 24 that were orally bioavailable, single-digit nanomolar FXIa inhibitors with excellent selectivity against relevant blood coagulation enzymes.
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Tripodi A, Chantarangkul V, Padovan L, Clerici M, Scalambrino E, Peyvandi F. Effect of emicizumab on global coagulation assays for plasma supplemented with apixaban or argatroban. J Thromb Thrombolysis 2019; 49:413-419. [PMID: 31728842 DOI: 10.1007/s11239-019-01993-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Emicizumab is a bi-specific humanized monoclonal antibody mimicking the factor (F) VIII cofactor activity in mediating the activation of FX by FIXa. Recent observations showed that emicizumab when added to pooled normal plasma (PNP), hemophilic plasma or PNP added with unfractionated heparin is able to interfere with coagulation assays. To further explore the mechanisms of assay interference we investigated the effect of emicizumab on global coagulation assays for the PNP added with two direct oral anticoagulants, apixaban or argatroban. Aliquots of PNP were added with purified apixaban or argatroban at a concentration of 500 ng/mL and emicizumab at concentrations ranging from 0 to 100 µg/mL. Plasma samples were then tested for the activated partial thromboplastin time (APTT) and for thrombin generation (the latter for the apixaban plasma only). Emicizumab at a 25-50 µg/mL shortened the APTT of the PNP with or without apixaban or argatroban. The extent of correction was greater for the apixaban or argatroban plasma and amounted to 35% or 42%, respectively. The parameters of thrombin generation (lag-time and time-to-peak) for the PNP supplemented with apixaban were shortened by 30% or 25%, respectively and the endogenous thrombin potential and the peak-thrombin were marginally affected. Emicizumab attenuates in vitro the anticoagulant activity of the PNP induced by apixaban or argatroban as documented by the correction of prolonged APTT and velocity of thrombin generation (i.e., lag-time and time-to-peak). Whether the above effects have any relevance in vivo is unknown.
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Affiliation(s)
- Armando Tripodi
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, Via Pace 9, 20122, Milan, Italy.
| | - Veena Chantarangkul
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, Via Pace 9, 20122, Milan, Italy
| | - Lidia Padovan
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, Via Pace 9, 20122, Milan, Italy
| | - Marigrazia Clerici
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, Via Pace 9, 20122, Milan, Italy
| | - Erica Scalambrino
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, Via Pace 9, 20122, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Flora Peyvandi
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, Via Pace 9, 20122, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
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Chauhan S, Mahajan VK, Mehta KS, Yadav RS, Chauhan PS, Bhushan S, Sharma V, Sharma A, Wadhwa D, Sharma A. Clinicoepidemiologic Features of Chronic Spontaneous Urticaria in Patients with Elevated Plasma D-Dimer Levels versus those without It: A Case-Control Cross-Sectional Study of 100 Indian Patients. Indian Dermatol Online J 2019; 10:632-638. [PMID: 32195199 PMCID: PMC6859760 DOI: 10.4103/idoj.idoj_505_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 01/19/2023] Open
Abstract
Background Activated coagulation cascade is implicated in urticaria pathogenesis marked by high plasma D-dimer, a marker of fibrinolysis, levels correlating with high urticaria activity score (UAS) and poor therapeutic outcome. Methods Quantitative plasma D-dimer levels and coagulation parameters in 100 (male:female ratio 1:3) Indian patients with chronic spontaneous urticaria and age- and gender-matched healthy controls were compared. The clinicoepidemiologic features of chronic urticaria were then compared among patients with normal (≤0.2 mg/L) and elevated (≥0.3 mg/L) plasma D-dimer levels. Results Plasma D-dimer in 23% patients and 4% controls and prothrombin time and activated partial thromboplastin time in 63% and 5% patients, respectively, were significantly higher compared with 58% and 1% of controls, respectively. About 18 of 72 (25%) patients with high UAS of ≥16-42 were compared with 5 of 28 (17.8%) patients with UAS7 of ≤15. Patients with elevated plasma D-dimer levels had significantly more systemic symptoms (86.9% vs. 81.8%) compared with patients with normal plasma D-dimer levels. Conclusion A subset of patients with chronic urticaria have elevated plasma D-dimer levels and exhibit higher UAS7 and systemic symptoms that may influence long-term prognosis and therapeutic choices. Small number of patients, a cross-sectional nature of study, lack of treatment outcome measures, information on self-medication, and unavailability of specific parameters for coagulation pathway activation remain few limitations of this study.
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Affiliation(s)
- Shailja Chauhan
- Department of Dermatology, Venereology and Leprosy, Dr. R. P. Govt. Medical College, Kangra (Tanda), Himachal Pradesh, India
| | - Vikram K Mahajan
- Department of Dermatology, Venereology and Leprosy, Dr. R. P. Govt. Medical College, Kangra (Tanda), Himachal Pradesh, India
| | - Karaninder S Mehta
- Department of Dermatology, Venereology and Leprosy, Dr. R. P. Govt. Medical College, Kangra (Tanda), Himachal Pradesh, India
| | - Rajinder S Yadav
- Department of Biochemistry, Dr. R. P. Govt. Medical College, Kangra (Tanda), Himachal Pradesh, India
| | - Pushpinder S Chauhan
- Department of Dermatology, Venereology and Leprosy, Dr. R. P. Govt. Medical College, Kangra (Tanda), Himachal Pradesh, India
| | - Satya Bhushan
- Department of Biochemistry, Dr. R. P. Govt. Medical College, Kangra (Tanda), Himachal Pradesh, India
| | - Vikas Sharma
- Department of Dermatology, Venereology and Leprosy, Dr. R. P. Govt. Medical College, Kangra (Tanda), Himachal Pradesh, India
| | - Anuj Sharma
- Department of Dermatology, Venereology and Leprosy, Dr. R. P. Govt. Medical College, Kangra (Tanda), Himachal Pradesh, India
| | - Dhaarna Wadhwa
- Department of Dermatology, Venereology and Leprosy, Dr. R. P. Govt. Medical College, Kangra (Tanda), Himachal Pradesh, India
| | - Aditi Sharma
- Department of Dermatology, Venereology and Leprosy, Dr. R. P. Govt. Medical College, Kangra (Tanda), Himachal Pradesh, India
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40
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Clark CG, Rossi KA, Corte JR, Fang T, Smallheer JM, De Lucca I, Nirschl DS, Orwat MJ, Pinto DJP, Hu Z, Wang Y, Yang W, Jeon Y, Ewing WR, Myers JE, Sheriff S, Lou Z, Bozarth JM, Wu Y, Rendina A, Harper T, Zheng J, Xin B, Xiang Q, Luettgen JM, Seiffert DA, Wexler RR, Lam PYS. Structure based design of macrocyclic factor XIa inhibitors: Discovery of cyclic P1 linker moieties with improved oral bioavailability. Bioorg Med Chem Lett 2019; 29:126604. [PMID: 31445854 DOI: 10.1016/j.bmcl.2019.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/30/2019] [Accepted: 08/04/2019] [Indexed: 01/28/2023]
Abstract
This manuscript describes the discovery of a series of macrocyclic inhibitors of FXIa with oral bioavailability. Assisted by structure based drug design and ligand bound X-ray crystal structures, the group linking the P1 moiety to the macrocyclic core was modified with the goal of reducing H-bond donors to improve pharmacokinetic performance versus 9. This effort resulted in the discovery of several cyclic P1 linkers, exemplified by 10, that are constrained mimics of the bioactive conformation displayed by the acrylamide linker of 9. These cyclic P1 linkers demonstrated enhanced bioavailability and improved potency.
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Affiliation(s)
- Charles G Clark
- Bristol-Myers Squibb Company, P.O. Box 4000, Princeton, NJ 08543, United States.
| | - Karen A Rossi
- Bristol-Myers Squibb Company, P.O. Box 4000, Princeton, NJ 08543, United States
| | - James R Corte
- Bristol-Myers Squibb Company, P.O. Box 4000, Princeton, NJ 08543, United States
| | - Tianan Fang
- Bristol-Myers Squibb Company, P.O. Box 4000, Princeton, NJ 08543, United States
| | - Joanne M Smallheer
- Bristol-Myers Squibb Company, P.O. Box 4000, Princeton, NJ 08543, United States
| | - Indawati De Lucca
- Bristol-Myers Squibb Company, P.O. Box 4000, Princeton, NJ 08543, United States
| | - David S Nirschl
- Bristol-Myers Squibb Company, P.O. Box 4000, Princeton, NJ 08543, United States
| | - Michael J Orwat
- Bristol-Myers Squibb Company, P.O. Box 4000, Princeton, NJ 08543, United States
| | - Donald J P Pinto
- Bristol-Myers Squibb Company, P.O. Box 4000, Princeton, NJ 08543, United States
| | - Zilun Hu
- Bristol-Myers Squibb Company, P.O. Box 4000, Princeton, NJ 08543, United States
| | - Yufeng Wang
- Bristol-Myers Squibb Company, P.O. Box 4000, Princeton, NJ 08543, United States
| | - Wu Yang
- Bristol-Myers Squibb Company, P.O. Box 4000, Princeton, NJ 08543, United States
| | - Yoon Jeon
- Bristol-Myers Squibb Company, P.O. Box 4000, Princeton, NJ 08543, United States
| | - William R Ewing
- Bristol-Myers Squibb Company, P.O. Box 4000, Princeton, NJ 08543, United States
| | - Joseph E Myers
- Bristol-Myers Squibb Company, P.O. Box 4000, Princeton, NJ 08543, United States
| | - Steven Sheriff
- Bristol-Myers Squibb Company, P.O. Box 4000, Princeton, NJ 08543, United States
| | - Zhen Lou
- Bristol-Myers Squibb Company, P.O. Box 4000, Princeton, NJ 08543, United States
| | - Jeffrey M Bozarth
- Bristol-Myers Squibb Company, P.O. Box 4000, Princeton, NJ 08543, United States
| | - Yiming Wu
- Bristol-Myers Squibb Company, P.O. Box 4000, Princeton, NJ 08543, United States
| | - Alan Rendina
- Bristol-Myers Squibb Company, P.O. Box 4000, Princeton, NJ 08543, United States
| | - Timothy Harper
- Bristol-Myers Squibb Company, P.O. Box 4000, Princeton, NJ 08543, United States
| | - Joanna Zheng
- Bristol-Myers Squibb Company, P.O. Box 4000, Princeton, NJ 08543, United States
| | - Baomin Xin
- Bristol-Myers Squibb Company, P.O. Box 4000, Princeton, NJ 08543, United States
| | - Qian Xiang
- Bristol-Myers Squibb Company, P.O. Box 4000, Princeton, NJ 08543, United States
| | - Joseph M Luettgen
- Bristol-Myers Squibb Company, P.O. Box 4000, Princeton, NJ 08543, United States
| | - Dietmar A Seiffert
- Bristol-Myers Squibb Company, P.O. Box 4000, Princeton, NJ 08543, United States
| | - Ruth R Wexler
- Bristol-Myers Squibb Company, P.O. Box 4000, Princeton, NJ 08543, United States
| | - Patrick Y S Lam
- Bristol-Myers Squibb Company, P.O. Box 4000, Princeton, NJ 08543, United States
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Arachchillage DRJ, Vipond L, Laffan M. Limitations on point care APTT for monitoring of unfractionated heparin in intensive care patients. Thromb Res 2019; 181:124-126. [PMID: 31400623 DOI: 10.1016/j.thromres.2019.07.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 07/30/2019] [Accepted: 07/31/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Deepa R J Arachchillage
- Department of Haematology, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom; Department of Haematology, Imperial College Healthcare NHS Trust, London, United Kingdom; Department of Haematology, Imperial College London, London, United Kingdom.
| | - Lisa Vipond
- Department of Haematology, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom
| | - Mike Laffan
- Department of Haematology, Imperial College Healthcare NHS Trust, London, United Kingdom; Department of Haematology, Imperial College London, London, United Kingdom
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Sato T, Nito T, Ueha R, Goto T, Yamasoba T. Investigation of the Safety of Injection Laryngoplasty under Antithrombotic Therapy. ORL J Otorhinolaryngol Relat Spec 2019; 81:215-223. [PMID: 31352442 DOI: 10.1159/000500991] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 12/17/2018] [Accepted: 05/15/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Glottic insufficiency negatively affects phonation and swallowing function. Injection laryngoplasty is a convenient and minimally invasive treatment for glottic insufficiency. This study assessed whether injection laryngoplasty is safe under continued administration of antithrombotic drugs, and aimed to establish measurable laboratory values under which such a procedure can be safely performed. METHOD This retrospective medical record review covered the period from November 2012 to June 2018. We examined 17 patients who underwent injection laryngoplasty (47 injections) under continued administration of antithrombotic drugs at the University of Tokyo Hospital. We analyzed clinical and demographic profiles, complications, and blood test values. Statistical analyses were performed regarding the risks of complications due to injection side, route of administration, and number of antithrombotic drugs. RESULTS No patients exhibited airway narrowing or dyspnea; however, bleeding after injection laryngoplasty was observed in 3 patients. All patients exhibited values within the optimal treatment range. There were no significant differences regarding the risks of complications due to injection side, route of administration, or number of antithrombotic drugs. CONCLUSIONS When the platelet count, prothrombin time-international normalized ratio, and activated partial thromboplastin time were within the optimal range prior to treatment, injection laryngoplasty could safely be performed, regardless of the administration of antithrombotic drugs.
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Affiliation(s)
- Taku Sato
- Department of Otolaryngology, The University of Tokyo, Tokyo, Japan,
| | - Takaharu Nito
- Department of Otolaryngology, The University of Tokyo, Tokyo, Japan
| | - Rumi Ueha
- Department of Otolaryngology, The University of Tokyo, Tokyo, Japan
| | - Takao Goto
- Department of Otolaryngology, The University of Tokyo, Tokyo, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology, The University of Tokyo, Tokyo, Japan
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Ambelu YA, Shiferaw MB, Abebe M, Enawgaw B. Prothrombin time, activated partial thromboplastin time and platelet counts of type II diabetes mellitus: a comparative study. J Diabetes Metab Disord 2019; 17:117-121. [PMID: 30918844 DOI: 10.1007/s40200-018-0347-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 07/24/2018] [Indexed: 10/28/2022]
Abstract
Background The incidence of cardiovascular disease due to thrombosis is 2-4 folds greater in diabetic patients. Prothrombin time, activated partial thromboplastin time and platelet count are hematological indices that give an insight into the coagulation status. Hence, this study aims to assess the coagulation status of type II diabetic patients. Methods A comparative cross-sectional study was conducted at Bahir Dar Felege Hiwot referral hospital, Northwest Ethiopia. A total of 40 treated type II diabetic, 40 untreated diabetics and 40 non-diabetic subjects were included. After taking informed consent, structured questionnaire was used to collect socio-demographic data. Following interview, 4 ml of blood was collected to determine PT, aPTT and platelet count of the three groups. The data were entered into SPSS version 20 and analyzed. One-way ANOVA was used to compare means of PT, aPTT and platelet count among the groups. A P value less than 0.05 was considered as statistically significant. Results The mean aPTT of non-diabetic, treated and untreated type II diabetic patient was 32.8 ± 4.12 s, 34.4 ± 5.3 s, and 25.42 ± 8.46 s, respectively. The proportion of untreated diabetic patients with normal PT, aPTT and platelet counts was 60.0%, 7.5 and 92.5%, respectively. There was a significant shortening of aPTT in untreated diabetic as compared to both treated and non-diabetic controls (P < 0.001). Conclusions Shortening of aPTT in untreated type II diabetic patients might be useful marker in patients with diabetes. Therefore, monitoring the aPTT in newly diagnosed diabetic patients is important.
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Affiliation(s)
- Yitayal Amogne Ambelu
- Department of Laboratory, College of Health Sciences, Debretabor University, Debre Tabor, Ethiopia.,4College of Medicine and Health Science, School of Biomedical and Laboratory Sciences, Department of Hematology & Immunohematology, University of Gondar, P.O. Box 196, Gondar, Ethiopia
| | | | - Molla Abebe
- 3College of Medicine and Health Science, School of Biomedical and Laboratory Sciences, Department of Clinical Chemistry, University of Gondar, Gondar, Ethiopia
| | - Bamlaku Enawgaw
- 4College of Medicine and Health Science, School of Biomedical and Laboratory Sciences, Department of Hematology & Immunohematology, University of Gondar, P.O. Box 196, Gondar, Ethiopia
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Ratano D, Alberio L, Delodder F, Faouzi M, Berger MM. Agreement between activated partial thromboplastin time and anti-Xa activity in critically ill patients receiving therapeutic unfractionated heparin. Thromb Res 2019; 175:53-58. [PMID: 30708169 DOI: 10.1016/j.thromres.2019.01.002] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/04/2018] [Accepted: 01/03/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND No study supports the use of either aPTT or anti-Xa activity for heparin monitoring in critical care patients. There are no strong data on the agreement between aPTT and anti-Xa. The aims of this study were to: 1. Analyse the agreement between aPTT and anti-Xa in a large population of critically ill patients under unfractionated heparin therapy (UFH), 2. Identify clinical and biological factors associated to agreement or disagreement, and 3. Analyse the impact of anti-Xa availability on the use of aPTT and UFH therapy. METHODS Retrospective study in a 35 beds mixed-ICU population between 2006 and 2016 in a University teaching hospital. INCLUSION CRITERIA delivery of a UFH dose >15,000 U/24 h during at least one day with one anti-Xa determination. DATA demographic variables, aPTT, anti-Xa, laboratory variables, presence of extracorporeal devices (ECD). Pairs of simultaneously dosed aPTT and anti-Xa [aPTT:anti-Xa] were analysed on the basis of their agreement within the sub-therapeutic, therapeutic (aPTT 50-80″, anti-Xa 0.3-0.7 U/ml) or supra-therapeutic ranges. RESULTS 2283 patient admissions (2085 patients) were analysed. 35,595 [aPTT:anti-Xa] pairs were found. The overall [aPTT:anti-Xa] agreement was 59.6% and lowest (54.3%) in presence of ECD compared to non-ECD patients (61.6%; p < 0.001). Sixteen demographic and biological variables were analysed and were not predictive of [aPTT:anti-Xa] agreement. No significant difference in administered UFH dose was observed after anti-Xa introduction. CONCLUSION In this large cohort, the [aPTT:anti-Xa] agreement is <60% and significantly lower in patients with ECD. None of the variables identified as potentially affecting the agreement were predictive. Availability of anti-Xa had neither effect on aPTT use nor on UFH-dose. These results call for a prospective study to determine the optimal UFH-therapy monitoring tool.
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Affiliation(s)
- Damian Ratano
- Service of Intensive Care and Burn Unit, Lausanne University Hospital (CHUV) and Faculty of Biology & Medicine, University of Lausanne, Lausanne, Switzerland.
| | - Lorenzo Alberio
- Division of Haematology and Central Haematology Laboratory, Lausanne University Hospital (CHUV) and Faculty of Biology & Medicine, University of Lausanne, Lausanne, Switzerland.
| | - Frederik Delodder
- Service of Intensive Care and Burn Unit, Lausanne University Hospital (CHUV) and Faculty of Biology & Medicine, University of Lausanne, Lausanne, Switzerland
| | - Mohamed Faouzi
- Institute of Social and Preventive Medicine (IUMSP), Faculty of Biology & Medicine, University of Lausanne, Lausanne, Switzerland.
| | - Mette M Berger
- Service of Intensive Care and Burn Unit, Lausanne University Hospital (CHUV) and Faculty of Biology & Medicine, University of Lausanne, Lausanne, Switzerland.
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Strazzulla A, Chakvetadze C, Picque M, Cassard B, Hernandez F, De Pontfarcy A, Flateau C, Danneels P, Belfeki N, Diamantis S. Evolution of haemostatic parameters and risk of bleeding during treatment with cefazolin. Eur J Clin Microbiol Infect Dis 2018; 38:177-183. [PMID: 30414092 DOI: 10.1007/s10096-018-3412-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 10/24/2018] [Indexed: 11/30/2022]
Abstract
In 2017, five cases of severe haemorrhages during treatment with cefazolin occurred in France. The aim of this study was to assess the risk of haemorrhage related to treatment with cefazolin by evaluating haemostatic parameters and bleeding events. A retrospective study was conducted from January 2016 to December 2017. Two populations were analysed: (i) overall population, which included all patients treated with cefazolin during this period and (ii) coagulation study population, which included all patients treated with cefazolin with available coagulation parameters (activated partial thromboplastin time (aPTT) and international normalised ratio (INR) at baseline and at the end of treatment or EoT). Values of either aPTT or INR at baseline and at EoT were compared. Cases of severe haemorrhages were reported and correlated with values of aPTT and INR. Overall, 132 patients received cefazolin and 59/132 (45%) were included in the coagulation study group. A significant increase of median aPTT was observed from baseline to EoT (39.5 and 44.3 sec; p = 0.004, respectively). Overall, severe haemorrhage occurred in 7/132 (5%) patients. Coagulation parameters were available in three of them, and no correlation was observed between bleeding events and aPTT increase. This study showed that bleeding is probably more frequent than ever reported before during cefazolin treatment. The significant increase of aPTT observed during cefazolin treatment was not correlated with risk of haemorrhage. Further studies are needed to explore the possible physio-pathological pathways behind the modification of haemostatic parameters and risk of haemorrhage.
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Affiliation(s)
- Alessio Strazzulla
- Infectious Diseases Unit, Centre Hospitalier Sud Ile de France, Melun, France.
| | | | - Marie Picque
- Medical Biology Laboratory, Centre Hospitalier Sud Ile de France, Melun, France
| | - Bruno Cassard
- Pharmacy, "Marc Jaquet", Centre Hospitalier Sud Ile de France, Melun, France
| | - Fabien Hernandez
- Pharmacy, "Marc Jaquet", Centre Hospitalier Sud Ile de France, Melun, France
| | - Astrid De Pontfarcy
- Infectious Diseases Unit, Centre Hospitalier Sud Ile de France, Melun, France
| | - Clara Flateau
- Infectious Diseases Unit, Centre Hospitalier Sud Ile de France, Melun, France
| | - Pierre Danneels
- Infectious Diseases Unit, Centre Hospitalier Sud Ile de France, Melun, France
| | - Nabil Belfeki
- Infectious Diseases Unit, Centre Hospitalier Sud Ile de France, Melun, France
| | - Sylvain Diamantis
- Infectious Diseases Unit, Centre Hospitalier Sud Ile de France, Melun, France
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Kumar N, Rajpal S, Ahluwalia J, Bose S, Uppal V, Varma N, Malhotra P, Varma S. Acquired Hemophilia A: Experience of a Tertiary Care Institute from North India. Indian J Hematol Blood Transfus 2018; 34:524-529. [PMID: 30127565 DOI: 10.1007/s12288-017-0873-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 08/31/2017] [Indexed: 10/18/2022] Open
Abstract
Acquired hemophilia A (AHA) is an uncommon bleeding disorder infrequently reported among Indians. The present retrospective data comprises eight cases of AHA over a period of 15 years. The mean age of patients was 59.7 years. The activated partial thromboplastin time was prolonged in all cases and the inhibitor screen showed the presence of inhibitors. Factor VIII: C assay was performed in 7 cases and all cases demonstrated low levels. Lupus anticoagulant was negative. Six patients were managed with steroids and symptomatic supportive care. These patients were followed up for a mean period of 3.5 years (range 1-5 years). Of these, there was one fatality prior to initiation of therapy and one patient continues to have inhibitors.
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Affiliation(s)
- Narender Kumar
- 1Department of Hematology, Postgraduate Institute of Medical Education and Research, Level 5, Research Block A, Sector 12, Chandigarh, 160012 India
| | - Sweta Rajpal
- 1Department of Hematology, Postgraduate Institute of Medical Education and Research, Level 5, Research Block A, Sector 12, Chandigarh, 160012 India
| | - Jasmina Ahluwalia
- 1Department of Hematology, Postgraduate Institute of Medical Education and Research, Level 5, Research Block A, Sector 12, Chandigarh, 160012 India
| | - Sunil Bose
- 1Department of Hematology, Postgraduate Institute of Medical Education and Research, Level 5, Research Block A, Sector 12, Chandigarh, 160012 India
| | - Varun Uppal
- 1Department of Hematology, Postgraduate Institute of Medical Education and Research, Level 5, Research Block A, Sector 12, Chandigarh, 160012 India
| | - Neelam Varma
- 1Department of Hematology, Postgraduate Institute of Medical Education and Research, Level 5, Research Block A, Sector 12, Chandigarh, 160012 India
| | - Pankaj Malhotra
- 2Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012 India
| | - Subhash Varma
- 2Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012 India
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Uwingabiye J, Zahid H, El Amrani M, Labrini F, Elkhazraji A, El Kabbaj D, Benyahia M, Yahyaoui A, Hadef R, Messaoudi N. Rare and unusual case of anti-factor XI antibodies in patient with plasma cell leukemia. BMC Hematol 2018; 18:18. [PMID: 30116534 PMCID: PMC6086047 DOI: 10.1186/s12878-018-0100-9] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 03/01/2018] [Indexed: 11/22/2022]
Abstract
Background The acquired inhibitors of coagulation have been observed in very rare cases of monoclonal gammopathies. We report a very rare case of anti-factor XI antibodies in patient with plasma cell leukemia (PCL). Case presentation This is a 59-year-old male patient without pathological history, admitted to the nephrology department for management of renal insufficiency and anemia syndrome. The history and physical examination revealed stigmata of hemorrhagic syndrome including hemothorax and hemoptysis. The hemostasis assessment showed an isolated prolonged activated partial thromboplastin time (APTT) with APTT ratio = 2.0.The index of circulating anticoagulant (37.2%) revealed the presence of circulating anticoagulants. The normalized dilute Russell viper venom time ratio of 0.99 has highlighted the absence of lupus anticoagulants. The coagulation factors assay objectified the decrease of the factor XI activity corrected by the addition of the control plasma confirming the presence of anti-factor XI autoantibodies. In addition, the blood count showed bicytopenia with non-regenerative normocytic normochromic anemia and thrombocytopenia. The blood smear demonstrated a plasma cell count of 49% (2842/mm3) evoking PCL. The bone marrow was invaded up to 90% by dystrophic plasma cells. The biochemical assessment suggested downstream renal and electrolyte disturbances from exuberant light chain production with abnormalities including hyperuricemia, hypercalcemia, elevated lactate dehydrogenase, non nephrotic-range proteinuria and high level of C reactive protein. The serum protein electrophoresis showed the presence of a monoclonal peak. The serum immunofixation test detects the presence of monoclonal free lambda light chains. He was treated with velcade, thalidomide and dexamethasone. The patient died after 2 weeks despite treatment. Conclusion Both PCL and anti-factor XI inhibitors are two very rare entities. To the best of our knowledge, this is the first reported case of a factor XI inhibitor arising in the setting of PCL. Factor inhibitors should be suspected in patients whose monoclonal gammopathies are accompanied by bleeding manifestations.
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Affiliation(s)
- Jean Uwingabiye
- 1Laboratory of Hematology and Immunohematology, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Hafid Zahid
- 1Laboratory of Hematology and Immunohematology, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Mohamed El Amrani
- 2Nephrology Department, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Fayçal Labrini
- 1Laboratory of Hematology and Immunohematology, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Abdelhak Elkhazraji
- 1Laboratory of Hematology and Immunohematology, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Driss El Kabbaj
- 2Nephrology Department, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Mohammed Benyahia
- 2Nephrology Department, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Anass Yahyaoui
- 1Laboratory of Hematology and Immunohematology, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Rachid Hadef
- 1Laboratory of Hematology and Immunohematology, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Nezha Messaoudi
- 1Laboratory of Hematology and Immunohematology, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
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Abstract
BACKGROUND This study investigated the effects of cooled and standard centrifuges on the results of coagulation tests to examine the effects of centrifugation temperature. METHODS Equal-volume blood samples from each patient were collected at the same time intervals and subjected to standard (25°C) and cooled centrifugation (2-4°C). Subsequently, the prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (aPTT), fibrinogen, and D-dimer values were determined in runs with the same lot numbers in the same coagulation device using the Dia-PT R (PT and INR), Dia-PTT-liquid (aPTT), Dia-FIB (fibrinogen), and Dia-D-dimer kits, respectively. RESULTS The study enrolled 771 participants. The PT was significantly (p < 0.018) higher in participants on anticoagulant therapy. The respective median values of the test parameters determined using the standard and cooled centrifuges were as follows: PT 10.30 versus 10.50 s; PT (INR) 1.04 versus 1.09 s; APTT 28.90 versus 29.40 s; fibrinogen 321.5 versus 322.1 mg/dL; and D-dimer 179.5 versus 168.7 µg FEU/mL. There were significant differences (p < 0.001) in the parameters between the values obtained with the standard and cooled centrifuges. CONCLUSIONS Centrifuge temperature can have a significant effect on the results of coagulation tests. However, broad and specific disease-based studies are needed.
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Affiliation(s)
- Hayrullah Yazar
- Department of Medical Biochemistry, Sakarya University Faculty of Medicine, Adapazan, Turkey
| | - Fatma Özdemir
- Department of Clinical Biochemistry, Sakarya University, Training and Research Hospital, Adapazan, Turkey
| | - Elif Köse
- Department of Public Health, Sakarya University, Training and Research Hospital, Adapazan, Turkey
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Kusuda M, Kimura SI, Misaki Y, Yoshimura K, Gomyo A, Hayakawa J, Tamaki M, Akahoshi Y, Ugai T, Kameda K, Wada H, Ishihara Y, Kawamura K, Sakamoto K, Sato M, Terasako-Saito K, Kikuchi M, Nakasone H, Kako S, Tanihara A, Kanda Y. Association between Activated Partial Thromboplastin Time and the Amount of Infused Heparin at Bone Marrow Transplantation. Biol Blood Marrow Transplant 2018. [PMID: 29518551 DOI: 10.1016/j.bbmt.2018.02.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The actual heparin concentration of harvested allogeneic bone marrow varies among harvest centers. We monitor the activated partial thromboplastin time (APTT) of the patient during bone marrow infusion and administer prophylactic protamine according to the APTT. We retrospectively reviewed the charts of consecutive patients who underwent bone marrow transplantation without bone marrow processing at our center between April 2007 and March 2016 (n = 94). APTT was monitored during marrow transfusion in 52 patients. We analyzed the relationship between the APTT ratio and several parameters related to heparin administration. As a result, the weight-based heparin administration rate (U/kg/hour) seemed to be more closely related to the APTT ratio (r = .38, P = .005) than to the total amount of heparin. There was no significant correlation between the APTT ratio and renal or liver function. Bleeding complications during and early after infusion were seen in 3 of 52 patients, and included intracranial, nasal, and punctured-skin bleeding. The APTT ratio during transfusion was over 5.88 in the former 2 patients and 2.14 in the latter. All of these patients recovered without sequelae. In conclusion, slow bone marrow infusion is recommended to decrease the weight-based heparin administration rate when the heparin concentration per patient body weight is high.
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Affiliation(s)
- Machiko Kusuda
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Shimotsuke, Japan
| | - Shun-Ichi Kimura
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Shimotsuke, Japan
| | - Yukiko Misaki
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Shimotsuke, Japan
| | - Kazuki Yoshimura
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Shimotsuke, Japan
| | - Ayumi Gomyo
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Shimotsuke, Japan
| | - Jin Hayakawa
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Shimotsuke, Japan
| | - Masaharu Tamaki
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Shimotsuke, Japan
| | - Yu Akahoshi
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Shimotsuke, Japan
| | - Tomotaka Ugai
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Shimotsuke, Japan
| | - Kazuaki Kameda
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Shimotsuke, Japan
| | - Hidenori Wada
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Shimotsuke, Japan
| | - Yuko Ishihara
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Shimotsuke, Japan
| | - Koji Kawamura
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Shimotsuke, Japan
| | - Kana Sakamoto
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Shimotsuke, Japan
| | - Miki Sato
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Shimotsuke, Japan
| | - Kiriko Terasako-Saito
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Shimotsuke, Japan
| | - Misato Kikuchi
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Shimotsuke, Japan
| | - Hideki Nakasone
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Shimotsuke, Japan
| | - Shinichi Kako
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Shimotsuke, Japan
| | - Aki Tanihara
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Shimotsuke, Japan
| | - Yoshinobu Kanda
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Shimotsuke, Japan.
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Sato K, Kuroda S, Kobayashi T, Shimizu S, Ohira M, Tahara H, Ide K, Fujii T, Ohdan H. A case report on the successful perioperative management of hepatectomy for hepatocellular carcinoma in a patient with von Willebrand disease. Int J Surg Case Rep 2018; 44:131-4. [PMID: 29501017 DOI: 10.1016/j.ijscr.2018.02.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 12/01/2017] [Revised: 01/23/2018] [Accepted: 02/22/2018] [Indexed: 11/21/2022] Open
Abstract
Although von Willebrand disease (VWD) is a common inherited bleeding disease, only 1 case of hepatectomy in a patient with VWD has been described. Perioperative hemostatic management is important especially in patients with VWD undergoing surgery because of the dysfunction of the platelet and destabilization of the blood clotting factor VIII. The patient was successfully treated by administering factor VIII/von Willebrand factor concentrate and by measuring activated partial thromboplastin time as an index for perioperative hemostatic management.
Introduction Although von Willebrand disease (VWD) is a common inherited bleeding disorder, very few cases of surgery in patients with VWD have been reported. Presentation of case A 77-year-old man was referred to our hospital for treatment of hepatocellular carcinoma (HCC) based on type C chronic hepatitis. He had also been treated for VWD in the hematology department of another hospital. Partial hepatectomy was performed with the administration of factor VIII/von Willebrand factor concentrate just before and after the operation. The perioperative course was uneventful, and the patient was discharged 12 days after surgery. Discussion VWD causes dysfunction of the platelet and destabilization of the blood clotting factor VIII. The patient was successfully treated with measurement of activated partial thromboplastin time (APTT) as an index for the management of hemostasis. Conclusion This report describes a rare case of a successful perioperative management of hepatectomy in a patient with VWD.
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