1
|
Kim AY, Baek HJ, Lee S, Choo E, Park YS, Lee H. Clinical and economic burden of immune tolerance induction in entire patients with hemophilia A: Insights from a real-world Korean setting. Thromb Res 2024; 237:196-202. [PMID: 38640641 DOI: 10.1016/j.thromres.2024.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 03/20/2024] [Accepted: 03/28/2024] [Indexed: 04/21/2024]
Abstract
INTRODUCTION The most notable challenge facing hemophilia A treatment is the development of inhibitors against factor VIII, resulting in increased clinical and socioeconomic burdens due to the need for expensive bypassing agents (BPAs). Although immune tolerance induction (ITI) is currently the primary approach for inhibiting and reducing the inhibitors, the lengthy duration of ITI necessitates the continued use of BPA to manage bleeding episodes. In this study, we aimed to obtain real-world evidence on the clinical and economic aspects and associated burdens experienced by patients with hemophilia A with inhibitors undergoing ITI in Korea. METHODS Claims data from January 1, 2007, to December 31, 2020, were used in this study. The study cohort comprised patients with hemophilia A undergoing ITI, who were categorized into three groups: successful, failed, or continuation of ITI. We evaluated clinical and economic burdens, including monthly healthcare visits, medication costs, and total medical expenses. RESULTS The study involved 33 cases of ITI across 32 patients. Excluding seven continuation cases where success could not be determined at the observation point, the estimated success rate of ITI was 80.8 %. The median duration of ITI for all patients was 25.7 months. While no significant disparities were noted in the ITI duration between successful and unsuccessful cases (24.51 vs. 25.66 months), substantial discrepancies were observed in the duration of BPA usage (11.10 vs. 25.66 months) and the number of prescribed BPAs (1.79 vs. 2.97). CONCLUSION Successful ITI reduced both clinical and economic burdens, resulting in decreased monthly medication expenses and overall medical costs.
Collapse
Affiliation(s)
- Ah-Young Kim
- Research Institute of Pharmaceutical Science and Technology (RIPST), Ajou University, Suwon, South Korea; Department of Pediatrics, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Hee Jo Baek
- Department of Pediatrics, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, South Korea
| | - Sukhyang Lee
- Research Institute of Pharmaceutical Science and Technology (RIPST), Ajou University, Suwon, South Korea; College of Pharmacy, Ajou University, Suwon, South Korea; Department of Biohealth Regulatory Science, Ajou University, Suwon, South Korea
| | - Eunjung Choo
- Research Institute of Pharmaceutical Science and Technology (RIPST), Ajou University, Suwon, South Korea
| | - Young Shil Park
- Department of Pediatrics, Kyung Hee University College of Medicine, Kyung Hee University, Seoul, South Korea.
| | - Hankil Lee
- Research Institute of Pharmaceutical Science and Technology (RIPST), Ajou University, Suwon, South Korea; College of Pharmacy, Ajou University, Suwon, South Korea; Department of Biohealth Regulatory Science, Ajou University, Suwon, South Korea.
| |
Collapse
|
2
|
Bosch A, Brunsvig Jarvis K, Brandão LR, Zou Y, Vincelli J, Amiri N, Avila L. The role of coagulation factors VIII, IX and XI in the prediction and mediation of recurrent thrombotic events in children with non-central venous catheter deep vein thrombosis. Thromb Res 2024; 236:228-235. [PMID: 38484629 DOI: 10.1016/j.thromres.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 03/04/2024] [Accepted: 03/05/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND The role of elevated coagulation factors VIII (FVIII), FIX, FXI for the prediction of recurrent thrombotic events in children after an index non-central venous catheter (non-CVC) related deep vein thrombosis (DVT) remains unclear. OBJECTIVE This study investigates the predictive role of FVIII, FIX, and FXI for recurrent thrombosis in children with index non-CVC DVTs, and the mediation effect of FVIII on chronic inflammation and recurrent thrombosis. METHODS Children aged 0-18 years diagnosed with an index non-CVC related DVT (1993-2020) were included in this single-center retrospective cohort study. Plasma levels of FVIII, FIX, FXI were measured cross-sectionally ≥30 days after the acute DVT. The association between the continuous variables FVIII, FIX, FXI and thrombosis recurrence was investigated using uni- and multivariable logistic regression, adjusting for age, sex, and chronic inflammation. Mediation analysis assessed the role of FVIII as a mediator between chronic inflammation and recurrent thrombosis. Ethics approval was obtained. RESULTS A total of 139 children with an index non-CVC related DVT were included. Thirty-eight (27 %) had a recurrent thrombosis at a median of 237 days (P25-P75 65-657 days) after the index DVT. In uni- and multivariable-analysis, FVIII, FIX or FXI did not predict thrombosis recurrence; However, chronic inflammation was an independent predictor. There was no evidence that FVIII mediated the effect of chronic inflammation on thrombosis recurrence. CONCLUSION We found no evidence that elevated FVIII, FIX or FXI predicted thrombosis recurrence, or evidence of a mediating role of FVIII. Underlying chronic inflammation predicted venous recurrent thrombotic events in this cohort.
Collapse
Affiliation(s)
- Alessandra Bosch
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada; University Children's Hospital Zurich, Department of Haematology, Zurich, Switzerland.
| | - Kirsten Brunsvig Jarvis
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada; Oslo University Hospital, Department of Pediatric Hematology and Oncology, Oslo, Norway
| | - Leonardo R Brandão
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Yushu Zou
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Vincelli
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nour Amiri
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Laura Avila
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| |
Collapse
|
3
|
Villacampa A, Alfaro E, Morales C, Díaz-García E, López-Fernández C, Bartha JL, López-Sánchez F, Lorenzo Ó, Moncada S, Sánchez-Ferrer CF, García-Río F, Cubillos-Zapata C, Peiró C. SARS-CoV-2 S protein activates NLRP3 inflammasome and deregulates coagulation factors in endothelial and immune cells. Cell Commun Signal 2024; 22:38. [PMID: 38225643 PMCID: PMC10788971 DOI: 10.1186/s12964-023-01397-6] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/12/2023] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND Hyperinflammation, hypercoagulation and endothelial injury are major findings in acute and post-COVID-19. The SARS-CoV-2 S protein has been detected as an isolated element in human tissues reservoirs and is the main product of mRNA COVID-19 vaccines. We investigated whether the S protein alone triggers pro-inflammatory and pro-coagulant responses in primary cultures of two cell types deeply affected by SARS-CoV-2, such are monocytes and endothelial cells. METHODS In human umbilical vein endothelial cells (HUVEC) and monocytes, the components of NF-κB and the NLRP3 inflammasome system, as well as coagulation regulators, were assessed by qRT-PCR, Western blot, flow cytometry, or indirect immunofluorescence. RESULTS S protein activated NF-κB, promoted pro-inflammatory cytokines release, and triggered the priming and activation of the NLRP3 inflammasome system resulting in mature IL-1β formation in both cell types. This was paralleled by enhanced production of coagulation factors such as von Willebrand factor (vWF), factor VIII or tissue factor, that was mediated, at least in part, by IL-1β. Additionally, S protein failed to enhance ADAMTS-13 levels to counteract the pro-coagulant activity of vWF multimers. Monocytes and HUVEC barely expressed angiotensin-converting enzyme-2. Pharmacological approaches and gene silencing showed that TLR4 receptors mediated the effects of S protein in monocytes, but not in HUVEC. CONCLUSION S protein behaves both as a pro-inflammatory and pro-coagulant stimulus in human monocytes and endothelial cells. Interfering with the receptors or signaling pathways evoked by the S protein may help preventing immune and vascular complications driven by such an isolated viral element. Video Abstract.
Collapse
Affiliation(s)
- Alicia Villacampa
- Department of Pharmacology, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Enrique Alfaro
- Respiratory Diseases Group, Respiratory Service, La Paz University Hospital, IdiPAZ, Madrid, Spain
- Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Madrid, Spain
| | - Cristina Morales
- Department of Pharmacology, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Elena Díaz-García
- Respiratory Diseases Group, Respiratory Service, La Paz University Hospital, IdiPAZ, Madrid, Spain
- Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Madrid, Spain
| | - Cristina López-Fernández
- Respiratory Diseases Group, Respiratory Service, La Paz University Hospital, IdiPAZ, Madrid, Spain
| | - José Luis Bartha
- Department of Obstetrics and Gynecology, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- Gynecology and Obstetrics Service, La Paz University Hospital, Madrid, Spain
| | | | - Óscar Lorenzo
- Laboratory of Diabetes and Vascular pathology, IIS-Fundación Jiménez Díaz, Madrid, Spain
- Biomedical Research Networking Centre on Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Salvador Moncada
- Department of Pharmacology, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Carlos F Sánchez-Ferrer
- Department of Pharmacology, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- Vascular Pharmacology and Metabolism (FARMAVASM) group, IdiPAZ, Madrid, Spain
| | - Francisco García-Río
- Respiratory Diseases Group, Respiratory Service, La Paz University Hospital, IdiPAZ, Madrid, Spain
- Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Carolina Cubillos-Zapata
- Respiratory Diseases Group, Respiratory Service, La Paz University Hospital, IdiPAZ, Madrid, Spain.
- Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Madrid, Spain.
| | - Concepción Peiró
- Department of Pharmacology, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.
- Vascular Pharmacology and Metabolism (FARMAVASM) group, IdiPAZ, Madrid, Spain.
| |
Collapse
|
4
|
Hannadjas I, James A, Davenport R, Lindsay C, Brohi K, Cole E. Prothrombin complex concentrate (PCC) for treatment of trauma-induced coagulopathy: systematic review and meta-analyses. Crit Care 2023; 27:422. [PMID: 37919775 PMCID: PMC10621181 DOI: 10.1186/s13054-023-04688-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/14/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Trauma-induced coagulopathy (TIC) is common in trauma patients with major hemorrhage. Prothrombin complex concentrate (PCC) is used as a potential treatment for the correction of TIC, but the efficacy, timing, and evidence to support its use in injured patients with hemorrhage are unclear. METHODS A systematic search of published studies was performed on MEDLINE and EMBASE databases using standardized search equations. Ongoing studies were identified using clinicaltrials.gov. Studies investigating the use of PCC to treat TIC (on its own or in combination with other treatments) in adult major trauma patients were included. Studies involving pediatric patients, studies of only traumatic brain injury (TBI), and studies involving only anticoagulated patients were excluded. Primary outcomes were in-hospital mortality and venous thromboembolism (VTE). Pooled effects of PCC use were reported using random-effects model meta-analyses. Risk of bias was assessed for each study, and we used the Grading of Recommendations Assessment, Development, and Evaluation to assess the quality of evidence. RESULTS After removing duplicates, 1745 reports were screened and nine observational studies and one randomized controlled trial (RCT) were included, with a total of 1150 patients receiving PCC. Most studies used 4-factor-PCC with a dose of 20-30U/Kg. Among observational studies, co-interventions included whole blood (n = 1), fibrinogen concentrate (n = 2), or fresh frozen plasma (n = 4). Outcomes were inconsistently reported across studies with wide variation in both measurements and time points. The eight observational studies included reported mortality with a pooled odds ratio of 0.97 [95% CI 0.56-1.69], and five reported deep venous thrombosis (DVT) with a pooled OR of 0.83 [95% CI 0.44-1.57]. When pooling the observational studies and the RCT, the OR for mortality and DVT was 0.94 [95% CI 0.60-1.45] and 1.00 [95% CI 0.64-1.55] respectively. CONCLUSIONS Among published studies of TIC, PCCs did not significantly reduce mortality, nor did they increase the risk of VTE. However, the potential thrombotic risk remains a concern that should be addressed in future studies. Several RCTs are currently ongoing to further explore the efficacy and safety of PCC.
Collapse
Affiliation(s)
- Ioannis Hannadjas
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, England
| | - Arthur James
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, England.
- GRC 29, AP-HP, DMU DREAM, Department of Anaesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Sorbonne University, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
| | - Ross Davenport
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, England
| | - Charlotte Lindsay
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, England
| | - Karim Brohi
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, England
| | - Elaine Cole
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, England
| |
Collapse
|
5
|
Uttaro E, Young MR, Falvey J, Corvelli JM, Acquisto NM. Use of four-factor prothrombin complex concentrate (4F-PCC) for management of bleeding not associated with therapeutic anticoagulant use. Transfus Apher Sci 2023; 62:103759. [PMID: 37453907 DOI: 10.1016/j.transci.2023.103759] [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: 03/08/2023] [Revised: 06/29/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION Four-factor prothrombin complex concentrate (4F-PCC) may be an option for patients with bleeding unrelated to therapeutic anticoagulation to help with bleeding cessation and reduce blood component requirements. MATERIALS AND METHODS Retrospective, observational study of adult patients who received 4F-PCC for bleeding not associated with therapeutic anticoagulation between June 2019 and July 2021. Primary outcome was to describe off-label 4F-PCC use in patients not on therapeutic anticoagulation for bleeding management in surgical and non-surgical patients. Additional outcomes evaluated were blood product use, chest tube and drainage output, and coagulation studies before and after 4F-PCC administration as well as other hemostatic agent use and thromboembolic events. RESULTS Seventy-six patients were included; median age 64 years (IQR 50-69), 66% of bleeding events were associated with surgery, and the majority of 4F-PCC doses ordered by cardiac surgery (68.4%). A total of 110 4F-PCC doses were administered; median 1 dose/patient (IQR 1-2), median total dose 1000 units (IQR 500-1484). Other hemostatic agents commonly administered were protamine (59%), desmopressin (43%), and tranexamic acid (42%). Packed red blood cells, fresh frozen plasma, platelet, and cell saver blood administration and prothrombin time (PT), international normalized ratio (INR), and partial thromboplastin time (aPTT) were significantly reduced following 4F-PCC administration. Eight patients (11%) experienced thromboembolic complications. CONCLUSION Relatively low doses of 4F-PCC (median total dose 1000 units) were associated with decreased blood component requirements and improved PT, INR, and aPTT values in patients with bleeding unrelated to therapeutic anticoagulation. Other hemostatic agent use was common and thromboembolic complications occurred.
Collapse
Affiliation(s)
- Elizabeth Uttaro
- Department of Pharmacy, University of Rochester Medical Center, 601 Elmwood Ave. Box 638, Rochester, NY 14642, USA.
| | - Mikaela R Young
- Department of Pharmacy, University of Rochester Medical Center, 601 Elmwood Ave. Box 638, Rochester, NY 14642, USA.
| | - Jennifer Falvey
- Department of Pharmacy, University of Rochester Medical Center, 601 Elmwood Ave. Box 638, Rochester, NY 14642, USA.
| | - Jenna M Corvelli
- Department of Pharmacy, University of Rochester Medical Center, 601 Elmwood Ave. Box 638, Rochester, NY 14642, USA.
| | - Nicole M Acquisto
- Department of Pharmacy, University of Rochester Medical Center, 601 Elmwood Ave. Box 638, Rochester, NY 14642, USA; Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave. Box 655, Rochester, NY 14642, USA.
| |
Collapse
|
6
|
Kim YS, Choi JW, Song SH, Hwang HY, Sohn SH, Kim JS, Kang Y, Gu JY, Kim KH, Kim HK. Comparison of the International Normalized Ratio Between a Point-of-Care Test and a Conventional Laboratory Test: the Latter Performs Better in Assessing Warfarin-induced Changes in Coagulation Factors. Ann Lab Med 2023; 43:337-344. [PMID: 36843402 PMCID: PMC9989533 DOI: 10.3343/alm.2023.43.4.337] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/08/2022] [Accepted: 01/16/2023] [Indexed: 02/28/2023] Open
Abstract
Background Point-of-care testing (POCT) coagulometers are increasingly used for monitoring warfarin therapy. However, in high international normalized ratio (INR) ranges, significant discrepancy in the INR between POCT and conventional laboratory tests occurs. We compared the INR of POCT (CoaguChek XS Plus; Roche Diagnostics, Mannheim, Germany) with that of a conventional laboratory test (ACL TOP 750; Instrumentation Laboratory SpA, Milan, Italy) and explored possible reasons for discrepancy. Methods Paired POCT and conventional laboratory test INRs were analyzed in 400 samples from 126 patients undergoing warfarin therapy after cardiac surgery. Coagulation factor and thrombin generation tests were compared using the Mann-Whitney U test. Correlations between coagulation factors and INRs were determined using Pearson correlation coefficients. Results The mean difference in the INR between the tests increased at high INR ranges. Endogenous thrombin potential levels were decreased at INR <2.0 for CoaguChek XS Plus and 2.0< INR <3.0 for ACL TOP 750 compared with those at INR <2.0 for both tests, indicating a better performance of ACL TOP 750 in assessing thrombin changes. The correlation coefficients of coagulation factors were stronger for ACL TOP 750 INR than for CoaguChek XS Plus INR. Vitamin K-dependent coagulation factors were found to contribute to the INR discrepancy. Conclusions Decreases in vitamin K-dependent coagulation and anticoagulation factors can explain the significant discrepancy between the two tests in high INR ranges. Since conventional laboratory test INR values are more reliable than POCT INR values, a confirmatory conventional laboratory test is required for high INR ranges.
Collapse
Affiliation(s)
- Ye-Seul Kim
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jae-Woong Choi
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea
| | - Sang Hoon Song
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Ho Young Hwang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea
| | - Suk Ho Sohn
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea
| | - Ji Seong Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea
| | - Yoonjin Kang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea
| | - Ja-Yoon Gu
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea.,Cancer Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung Hwan Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea
| | - Hyun Kyung Kim
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea.,Cancer Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
7
|
Jin FM, Wang M, Wu XM, Xiao H, Wang DX, Wang GM, Zhang CG, Zhao HR. Effects of wasp venom on venous thrombosis in rats. Iran J Basic Med Sci 2022; 25:822-826. [PMID: 36033945 PMCID: PMC9392573 DOI: 10.22038/ijbms.2022.63219.13962] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 06/21/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES This study aimed to investigate the potential effects of wasp venom (WV) from Vespa magnifica on antithrombosis in rats with inferior vena cava (IVC) thrombosis. MATERIALS AND METHODS The thrombosis rat model was established by improving the IVC stenosis, in which rats were subjected to IVC ligation for 75 min. Rats were administered argatroban (IP) or WV (s.c.) for 4 hr after IVC thrombosis. The weight, inhibition rate, and pathological morphology of the thrombosis induced by IVC ligation and the variation in four coagulation parameters, coagulation factors, and CD61+CD62P+ were simultaneously determined in IVC rats. RESULTS The thrombus formed as a result of IVC ligation was stable. Compared with the control group, the weight of the thrombus was significantly reduced in the argatroban group. Thrombus weight was reduced by treatment with 0.6, 0.2, and 0.05 mg/kg WV, with inhibition rates of 52.19%, 35.32%, and 28.98%, respectively. Inflammatory cells adhered to and infiltrated the vessel wall in the IVC group more than in the sham group. However, the pathological morphology and CD61+CD62P+ of the WV treatment groups tended to be normal. CONCLUSION We improved the model of IVC thrombosis to be suitable for evaluation of antithrombotic drugs. Our findings demonstrated that WV could inhibit IVC thrombosis associated with reducing coagulation factors V and CD61+CD62p expression in rats.
Collapse
Affiliation(s)
- Fan-mao Jin
- Lishui City People’s Hospital, Lishui, Zhejiang 323000, People’s Republic of China,These authors contributed equally to this work
| | - Mei Wang
- Yunnan Provincial Key Laboratory of Entomological Biopharmaceutical R&D, Dali University, Dali, China,National-Local Joint Engineering Research Center of Entomoceutics, Dali University, Dali, China,These authors contributed equally to this work
| | - Xiu-mei Wu
- Yunnan Provincial Key Laboratory of Entomological Biopharmaceutical R&D, Dali University, Dali, China,National-Local Joint Engineering Research Center of Entomoceutics, Dali University, Dali, China
| | - Huai Xiao
- Yunnan Provincial Key Laboratory of Entomological Biopharmaceutical R&D, Dali University, Dali, China
| | - De-xiao Wang
- Yunnan Provincial Key Laboratory of Entomological Biopharmaceutical R&D, Dali University, Dali, China,Genetic Testing Center, The First Affiliated Hospital of Dali University, Dali University, Dali, China
| | - Guang-ming Wang
- Genetic Testing Center, The First Affiliated Hospital of Dali University, Dali University, Dali, China
| | - Cheng-gui Zhang
- Yunnan Provincial Key Laboratory of Entomological Biopharmaceutical R&D, Dali University, Dali, China,National-Local Joint Engineering Research Center of Entomoceutics, Dali University, Dali, China,Corresponding authors: Cheng-gui Zhang. Yunnan Provincial Key Laboratory of Entomological Biopharmaceutical R&D, Dali University, Dali, China; National-Local Joint Engineering Research Center of Entomoceutics, Dali University, Dali, China. ; Hai-rong Zhao. Yunnan Provincial Key Laboratory of Entomological Biopharmaceutical R&D, Dali University, Dali, China; Genetic Testing Center, The First Affiliated Hospital of Dali University, Dali University, Dali, China; National-Local Joint Engineering Research Center of Entomoceutics, Dali University, Dali, China.
| | - Hai-rong Zhao
- Yunnan Provincial Key Laboratory of Entomological Biopharmaceutical R&D, Dali University, Dali, China,National-Local Joint Engineering Research Center of Entomoceutics, Dali University, Dali, China,Genetic Testing Center, The First Affiliated Hospital of Dali University, Dali University, Dali, China,Corresponding authors: Cheng-gui Zhang. Yunnan Provincial Key Laboratory of Entomological Biopharmaceutical R&D, Dali University, Dali, China; National-Local Joint Engineering Research Center of Entomoceutics, Dali University, Dali, China. ; Hai-rong Zhao. Yunnan Provincial Key Laboratory of Entomological Biopharmaceutical R&D, Dali University, Dali, China; Genetic Testing Center, The First Affiliated Hospital of Dali University, Dali University, Dali, China; National-Local Joint Engineering Research Center of Entomoceutics, Dali University, Dali, China.
| |
Collapse
|
8
|
Chen J, Ye Y, Huang D, Pan D, Qiu X, Lei L, Luo X, Li J, Wu K, Xiao S, Liu S, Zeng X. The mediating role of coagulation function on the association of prenatal exposure to aflatoxin B1 and postpartum hemorrhage in Guangxi, China. Environ Sci Pollut Res Int 2022; 29:37543-37555. [PMID: 35066843 DOI: 10.1007/s11356-021-18186-8] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 12/14/2021] [Indexed: 06/14/2023]
Abstract
Pregnant women are vulnerable to certain environmental agents, one of which is aflatoxin. As one of the most popular aflatoxins, Aflatoxin B1 (AFB1) has recently garnered increased attention concerning its potential association between exposure and adverse pregnancy outcomes. The aims of the study were to examine the associations between prenatal exposure to AFB1 and postpartum hemorrhage (PPH), and whether coagulation function has a mediating effect on their relationship. A total of 379 mother-infant pairs were included in the present study. Prenatal serum AFB1 albumin (AFB1-Alb) adduct levels in peripheral venous blood were detected by using an ELISA kit. Multiple linear and logistics regression models were applied to analyze the relationship between AFB1-Alb levels and PPH. We found mothers with high levels of AFB1-Alb adduct levels had significantly increased postpartum blood loss (partial regression coefficient (β) = 50.71, 95% confidence interval (CI) 3.48, 97.95). Mothers with high levels of AFB1-Alb adduct levels also had significantly increased risk of PPH (odds ratio (OR) = 4.81, 95% CI 1.01, 22.98). Moreover, concentrations of AFB1-Alb were positively associated with activated partial thromboplastin time (APTT) while negatively associated with fibrinogen (FIB). One-unit increase in APTT was correlated with a 6.62-ml (95% CI 3.04, 10.20) increase in postpartum blood loss. Mediation analysis suggested that the maternal blood APTT levels had a positive mediating effect in the association between AFB1-Alb adduct levels and postpartum blood loss (β = 0.32, 95% CI 0.04, 0.68). These results indicated that prenatal exposure to AFB1 was associated with increased postpartum blood loss, possibly by interfering with maternal APTT levels.
Collapse
Affiliation(s)
- Jiehua Chen
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, No. 22 Shuangyong Road, Nanning, 530021, Guangxi, China
| | - Ye Ye
- Guangxi Liuzhou Iron & Steel Group Co. Ltd Center for Disease Control and Prevention, Liuzhou, 545002, Guangxi, China
| | - Dongping Huang
- Department of Sanitary Chemistry, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Dongxiang Pan
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, No. 22 Shuangyong Road, Nanning, 530021, Guangxi, China
| | - Xiaoqiang Qiu
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, No. 22 Shuangyong Road, Nanning, 530021, Guangxi, China
| | - Lei Lei
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, No. 22 Shuangyong Road, Nanning, 530021, Guangxi, China
| | - Xingxi Luo
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, No. 22 Shuangyong Road, Nanning, 530021, Guangxi, China
| | - Jinxiu Li
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, No. 22 Shuangyong Road, Nanning, 530021, Guangxi, China
| | - Kaili Wu
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, No. 22 Shuangyong Road, Nanning, 530021, Guangxi, China
| | - Suyang Xiao
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, No. 22 Shuangyong Road, Nanning, 530021, Guangxi, China
| | - Shun Liu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Guangxi Medical University, No. 22 Shuangyong Road, Nanning, 530021, Guangxi, China.
| | - Xiaoyun Zeng
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, No. 22 Shuangyong Road, Nanning, 530021, Guangxi, China.
| |
Collapse
|
9
|
Whitaker C, McKinney A, Bollig R, Hieb N, Roberts RF, Rowe AS. Incidence of thrombotic complications related to weight-based dosing of activated prothrombin complex concentrate (aPCC) for reversal of apixaban and rivaroxaban in obese patients. J Thromb Thrombolysis 2021; 53:861-867. [PMID: 34787787 DOI: 10.1007/s11239-021-02605-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/04/2021] [Indexed: 11/24/2022]
Abstract
Factor eight inhibitor bypassing activity (aPCC) is recommended as a non-specific reversal agent for direct oral anticoagulants (DOACs) according to the 2017 American College of Cardiology (ACC) guidelines for reversal of anticoagulation. Factor eight inhibitor bypassing activity carries a black box warning for thrombotic events such as stroke, pulmonary embolism, deep vein thrombosis, and myocardial infarction, particularly at high doses. This was a retrospective, single-center, cohort investigation that included patients who received a weight-based dose of aPCC for reversal of apixaban and rivaroxaban between January 1, 2015, and December 31, 2020. Patients were grouped by BMI as obese (BMI ≥ 30 kg/m2) or non-obese (BMI < 30 kg/m2) for analysis. The primary outcome of this investigation was the occurrence of thrombotic complications [venous thromboembolism (VTE), myocardial infarction, stroke] documented in the medical record at any point during hospitalization after administration of aPCC. Secondary outcomes included bleeding complications, in-hospital mortality, ICU and hospital length of stay. Patients in the obese group were younger [76.4 years (SD +/- 11.3 years) vs. 69.6 years (SD +/- 12.4 years); p < 0.0001] and a higher proportion had a diagnosis of diabetes mellitus prior to admission [37 (19.2%) vs. 35 (36.8%); p = 0.0011]. There was no difference in the primary outcome of thrombotic events between non-obese and obese patients [12 (6.2%) vs. 5 (5.3%); p = 0.75], or for any of the secondary outcomes of bleeding, in-hospital mortality or length of stay. This investigation did not reveal a difference in rates of thrombosis or bleeding events between obese and non-obese patients who received aPCC for reversal of apixaban and rivaroxaban.
Collapse
Affiliation(s)
- Caitlyn Whitaker
- Department of Pharmacy, University of Tennessee Medical Center, Knoxville, TN, USA
| | - Amanda McKinney
- Department of Pharmacy, University of Tennessee Medical Center, Knoxville, TN, USA
| | - Reagan Bollig
- Department of Surgery, University of Tennessee Medical Center, Knoxville, TN, USA
| | - Nathan Hieb
- Department of Surgery, University of Tennessee Medical Center, Knoxville, TN, USA
| | - R Frank Roberts
- Department of Surgery, University of Tennessee Medical Center, Knoxville, TN, USA
| | - A Shaun Rowe
- Department of Pharmacy, University of Tennessee Medical Center, Knoxville, TN, USA. .,Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, Knoxville, TN, USA.
| |
Collapse
|
10
|
Abstract
Bleeding is associated with an increased morbidity and mortality. Anatomic and hemostatic causes play a central role in the pathophysiology of bleeding, with anatomic causes being by far more common. While trauma and invasive procedures are the leading causes of bleeding in surgical disciplines, gastrointestinal bleeding is the major cause of bleeding in internal medicine. Major bleedings lead to secondary homeostatic changes, which in turn not only contribute to further bleeding, but also to the pathogenesis of organ dysfunction. Acquired coagulopathies due to antithrombotic treatment or an underlying disease also contribute to the extent and the dynamics of bleeding, while hereditary bleeding disorders are seldom. The balance between the physiological pro- and anticoagulant pathway plays a significant role in the pathophysiology of bleeding and coagulation. Therefore, the pathophysiology of bleeding cannot be described by means of easily available laboratory coagulation workup. The aim of coagulation correction during the management of life-threatening bleeding is not to normalize coagulation, but rather to stop bleeding. Besides a careful clinical evaluation of the course of bleeding coupled with basic understanding of the physiology of coagulation, targeted laboratory coagulation workup can contribute to a rational coagulation treatment concept.
Collapse
Affiliation(s)
- Sirak Petros
- Interdisziplinäre Internistische Intensivmedizin, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland.
| |
Collapse
|
11
|
Naeem Z, Allan S, Hernandez A, Galanakis DK, Singer AJ. Clinical utilization of four-factor prothrombin complex concentrate: a retrospective single center study. Clin Exp Emerg Med 2021; 8:75-81. [PMID: 34237811 PMCID: PMC8273669 DOI: 10.15441/ceem.20.017] [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: 02/18/2020] [Revised: 06/16/2020] [Accepted: 06/19/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Four-factor prothrombin complex concentrate (4F-PCC) was approved by the US Food and Drug Administration in 2013 for management of severely bleeding patients on warfarin therapy. We describe use of 4F-PCC at a large, suburban academic center. METHODS We retrospectively reviewed all patients receiving 4F-PCC from its introduction through 2016 at a large level 1 trauma center. Clinical and demographic data were obtained, including indications for anticoagulation and antiplatelet agents, comorbidities, concomitant medications, etiology and site of bleeding, as well as disposition, length of stay, mortality, and thrombotic events. RESULTS One hundred eighty-four patients received 4F-PCC. Mean age was 72 years; 40.8% were female. Indications for 4F-PCC administration included: active bleeding (74%), reversal prior to a procedure (14%), and elevated international normalized ratio (12%). Warfarin was the most common concomitant medication (71.1%). Most patients were receiving anticoagulation for atrial fibrillation (63%). Concomitant treatments for bleeding included vitamin K (58.2%), packed red blood cells (50%), fresh frozen plasma (38%), and platelets (26.1%), amongst others. Median length of hospital stay was 8.4 days. Nine patients (4.9%) developed thrombosis within 90 days of 4F-PCC. Mortality was 24.5%, with notably higher rates amongst those who received 4F-PCC for off-label indications (19.1% on-label mortality vs. 37.7% off-label mortality on chi-square analysis, P=0.01). CONCLUSION This study demonstrates that 4F-PCC is being utilized for indications other than the reversal of warfarin-induced coagulopathy. Further investigation is warranted to determine the efficacy and safety of 4F-PCC for these potential indications.
Collapse
Affiliation(s)
- Zaina Naeem
- Department of Emergency Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Salsabeel Allan
- Department of Emergency Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Aneury Hernandez
- Department of Emergency Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Dennis K Galanakis
- Department of Pathology, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Adam J. Singer
- Department of Emergency Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| |
Collapse
|
12
|
Margraf DJ, Seaburg S, Beilman GJ, Wolfson J, Gipson JC, Chapman SA. Propensity score adjusted comparison of three-factor versus four-factor prothrombin complex concentrate for emergent warfarin reversal: a retrospective cohort study. BMC Emerg Med 2020; 20:93. [PMID: 33243152 PMCID: PMC7691107 DOI: 10.1186/s12873-020-00386-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 11/12/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Prothrombin Complex Concentrates (PCC) are prescribed for emergent warfarin reversal (EWR). The comparative effectiveness and safety among PCC products are not fully understood. METHODS Patients in an academic level one trauma center who received PCC3 or PCC4 for EWR were identified. Patient characteristics, PCC dose and time of dose, pre- and post-INR and time of measurement, fresh frozen plasma and vitamin K doses, and patient outcomes were collected. Patients whose pre-PCC International Normalized Ratio (INR) was > 6 h before PCC dose or the pre-post PCC INR was > 12 h were excluded. The primary outcome was achieving an INR ≤ 1.5 post PCC. Secondary outcomes were the change in INR over time, post PCC INR, thromboembolic events (TE), and death during hospital stay. Logistic regression modelled the primary outcome with and without a propensity score adjustment accounting for age, sex, actual body weight, dose, initial INR value, and time between INR measurements. Data are reported as median (IQR) or n (%) with p < 0.05 considered significant. RESULTS Eighty patients were included (PCC3 = 57, PCC4 = 23). More PCC4 patients achieved goal INR (87.0% vs. 31.6%, odds ratio (OR) = 14.4, 95% CI: 3.80-54.93, p < 0.001). This result remained true after adjusting for possible confounders (AOR = 10.7, 95% CI: 2.17-51.24, p < 0.001). The post-PCC INR was lower in the PCC4 group (1.3 (1.3-1.5) vs. 1.7 (1.5-2.0)). The INR change was greater for PCC4 (2.3 (1.3-3.3) vs. 1.1 (0.6-2.0), p = 0.003). Death during hospital stay (p = 0.52) and TE (p = 1.00) were not significantly different. CONCLUSIONS PCC4 was associated with a higher achievement of goal INR than PCC3. This relationship was observed in the unadjusted and propensity score adjusted results.
Collapse
Affiliation(s)
- David J Margraf
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, 7-115E Weaver-Densford Hall, 308 Harvard St. SE, Minneapolis, MN, 55455, USA
| | - Scott Seaburg
- Department of Pharmacy Services, North Memorial Health Hospital, Robbinsdale, MN, USA
| | - Gregory J Beilman
- Division of Critical Care & Acute Care Surgery, Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Julian Wolfson
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Jonathan C Gipson
- Trauma and Acute Care Surgery, North Memorial Health Hospital, Robbinsdale, MN, USA
| | - Scott A Chapman
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, 7-115E Weaver-Densford Hall, 308 Harvard St. SE, Minneapolis, MN, 55455, USA.
| |
Collapse
|
13
|
Sousa Bomfim A, Corrêa de Freitas MC, Picanço Castro V, Abreu Soares Neto M, Pádua R, Covas DT, Sousa Russo EM. Generation of hyperfunctional recombinant human factor IX variants expressed in human cell line SK-Hep-1. Biotechnol Lett 2020; 43:143-152. [PMID: 33130980 DOI: 10.1007/s10529-020-03040-7] [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: 12/05/2019] [Accepted: 10/27/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To develop recombinant factor IX (FIX) variants with augmented clotting activity. RESULTS We generated three new variants, FIX-YKALW, FIX-ALL and FIX-LLW, expressed in SK-Hep-1 cells and characterized in vitro and in vivo. FIX-YKALW showed the highest antigen expression level among the variants (2.17 µg-mL), followed by FIX-LLW (1.5 µg-mL) and FIX-ALL (0.9 µg-mL). The expression level of FIX variants was two-five fold lower than FIX-wild-type (FIX-WT) (4.37 µg-mL). However, the biological activities of FIX variants were 15-31 times greater than FIX-WT in the chromogenic assay. Moreover, the new variants FIX-YKALW, FIX-LLW and FIX-ALL also presented higher specific activity than FIX-WT (17, 20 and 29-fold higher, respectively). FIX variants demonstrated a better clotting time than FIX-WT. In hemophilia B mice, we observed that FIX-YKALW promoted hemostatic protection. CONCLUSION We have developed three improved FIX proteins with potential for use in protein replacement therapy for hemophilia B.
Collapse
Affiliation(s)
- Aline Sousa Bomfim
- Department of Clinical, Toxicological and Food Science Analysis, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, São Paulo, Brazil. .,Laboratory of Biotechnology, Center for Cell-Based Therapy and Regional Blood Center, University of São Paulo, São Paulo, Brazil. .,Department of Clinical, Toxicological and Food Science Analysis, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Café Avenue, Block R, Room 7, Ribeirão Preto, SP, ZIP 14040-903, Brazil.
| | | | - Virgínia Picanço Castro
- Laboratory of Biotechnology, Center for Cell-Based Therapy and Regional Blood Center, University of São Paulo, São Paulo, Brazil
| | - Mario Abreu Soares Neto
- Laboratory of Biotechnology, Center for Cell-Based Therapy and Regional Blood Center, University of São Paulo, São Paulo, Brazil
| | - Ricardo Pádua
- Department of Physics and Chemistry, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Dimas Tadeu Covas
- Laboratory of Biotechnology, Center for Cell-Based Therapy and Regional Blood Center, University of São Paulo, São Paulo, Brazil.,Department of Medical Clinic, Faculty of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Elisa Maria Sousa Russo
- Department of Clinical, Toxicological and Food Science Analysis, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.,Laboratory of Biotechnology, Center for Cell-Based Therapy and Regional Blood Center, University of São Paulo, São Paulo, Brazil
| |
Collapse
|
14
|
Buis DTP, Christen T, Smit RAJ, de Mutsert R, Jukema JW, Cannegieter SC, Lijfering WM, Rosendaal FR. The association between leptin concentration and blood coagulation: Results from the NEO study. Thromb Res 2020; 188:44-48. [PMID: 32050106 DOI: 10.1016/j.thromres.2020.01.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 01/02/2020] [Accepted: 01/19/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND The adipocyte-derived hormone leptin has been associated with altered blood coagulation in in vitro studies. However, it is unclear whether this association is relevant in vivo and to what extent this association is influenced by total body fat. Therefore, we aimed to examine the association between serum leptin and blood coagulation while taking total body fat into account in a population-based cohort study. METHODS We performed a cross-sectional analysis with baseline measurements of 5797 participants of the Netherlands Epidemiology of Obesity (NEO) study, a population-based cohort of middle-aged men and women. We examined associations between serum leptin concentration and coagulation factor concentrations and parameters of platelet activation in linear regression analyses. All analyses were adjusted for multiple covariates, including total body fat. RESULTS In multivariable adjusted analyses a 1 μg/L higher serum leptin concentration was associated with a 0.22 IU/dL (95% CI: 0.11, 0.32) higher FVIII concentration and a 0.20 IU/dL (95% CI: 0.14, 0.27) higher FIX concentration (3.5 IU/dL FVIII and 3.2 IU/dL FIX per SD leptin). Serum leptin concentration was not associated with FXI, fibrinogen, platelet count, mean platelet volume and platelet distribution width in multivariable adjusted analyses. DISCUSSION This study showed that serum leptin concentration was associated with higher concentrations of FVIII and FIX in an observational study, which could be clinically relevant.
Collapse
Affiliation(s)
- D T P Buis
- Clinical Epidemiology, C7-P, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, the Netherlands.
| | - T Christen
- Clinical Epidemiology, C7-P, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, the Netherlands
| | - R A J Smit
- Clinical Epidemiology, C7-P, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, the Netherlands
| | - R de Mutsert
- Clinical Epidemiology, C7-P, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, the Netherlands
| | - J W Jukema
- Clinical Epidemiology, C7-P, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, the Netherlands
| | - S C Cannegieter
- Clinical Epidemiology, C7-P, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, the Netherlands
| | - W M Lijfering
- Clinical Epidemiology, C7-P, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, the Netherlands
| | - F R Rosendaal
- Clinical Epidemiology, C7-P, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, the Netherlands
| |
Collapse
|
15
|
Peng HM, Wang LC, Zhai JL, Jiang C, Weng XS, Feng B, Gao N. Incidence of Symptomatic Venous Thromboembolism in Patients with Hemophilia Undergoing Hip and Knee Joint Replacement without Chemoprophylaxis: A Retrospective Study. Orthop Surg 2019; 11:236-240. [PMID: 30932356 PMCID: PMC6594532 DOI: 10.1111/os.12444] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 04/09/2018] [Accepted: 04/15/2018] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To establish the prevalence of clinically significant venous thromboembolic events (VTE) in hemophilia patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA) without chemoprophylaxis and a modified coagulation factor substitution. METHODS A cohort of patients who underwent THA and TKA from June 2002 to April 2017 were included. Based on World Federation of Hemophilia (WFH) guidelines, a modified coagulation factor substitution regimen was adopted. All patients were under a standardized postoperative protocol with routine mechanical prophylaxis against VTE. None of the patients received prophylactic anticoagulation. Only symptomatic patients were referred for radiological examination to exclude VTE. We evaluated the patient demographics and calculated the prevalence of VTE in our cohort. RESULTS A total of 98 patients were reviewed. The patients were all men. Thirty-one patients underwent primary THA with 39 hip arthroplasties (only 1 case with hemophilia B) and 67 patients underwent primary TKA with 101 knee arthroplasties (5 cases with hemophilia B). The mean age was 34.2 ± 7.8 years. The mean body mass index was 21.2 ± 5.7 kg/m2 . There was 100% compliance to mechanical prophylaxis. The mean time to ambulation was 6.8 days (±2.5 days), and the mean hospital stay was 32.4 days (±7.1 days). There was only 1 hemophilia B patient with clinically significant VTE. None of the other 97 surgical cases had symptomatic VTE within 6 months after the procedure. This translates to a prevalence of 1.02%. CONCLUSION Given the low incidence (1.02%) of clinically significant VTE in our cohort, routine chemoprophylaxis in hemophilia patients undergoing THA and TKA may not be needed.
Collapse
Affiliation(s)
- Hui-Ming Peng
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Long-Chao Wang
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Ji-Liang Zhai
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Chao Jiang
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xi-Sheng Weng
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Bin Feng
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Na Gao
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| |
Collapse
|
16
|
Díaz-Ricart M, Isola IM, Escolar G. Emicizumab for routine prophylaxis to prevent bleeding episodes in patients with hemophilia A. Drugs Today (Barc) 2018; 54:591-600. [PMID: 30398480 DOI: 10.1358/dot.2018.54.10.2869771] [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: 10/28/2022]
Abstract
Hemophilia A is an X-linked bleeding disorder caused by defects in the gene encoding factor VIII (FVIII). Routine prophylaxis with exogenous FVIII requires frequent intravenous injections. One of the most challenging issues in the treatment of hemophilia A is the development of alloantibodies against infused FVIII. Presence of inhibitors results in an ineffective factor replacement therapy and increases the risk of morbidity and mortality in these patients. Therefore, there is growing interest in the development of new strategies for the prophylaxis and prevention of bleeding in patients with hemophilia to circumvent these drawbacks. Emicizumab (ACE-910; Roche, Genentech and Chugai Pharmaceutical) is a recombinant humanized bispecific antibody that restores the function of missing FVIII by bridging activated FIX and FX, simulating the cofactor function of FVIII.
Collapse
Affiliation(s)
- M Díaz-Ricart
- Hematopatologia, Anatomia Patològica, Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain.
| | - I M Isola
- Hematopatologia, Anatomia Patològica, Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - G Escolar
- Hematopatologia, Anatomia Patològica, Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| |
Collapse
|
17
|
Tong KM, Wang JD, Chang ST, Cheng YY, Wang SS. Outcome of perioperative hemostatic management in patients with hemophilia without inhibitors undergoing 161 invasive or surgical procedures. J Chin Med Assoc 2018; 81:926-929. [PMID: 30017811 DOI: 10.1016/j.jcma.2017.11.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 11/27/2017] [Accepted: 11/30/2017] [Indexed: 10/28/2022] Open
Abstract
Perioperative management of persons with hemophilia (PWH) is a challenge for surgeons and hematologists. Reductions in mortality rate and complications have been achieved since the introduction of clotting factor concentrates (CFCs), which improve hemostatic control. However, there is no clear consensus on the optimal dosing of CFC administration. The aim of this study was to evaluate the outcome of PWH without inhibitors in patients undergoing invasive or surgical procedures. A total of 161 procedures, including 57 major and 104 minor ones were retrospectively reviewed. The characteristics of PWH, age at procedure, duration and total amount of CFC administration during the perioperative period, hemostatic adequacy, and complications were summarized. The study showed a low rate of bleeding (1.2%), infection (0%), thromboembolic event (0%), and inhibitor development (0%). The results revealed the doses and duration of CFC administration for several major and minor procedures which were capable of achieving excellent hemostatic control.
Collapse
Affiliation(s)
- Kwok-Man Tong
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Jiaan-Der Wang
- Center for Rare Disease and Hemophilia, Department of Paediatrics, Taichung Veterans General Hospital, Taichung, Taiwan, ROC; School of Medicine, China Medical University, Taichung, Taiwan, ROC.
| | - Shin-Tsu Chang
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC; Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Yuan-Yang Cheng
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Shian-Shiang Wang
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| |
Collapse
|
18
|
Hoffmeister HM, Darius H, Buerke M. [Hemorrhage under direct oral anticoagulants : Occurrence and treatment in intensive care patients]. Med Klin Intensivmed Notfmed 2018; 113:284-292. [PMID: 29728712 DOI: 10.1007/s00063-018-0436-8] [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: 03/27/2018] [Accepted: 03/27/2018] [Indexed: 10/17/2022]
Abstract
The use of anticoagulants is associated with an increased risk of bleeding and nevertheless bleeding complications can be lifethreatening. The focus is on bleeding under direct oral anticoagulants (DOAC) because antidotes and specific measures are lacking for some DOACs. Furthermore, routinely carried out clotting tests cannot be used to determine the degree of anticoagulation under DOACs. Therefore, it becomes difficult to determine whether the coagulation inhibition effect is present. This article presents the treatment of hemorrhage in patients with DOACs in the intensive care unit. Further, the indications for DOACS and details of administration and monitoring are presented.
Collapse
Affiliation(s)
- H M Hoffmeister
- Klinik für Kardiologie und Allgemeine Innere Medizin, Städtisches Klinikum Solingen, Gotenstraße 1, 42653, Solingen, Deutschland.
| | - H Darius
- Klinik für Innere Medizin - Kardiologie, Angiologie, Nephrologie und konservative Intensivmedizin, Vivantes Klinikum Neukölln, Berlin, Deutschland
| | - M Buerke
- Medizinische Klinik II, Kardiologie, Angiologie, Internistische Intensivmedizin, St. Marien-Krankenhaus, Siegen, Deutschland.,Klinik und Poliklinik für Innere Medizin III, Universitätsklinikum Halle (Saale), Martin-Luther-Universität Halle-Wittenberg, Halle/Saale, Deutschland
| |
Collapse
|
19
|
Schellekens MMI, van Alebeek ME, Arntz RM, Synhaeve NE, Maaijwee NAMM, Schoonderwaldt HC, van der Vlugt MJ, van Dijk EJ, Rutten-Jacobs LCA, de Leeuw FE. Prothrombotic factors do not increase the risk of recurrent ischemic events after cryptogenic stroke at young age: the FUTURE study. J Thromb Thrombolysis 2018; 45:504-511. [PMID: 29480382 PMCID: PMC5889776 DOI: 10.1007/s11239-018-1631-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND The role of hypercoagulable states and preceding infections in the etiology of young stroke and their role in developing recurrent ischemic events remains unclear. Our aim is to determine the prevalence of these conditions in patients with cryptogenic stroke at young age and to assess the long-term risk of recurrent ischemic events in patients with and without a hypercoagulable state or a recent pre-stroke infection with Borrelia or Syphilis. PATIENTS AND METHODS We prospectively included patients with a first-ever transient ischemic attack or ischemic stroke, aged 18-50, admitted to our hospital between 1995 and 2010. A retrospective analysis was conducted of prothrombotic factors and preceding infections. Outcome was recurrent ischemic events. RESULTS Prevalence of prothrombotic factors did not significantly differ between patients with a cryptogenic stroke and with an identified cause (24/120 (20.0%) and 32/174 (18.4%) respectively). In patients with a cryptogenic stroke the long-term risk [mean follow-up of 8.9 years (SD 4.6)] of any recurrent ischemic event or recurrent cerebral ischemia did not significantly differ between patients with and without a hypercoagulable state or a recent infection. In patients with a cryptogenic stroke 15-years cumulative risk of any recurrent ischemic event was 24 and 23% in patients with and without any prothrombotic factor respectively. CONCLUSIONS The prevalence of prothrombotic factors and preceding infections did not significantly differ between stroke patients with a cryptogenic versus an identified cause of stroke and neither is significantly associated with an increased risk of recurrent ischemic events after cryptogenic stroke.
Collapse
Affiliation(s)
- Mijntje M I Schellekens
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Center for Neuroscience, RadboudUMC, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Mayte E van Alebeek
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Center for Neuroscience, RadboudUMC, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Renate M Arntz
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Center for Neuroscience, RadboudUMC, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Nathalie E Synhaeve
- Department of Neurology, Elisabeth Tweesteden Hospital, PO Box 90151, 5000 LC, Tilburg, The Netherlands
| | - Noortje A M M Maaijwee
- Center for Neurology and Neurorehabilitation, Luzern State Hospital, Spitalstrasse 31, 6000, Luzern 16, Switzerland
| | - Hennie C Schoonderwaldt
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Center for Neuroscience, RadboudUMC, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | | | - Ewoud J van Dijk
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Center for Neuroscience, RadboudUMC, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | | | - Frank-Erik de Leeuw
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Center for Neuroscience, RadboudUMC, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
| |
Collapse
|
20
|
Herold J, Mitrasch A, Lorenz E, Lodes U, Tanev I, Braun-Dullaeus R, Meyer F. [Vomiting and collapse of a 28-year-old male long distance runner in middle European Summer]. Internist (Berl) 2018; 59:850-856. [PMID: 29651510 DOI: 10.1007/s00108-018-0415-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Hyperthermia often ends fatally and must therefore be promptly recognized and adequately treated. CASE A 28-year-old man participated in a long-distance race (3 km) on a hot summer day (28 °C). The runner collapsed, had to vomit but continued the run and reached the finish. Neurologically, the patient presented with intermittent cerebral seizures. External cooling batteries were immediately applied and cold infusions were started. The patient was admitted to the intensive care unit of the university hospital (body temperature 40.2 °C). After a few hours, a manifest disseminated intravascular coagulopathy developed with multiple organ failure. It took 12 l of volume replacement, 8 units of fresh frozen plasma and 2 units of erythrocyte concentrates in the first 12 h to stabilize the patient. Although with the help of forced external cooling and application of cold infusions, the body temperature could be lowered to 38 °C by the next morning, the overall situation of the patient continued to deteriorate. Despite dialysis and massive substitution of coagulation factors, the patient could not be sufficiently stabilized and died of brain edema. CONCLUSION Not only the old or young children are subject to the potential danger of a fatal heat stroke but also young athletic persons after normal sports activities (3 km run). Cooling must be started immediately and the patient must be hospitalized as a vital emergency. If hemostasis fails due to the heat-related loss of hepatogenic protein synthesis, a viscious circle begins, which, as in the reported case, is irreversible despite maximum therapy and substitution.
Collapse
Affiliation(s)
- J Herold
- Klinik für Kardiologie und Angiologie, Medizinische Fakultät der Otto-von-Guericke-Universität, Universitätsklinikum Magdeburg A.ö.R., Leipziger Str. 44, 39120, Magdeburg, Deutschland.
| | - A Mitrasch
- Klinik für Kardiologie und Angiologie, Medizinische Fakultät der Otto-von-Guericke-Universität, Universitätsklinikum Magdeburg A.ö.R., Leipziger Str. 44, 39120, Magdeburg, Deutschland
| | - E Lorenz
- Klinik für Allgemein‑, Viszeral‑, Gefäß- und Transplantationschirurgie, Medizinische Fakultät der Otto-von-Guericke-Universität, Universitätsklinikum Magdeburg A.ö.R., Magdeburg, Deutschland
| | - U Lodes
- Klinik für Anästhesiologie und Intensivtherapie, Medizinische Fakultät der Otto-von-Guericke-Universität, Universitätsklinikum Magdeburg A.ö.R., Magdeburg, Deutschland
| | - I Tanev
- Klinik für Kardiologie und Angiologie, Medizinische Fakultät der Otto-von-Guericke-Universität, Universitätsklinikum Magdeburg A.ö.R., Leipziger Str. 44, 39120, Magdeburg, Deutschland
| | - R Braun-Dullaeus
- Klinik für Kardiologie und Angiologie, Medizinische Fakultät der Otto-von-Guericke-Universität, Universitätsklinikum Magdeburg A.ö.R., Leipziger Str. 44, 39120, Magdeburg, Deutschland
| | - F Meyer
- Klinik für Allgemein‑, Viszeral‑, Gefäß- und Transplantationschirurgie, Medizinische Fakultät der Otto-von-Guericke-Universität, Universitätsklinikum Magdeburg A.ö.R., Magdeburg, Deutschland
| |
Collapse
|
21
|
Alarfaj SJ, Jarrell DH, Patanwala AE. Comparison of drug administration logistics between prothrombin complex concentrates and plasma in the emergency department. Am J Emerg Med 2018; 36:2182-2186. [PMID: 29622392 DOI: 10.1016/j.ajem.2018.03.064] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 03/22/2018] [Accepted: 03/23/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Prothrombin complex concentrate (PCC) is used as an alternative to fresh frozen plasma (FFP) for emergency bleeding. The primary objective of this study was to compare the time from order to start of administration between 3-factor PCC (PCC3), 4-factor (PCC4), and FFP in the emergency department (ED). The secondary objective was to evaluate the effect of an ED pharmacist on time to administration of PCCs. METHODS This was a single center three-arm retrospective cohort study. Adult patients in the ED with bleeding were included. The primary outcome measure was the time from order to administration, which was compared between PCC3, PCC4, and FFP. The time from order to administration was also compared when the ED pharmacist was involved versus not involved in the care of patients receiving PCC. RESULTS There were 90 patients included in the study cohort (30 in each group). The median age was 69years (IQR 57-82years), and 57% (n=52) were male. The median time from order to administration was 36min (IQR 20-58min) for PCC3, 34min (IQR 18-48min) for PCC4, and 92min (IQR 63-133) for FFP (PCC3 versus PCC4, p=0.429; PCC3 versus FFP, p<0.001; PCC4 versus FFP, p<0.001). The median time from order to administration was significantly decreased when the ED pharmacist was involved (24min [IQR 15-35min] versus 42min [IQR 32-59min], p<0.001). CONCLUSIONS Time from order to administration is faster with PCC than FFP. ED pharmacist involvement decreases the time from order to administration of PCC.
Collapse
Affiliation(s)
- Sumaiah J Alarfaj
- Department of Pharmaceutical Practice, College of Pharmacy, Princess Nourah bint Abdulrahman University, P.O Box 84428, Riyadh, Saudi Arabia; Department of Pharmacy Practice and Science, College of Pharmacy, The University of Arizona, 1295 N Martin Ave, PO Box 210202, Tucson, AZ 85721, USA
| | - Daniel H Jarrell
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Arizona, 1295 N Martin Ave, PO Box 210202, Tucson, AZ 85721, USA
| | - Asad E Patanwala
- Department of Pharmacy Services, Banner - University Medical Center Tucson, 1501 N Campbell Ave, Tucson, AZ 85724, USA.
| |
Collapse
|
22
|
Maguire CM, Lavin M, Doyle M, Byrne M, Prina‐Mello A, O'Donnell JS, Volkov Y. The anticoagulant properties of cadmium telluride quantum dots. J Interdiscip Nanomed 2018; 3:16-28. [PMID: 29938115 PMCID: PMC5993270 DOI: 10.1002/jin2.35] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 02/09/2018] [Accepted: 02/23/2018] [Indexed: 01/01/2023]
Abstract
The size-dependent optical properties of quantum dots (QDs) are frequently exploited for use in medical imaging and labelling applications. Similarly, presented here, they also elicit profound size-dependent anticoagulant properties. Cadmium telluride quantum dot (QDs) (3.2 nm) were shown to have a dramatic anticoagulant effect centred on around the intrinsic coagulation pathway, compared to their 3.6 nm counterparts. Several clinically relevant diagnostic tests were carried out over a concentration range of the QDs and demonstrated that the 3.2 nm QDs elicited their response on the intrinsic pathway as a whole, yet the activity of the individual intrinsic coagulation factors was not affected. The mechanism appears also to be strongly influenced by the concentration of calcium ions and not cadmium ions leached from the QDs. Static and shear-based primary haemostasis assays were also carried out, demonstrating a profound anticoagulant effect which was independent of platelets and phospholipids. The data presented here suggest that the physical-chemical properties of the QDs may have a role in the modulation of haemostasis and the coagulation cascade, in a yet not fully understood mechanism. This study has implications for the use of similar QDs as diagnostic or therapeutic tools in vivo, and for the occupational health and safety of those working with such materials.
Collapse
Affiliation(s)
- Ciarán M. Maguire
- School of Medicine, Trinity Translational Medicine Institute, Trinity College DublinDublinIreland
- AMBER Centre, CRANN Institute, Trinity College DublinDublinIreland
| | - Michelle Lavin
- National Coagulation Centre, St. James's HospitalDublinIreland
- Irish Centre for Vascular Biology, Royal College of Surgeons in IrelandDublinIreland
| | - Mairead Doyle
- National Coagulation Centre, St. James's HospitalDublinIreland
| | - Mary Byrne
- National Coagulation Centre, St. James's HospitalDublinIreland
| | - Adriele Prina‐Mello
- School of Medicine, Trinity Translational Medicine Institute, Trinity College DublinDublinIreland
- AMBER Centre, CRANN Institute, Trinity College DublinDublinIreland
| | - James S. O'Donnell
- National Coagulation Centre, St. James's HospitalDublinIreland
- Irish Centre for Vascular Biology, Royal College of Surgeons in IrelandDublinIreland
| | - Yuri Volkov
- School of Medicine, Trinity Translational Medicine Institute, Trinity College DublinDublinIreland
- AMBER Centre, CRANN Institute, Trinity College DublinDublinIreland
- International Laboratory of Magnetically Controlled Nanosystems for Theranostics of Oncological and Cardiovascular DiseasesITMO UniversitySt. PetersburgRussia
| |
Collapse
|
23
|
Yuan Y, Vora N, Sun CL, Li D, Soto-Perez-de-Celis E, Mortimer J, Luu TH, Somlo G, Waisman J, Smith D, Chao J, Katheria V, Synold T, Tran V, Mi S, Levi A, Arsenyan A, Choi J, Zavala L, Yost S, Hurria A. Association of pre-chemotherapy peripheral blood pro-inflammatory and coagulation factors with reduced relative dose intensity in women with breast cancer. Breast Cancer Res 2017; 19:101. [PMID: 28851415 PMCID: PMC5576099 DOI: 10.1186/s13058-017-0895-5] [Citation(s) in RCA: 4] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 08/11/2017] [Indexed: 11/10/2022] Open
Abstract
Background Chemotherapy decreases the risk of relapse and mortality in early-stage breast cancer (BC), but it comes with the risk of toxicity. Chemotherapy efficacy depends on relative dose intensity (RDI), and an RDI < 85% is associated with worse overall survival. The pro-inflammatory (interleukin (IL)-6, C-reactive protein (CRP)) and coagulation factors (D-dimer) serve as biomarkers of aging. The purpose of this study is to determine if these biomarkers are associated with reduced RDI in women with stage I–III BC. Methods This study enrolled women with stage I–III BC. Prior to adjuvant or neoadjuvant chemotherapy, peripheral blood was collected for biomarker measurement. Dose reductions and delays were captured and utilized to calculate the RDI delivered. Univariate and multivariate analyses were performed to describe the association between pre-chemotherapy IL-6, CRP, and D-dimer levels and an RDI < 85%, controlling for relevant tumor and patient factors (age, stage, receptor status, chemotherapy regimen, and pre-chemotherapy physical function and comorbidity). Results A total of 159 patients (mean age 58 years, range 30–81, SD 11.3) with stage I–III BC were enrolled. An RDI < 85% occurred in 22.6% (N = 36) of patients and was associated with higher pre-chemotherapy IL-6 (OR 1.14, 95% CI 1.04–1.25; p = 0.006) and D-dimer (OR 2.32, 95% CI 1.27–4.24; p = 0.006) levels, increased age (p = 0.001), increased number of comorbidities (p = 0.01), and decreased physical function by the Medical Outcomes Survey Activities of Daily Living (ADL) Scale (p = 0.009) in univariate analysis. A multivariate model, including two biomarkers (IL-6 and D-dimer), age, ADL, BC stage, and chemotherapy regimen, demonstrated a significant association between the increased biomarkers and reduced RDI < 85% (OR 2.54; p = 0.04). Conclusions Increased pre-chemotherapy biomarkers of aging (IL-6 and D-dimer) are associated with reduced RDI (<85%). Future studies are underway to validate these findings. Trial registration ClinicalTrials.gov, NCT01030250. Registered on 3 November 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13058-017-0895-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Yuan Yuan
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA.
| | - Nilesh Vora
- Long Beach Memorial Medical Center, Long Beach, CA, USA
| | - Can-Lan Sun
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - Daneng Li
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | | | - Joanne Mortimer
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - The-Hang Luu
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - George Somlo
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - James Waisman
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - David Smith
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - Joseph Chao
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - Vani Katheria
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - Timothy Synold
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - Vivi Tran
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - Shu Mi
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - Abrahm Levi
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - Anait Arsenyan
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - Jennifer Choi
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - Laura Zavala
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - Susan Yost
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - Arti Hurria
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| |
Collapse
|
24
|
Darius H. [NOAC: Real-life data and the role of antidotes for the treatment of bleeding]. Med Klin Intensivmed Notfmed 2017; 112:99-104. [PMID: 28144725 DOI: 10.1007/s00063-016-0258-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 12/09/2016] [Accepted: 12/21/2016] [Indexed: 11/27/2022]
Abstract
The non-vitamin K antagonists (NOAC) are an integral component of our antithrombotic prevention and therapy. For four of the NOAC, their non-inferiority or even superiority versus vitamin K antagonists (VKA) has been proven. Thus, the management of special patient cohorts or the management of active bleeding complications is a focus of current discussion.In addition to prospective trials, numerous retrospective analyses of health insurers or public health provider data have been analyzed and published as "real life" or "real-world evidence" data. In almost all data sets the results of the NOAC approval trials were confirmed, demonstrating their non-inferiority or even superiority versus VKA. Attempts to compare the various NOAC with each other must be viewed critically since the real-world evidence (RWE) analysis provides very divergent results depending on the cohorts analyzed. Thus, a substantial prescriber-bias must be taken into account and never be excluded.In order to improve the management of bleeding complications, NOAC antidotes were developed. While the factors Xa antidote, andexanet alpha, a modified coagulation factor deleted of an intrinsic activity, will not be available before 2018, the dabigatran antidote idarucizumab is already in clinical use. Idarucizumab, a monoclonal antibody fragment directed against dabigatran, is able to completely antagonize the effect of dabigatran within minutes. Therefore, the drug has the potential to terminate life-threatening bleeding complications earlier and make emergency surgical or interventional procedures possible without an elevated bleeding risk.
Collapse
|
25
|
Thomas O, Rein H, Strandberg K, Schött U. Coagulative safety of epidural catheters after major upper gastrointestinal surgery: advanced and routine coagulation analysis in 38 patients. Perioper Med (Lond) 2016; 5:28. [PMID: 27777753 PMCID: PMC5067910 DOI: 10.1186/s13741-016-0053-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 09/26/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The risk of spinal haematoma in patients receiving epidural catheters is estimated using routine coagulation tests, but guidelines are inconsistent in their recommendations on what to do when results indicate slight hypocoagulation. Postoperative patients are prone to thrombosis, and thromboelastometry has previously shown hypercoagulation in this setting. We aimed to better understand perioperative haemostasis by comparing results from routine and advanced tests, hypothesizing that patients undergoing major upper gastrointestinal surgery would be deficient in vitamin K-dependent coagulation factors because of malnutrition, or hypocoagulative because of accumulation of low molecular weight heparin (LMWH). METHODS Thirty-eight patients receiving epidural analgesia for major upper gastrointestinal surgery were included. We took blood at the time of preoperative epidural catheterization and at catheter withdrawal. Prothrombin time-international normalized ratio (PT-INR), activated partial thromboplastin time (aPTT) and platelet count (Plc) were analysed, and also albumin, proteins induced by vitamin K absence (PIVKA-II), rotational thromboelastometry (ROTEM®), multiple electrode aggregometry (Multiplate®) and activities of factors II, VII, IX, X, XI, XII and XIII. RESULTS Postoperative coagulation was characterized by thrombocytosis and hyperfibrinogenaemia. Mean PT-INR increased significantly from 1.0 ± 0.1 to 1.2 ± 0.2 and mean aPTT increased significantly from 27 ± 3 to 30 ± 4 s. Activity of vitamin K-dependent factors did not decrease significantly: FIX and FX activity increased. FXII and FXIII decreased significantly. Mean Plc increased from 213 ± 153 × 106/L while all mean ROTEM-MCFs (maximal clot firmnesses) especially FIBTEM-MCF increased significantly to above the reference interval. All mean ROTEM® clotting times were within their reference intervals both before and after surgery. ROTEM® (HEPTEM minus INTEM) results were spread around 0. There were significant correlations between routine tests and the expected coagulation factors, but not any of the viscoelastic parameters or PIVKA-II. Multiplate® area under curve and EXTEM-MCF correlated significantly to Plc as did EXTEM-MCF to fibrinogen, FIX, FX and FXIII; and FIBTEM-MCF to Plc, FII, FXI and FXIII. CONCLUSIONS The increase in PT-INR may be caused by decreased postoperative FVII while the elevated aPTT may be caused by low FXII. The mild postoperative hypocoagulation indicated by routine tests is not consistent with thromboelastometry. The relevance of ROTEM® and Multiplate® in the context of moderately increased routine tests remains unclear. Trial registration number is not applicable since this is not a clinical trial.
Collapse
Affiliation(s)
- Owain Thomas
- Faculty of Medicine, University of Lund, 22100 Lund, Sweden ; Department of Paediatric Anaesthesia and Intensive Care, SUS Lund University Hospital, 22185 Lund, Sweden
| | | | - Karin Strandberg
- Faculty of Medicine, University of Lund, 22100 Lund, Sweden ; Coagulation Laboratory, Department of Clinical Chemistry, Division of Laboratory Medicine, Skåne University Hospital, 21428 Malmö, Sweden
| | - Ulf Schött
- Faculty of Medicine, University of Lund, 22100 Lund, Sweden ; Department of Anaesthesia and Intensive Care, SUS Lund University Hospital, 22185 Lund, Sweden
| |
Collapse
|
26
|
Moustafa F, Saint-Denis J, Laporte S, Mismetti P, Schmidt J. Comparison of blood coagulation factors between patients with gastrointestinal or intracranial bleeding under vitamin K antagonists. Eur J Intern Med 2016; 33:e22-4. [PMID: 27209417 DOI: 10.1016/j.ejim.2016.05.001] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 04/29/2016] [Accepted: 05/02/2016] [Indexed: 11/27/2022]
Affiliation(s)
- F Moustafa
- Service des Urgences Adultes, CHU Gabriel Montpied, Clermont-Ferrand, France.
| | - J Saint-Denis
- Service des Urgences Adultes, CHU Gabriel Montpied, Clermont-Ferrand, France; Université d'Auvergne, Clermont-I, UFR de Médecine, Clermont-Ferrand, France
| | - S Laporte
- EA3065, Université Jean Monnet, Saint-Etienne, France; Unité de Recherche Clinique, Innovation, et Pharmacologie, Centre hospitalo-universitaire de Saint-Etienne, Hôpital Nord, Saint-Etienne, France
| | - P Mismetti
- EA3065, Université Jean Monnet, Saint-Etienne, France; Unité de Recherche Clinique, Innovation, et Pharmacologie, Centre hospitalo-universitaire de Saint-Etienne, Hôpital Nord, Saint-Etienne, France; Service de Médecine interne et Thérapeutique, Centre hospitalo-universitaire de Saint-Etienne, Hôpital Nord, Saint-Etienne, France
| | - J Schmidt
- Service des Urgences Adultes, CHU Gabriel Montpied, Clermont-Ferrand, France; Université d'Auvergne, Clermont-I, UFR de Médecine, Clermont-Ferrand, France
| |
Collapse
|
27
|
Abstract
Blood products are frequently used in intensive care medicine although there is little evidence of improvement in clinical outcome. The threshold for erythrocyte transfusion in non-bleeding critically ill patients is currently a hemoglobin level of 7.0 g/dl. The indications for platelet transfusion must be assessed after evaluation of the cause of thrombocytopenia, the clinical condition and the expected effect. The use of plasma should also be critically viewed, mainly due to hypervolemia. Prothrombin complex concentrates are better than plasma for warfarin reversal. There is good evidence for the use of albumin for massive paracentesis, in the treatment of hepatorenal syndrome type 1 and spontaneous bacterial peritonitis. Albumin infusion can have favorable effects in severe sepsis and septic shock. A restrictive strategy should be favored in the use of blood products and the decision should be based on a critical appraisal of the available evidence.
Collapse
Affiliation(s)
- S Petros
- Interdisziplinäre Internistische Intensivmedizin, Zentrum für Hämostaseologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland.
| |
Collapse
|
28
|
Kim JA, Kim JE, Song SH, Kim HK. Influence of blood lipids on global coagulation test results. Ann Lab Med 2014; 35:15-21. [PMID: 25553275 PMCID: PMC4272949 DOI: 10.3343/alm.2015.35.1.15] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 07/02/2014] [Accepted: 10/19/2014] [Indexed: 11/19/2022] Open
Abstract
Background High levels of blood lipids have been associated with high levels of coagulation factors. We investigated whether blood lipids influence the results of global coagulation tests, including prothrombin time (PT), activated partial thromboplastin time (aPTT), and thrombin generation assay (TGA). Methods PT, aPTT, and TGA, along with procoagulant and anticoagulant factors, were measured in 488 normal individuals. Vitamin K status was assessed with prothrombin-induced by vitamin K absence-II (PIVKA-II). Results The procoagulant factors II, VII, IX, X, and XI and anticoagulant factors protein C and protein S showed significant correlations with triglyceride, and the procoagulant factors II, V, VII, IX, X, XI, and XII and anticoagulant factors antithrombin and protein C correlated with total cholesterol. There were no correlations of blood lipid levels with PIVKA-II levels. Subjects with high triglyceride levels (≥200 mg/dL) showed shorter PT values than those with lower triglyceride levels. However, aPTT value was not changed in terms of blood lipid levels. In both 1 and 5 pM tissue factor-induced TGAs, subjects in the high-triglyceride or high-cholesterol groups (≥240 mg/dL) had high levels of lag time, time-to-peak, and endogenous thrombin potential. Total cholesterol was a significant determinant of PT and TGA values. Conclusion High blood lipids were related with increased coagulation activity in a normal population. Our findings are expected to help interpret the global coagulation test results in individuals with high lipid levels.
Collapse
Affiliation(s)
- Jung-Ah Kim
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Ji-Eun Kim
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Hoon Song
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Kyung Kim
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea. ; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
29
|
Mahmoodian Shooshtari M, Mousavi Hosseini K. Evaluation of the plasma quality after filtration. Daru 2010; 18:114-7. [PMID: 22615604 PMCID: PMC3304377] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2009] [Revised: 04/25/2010] [Accepted: 05/25/2010] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND THE PURPOSE OF THE STUDY The quality of some of the human plasma derived drugs such as coagulation factor VIII and coagulation factor IX which can be used for the treatment of hemophilia A and B, depends on their activity which may be affected by filtration. In this study the quality of plasma with respect to coagulation factors FVII, FVIII, FIX, FV, FXI, Fibrinogen, antithrombin III, anti-plasmin and antitrypsin activities obtained after plasma filtration with CPD (citrate-phosphate-dextrose) using integral filter was evaluated. METHODS Sixty units of plasma were individually separated from whole blood by centrifugation and immediately filtered by integral filter system. Specific plasma filtration was carried out between 4 and 20 hrs after blood donation. Before filtration, 60 units of non filtered fresh plasmas were kept as control. Coagulation factors were determined by one-stage clotting assay in an automated system. Antithrombin III activity was determined by immunochrom assay in an automated system. Activity of anti-plasmin was determined by Berichrom α(2)-antiplasmin and antitrypsin activity was assayed with human neutrophil elastase. RESULTS The activity of coagulation factors FVIII, FIX, Fibrinogen, FV, and FXI, were not affected by filtration, in all experiments. Filtration only caused negligible change in FVII activity. Antithrombin III, anti-plasmin and antitrypsin activities were not influenced by filtration. Nonfiltrated and filtrated plasma values were not significantly different (P> 0.05). CONCLUSIONS Plasma filtration dose not result in a measurable impairment of coagulation factors and inhibitors. Although a little changes in FVII activity was observed after filtration, but these filtration-dependent changes apparently have no impact on the therapeutic quality of whole blood- filtered fresh plasma for transfusion.
Collapse
|