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Hay CRM, Lozier JN, Lee CA, Laffan M, Tradati F, Santagostino E, Ciavarella N, Schiavoni M, Fukui H, Yoshioka A, Teitel J, Mannucci PM, Kasper CK. Safety Profile of Porcine Factor VIII and Its Use as Hospital and Home-Therapy for Patients with Haemophilia-A and Inhibitors: the Results of An International Survey. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1650216] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryA multicentre retrospective survey was conducted to re-assess the use of porcine factor VIII (HYATE:C), its side effects and the selection of patients for regular or home-therapy. 15,152,000 units of HYATE:C were used by 154 patients. The median inhibitor cross-reactivity to porcine VIIIC of 137 patients was 15%, 27% of patients lacking cross-reactivity. An absent, intermediate or brisk specific antiporcine anamnestic response was observed in 29, 40 and 31% of patients respectively. Seven patients were treated on-demand as home-therapy for a median 6.2, range 1.5-13 years. 23 further patients were treated regularly in hospital for a median of 3, range 2-7 years. This group used 8,319,000 U of porcine VIIIC for 2,000 bleeding episodes.The incidence of transfusion reactions was 0.001%, 0.64% and 2.3%, for domiciliary infusions, infusions in multiply treated inpatients, and unselected in-patient infusions, respectively. The risk of reactions was dose-related. A post-infusion fall in platelet count was common, but usually transient and clinically insignificant. This was also dose-related (r = -0.64, p = 0.002). Marked reductions in platelet count were occasionally seen, usually with intensive replacement therapy. The relative lack of side effects observed amongst patients treated at home is attributable to the low, median 33 U/kg, dose used by this group.A subgroup of inhibitor patients, identifiable by their absent or modest anamnestic response to porcine factor VIII may be treated regularly and safely with this product in small doses, over a period of years.
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Affiliation(s)
- C R M Hay
- The University Dept of Haematology, Royal Liverpool University Hospital, Prescot St, Liverpool UK
| | - J N Lozier
- The Division of Haematology, University of North Carolina at Chapel Hill, NC, USA
| | - C A Lee
- The Dept of Haematology, Royal Free Hospital and Medical School, Pond St, London, UK
| | - M Laffan
- The Dept of Haematology, Royal Free Hospital and Medical School, Pond St, London, UK
| | - F Tradati
- The Hemophilia and Thrombosis Centre A. Bianchi Bonoml, Via Pace, Milan, Italy
| | - E Santagostino
- The Hemophilia and Thrombosis Centre A. Bianchi Bonoml, Via Pace, Milan, Italy
| | - N Ciavarella
- The Ospedale Consorziale-Policlinlco, Bari, Italy
| | - M Schiavoni
- The Ospedale Consorziale-Policlinlco, Bari, Italy
| | - H Fukui
- The Dept of Paediatrics, Nara Medical University, Kashihara City, Japan
| | - A Yoshioka
- The Dept of Paediatrics, Nara Medical University, Kashihara City, Japan
| | - J Teitel
- The Division of Haematology, University of Toronto, St Michaels Hospital, Toronto, Canada
| | - P M Mannucci
- The Hemophilia and Thrombosis Centre A. Bianchi Bonoml, Via Pace, Milan, Italy
| | - C K Kasper
- The University of Southern California and Orthopaedic Hospital, Los Angeles, CA, USA
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2
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Mannucci P, Santagostino E, Di Bona E, Gentili G, Ghirardini A, Schiavoni M, Mele A. The Outbreak of Hepatitis A in
Italian Patients with
Hemophilia: Facts and Fancies. Vox Sang 2017. [DOI: 10.1159/000462668] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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3
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Ciavarella N, Schiavoni M, Fasano A, Giliberti M, Ettorre C, Stefanile C. Immune Tolerance in Two High
Responder, Severe Hemophilia A
Patients with Inhibitors:
The Importance of High Doses and the
Duration of the Treatment. Vox Sang 2017. [DOI: 10.1159/000462148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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4
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Villa A, Plebani M, Schiavoni M, Milone C, Piperopoulos E, Galvagno S, Prati L. Tuning hydrophilic properties of carbon nanotubes: A challenge for enhancing selectivity in Pd catalyzed alcohol oxidation. Catal Today 2012. [DOI: 10.1016/j.cattod.2011.09.041] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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5
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Astermark J, Altisent C, Batorova A, Diniz MJ, Gringeri A, Holme PA, Karafoulidou A, Lopez-Fernández MF, Reipert BM, Rocino A, Schiavoni M, von Depka M, Windyga J, Fijnvandraat K. Non-genetic risk factors and the development of inhibitors in haemophilia: a comprehensive review and consensus report. Haemophilia 2010; 16:747-66. [PMID: 20398077 DOI: 10.1111/j.1365-2516.2010.02231.x] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
SUMMARY The development of inhibitors to the infused factor in patients with haemophilia is a serious clinical problem. Recent evidence suggests that alongside the strong genetic contribution to inhibitor formation, there are a number of non-genetic factors--perceived by the immune system as danger signals--which promote formation of inhibitors. This study provides a comprehensive review of clinical studies relating to these factors and also presents a survey of opinion concerning their importance and clinical influence, conducted among the members of the European Haemophilia Treatment Standardisation Board (EHTSB). Taken together, this information highlights the lack of robust data concerning the influence of several non-genetic risk factors on inhibitor development, and an urgent need for prospective, well-conducted studies that adhere to recommendations made by the European Medicines Agency (EMEA) for studying inhibitors. Based on current literature, the EHTSB formulated consensus recommendations. It is desirable to minimize intensive treatment wherever possible, given the clinical situation. Prophylaxis should be offered to all children, although we still need to determine optimal dosing with respect to inhibitor development, and age for starting treatment. Vaccinations should be given subcutaneously and concomitant factor concentrate infusions avoided. According to the board, there is no evidence in the literature supporting suggestions that the type of concentrate influences inhibitor risk; but all patients should be monitored during their first exposures. Furthermore, there is no evidence to support an association between pregnancy-related issues, breast feeding and treatment-related factors (e.g. route of administration, or use of blood components) and inhibitor development.
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Affiliation(s)
- J Astermark
- Centre for Thrombosis and Haemostasis, Malmö University Hospital, Malmö, Sweden.
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6
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Astermark J, Rocino A, Von Depka M, Van Den Berg HM, Gringeri A, Mantovani LG, Morado M, Garrido RP, Schiavoni M, Villar A, Windyga J. Current use of by-passing agents in Europe in the management of acute bleeds in patients with haemophilia and inhibitors. Haemophilia 2007; 13:38-45. [PMID: 17212723 DOI: 10.1111/j.1365-2516.2006.01403.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The ultimate goal of treatment for patients with inhibitory antibodies should be to permanently eradicate the inhibitor by immune tolerance induction therapy (ITI). However, ITI procedures fail in a substantial number of patients and in many countries ITI is not even offered owing to its high cost. How patients with inhibitors are managed in different European countries is evaluated with a special focus on the use of by-passing agents, i.e. recombinant FVIIa (rFVIIa) and activated prothrombin complex concentrates (aPCC), as well as the type of monitoring performed. Investigators from 22 large haemophilia centres participating within the network of the European Haemophilia Therapy Standardisation Board (EHTSB) were asked to complete a questionnaire. rFVIIa was routinely used in all centres for both children and adults at dosages ranging from 90 to 250 mug kg(-1) at an interval of 2-4 h. aPCC was used in 85% of the centres in adults and in 25% of the centres in children with haemophilia A at dosages of 50-100 IU kg(-1) every 6-12 h. The corresponding figures for children and adults with haemophilia B were 40% and 15% of the centres, respectively. Higher dosages of both agents were considered in the case of life-threatening bleeds. General recommendations were developed, based on the information provided by the survey. The results clearly indicate the need for well-designed comparative studies to optimize the use of by-passing agents.
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Affiliation(s)
- J Astermark
- Department for Coagulation Disorders, Malmö University Hospital, Malmö, Sweden.
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7
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Gringeri A, Musso R, Mazzucconi MG, Piseddu G, Schiavoni M, Pignoloni P, Mannucci PM. Immune tolerance induction with a high purity von Willebrand factor/VIII complex concentrate in haemophilia A patients with inhibitors at high risk of a poor response. Haemophilia 2007; 13:373-9. [PMID: 17610550 DOI: 10.1111/j.1365-2516.2007.01484.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Immune tolerance induction (ITI) is effective in approximately 70% of haemophilia patients with inhibitors. Poor prognostic factors are age >6 years, ITI started >1 year from inhibitor development, inhibitor peaks >200 BU, inhibitor titre >10 BU when ITI is started and previously failed ITI. The objective of this study was to identify the effectiveness in ITI of a high purity von Willebrand factor/factor VIII (VWF/FVIII) complex concentrate in inhibitor patients at high risk of failure. Patients with severe or moderate haemophilia A and high responding inhibitors who had at least one poor prognostic factor for ITI failure were prospectively followed-up. Success was defined by undetectable inhibitor, recovery and half life >66% of expected values. ITI dose regimens were chosen by each haemophilia centre. Seventeen haemophiliacs (16 severe, one moderate), aged 4-54 years (median 23) were followed-up for 6-71 months. Poor prognostic factors were delayed-onset ITI (n = 16), age >6 years (n = 16), previously failed ITI (n = 4), inhibitor peak >200 BU (n = 2) and inhibitor >10 BU when ITI was started (n = 4). Complete success was obtained in nine patients (53%) after 4-30 months of treatment (median 24), including two of four patients who had previously failed ITI. Seven patients achieved a partial success, with sustained low inhibitor titres (median 1.5 BU, range 1.1-2.8) but abnormal recovery and/or half-life, while the remaining patient withdrew ITI after 12 months when the inhibitor titer was still 70 BU. These findings suggest that high purity VWF/FVIII complex concentrates are effective in ITI, even in patients at high risk of failure.
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Affiliation(s)
- A Gringeri
- A. Bianchi Bonomi Haemophilia and Thrombosis Centre, Department of Medicine and Medical Specialties, University of Milan and IRCCS Maggiore Hospital, Milan, Italy.
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8
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Astermark J, Morado M, Rocino A, van den Berg HM, von Depka M, Gringeri A, Mantovani L, Garrido RP, Schiavoni M, Villar A, Windyga J. Current European practice in immune tolerance induction therapy in patients with haemophilia and inhibitors. Haemophilia 2006; 12:363-71. [PMID: 16834735 DOI: 10.1111/j.1365-2516.2006.01296.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The management of patients with inhibitors is an important challenge in haemophilia care. The lack of randomized controlled trials means that clinical decisions are generally based on subjective opinions, and purchasers' attention is likely to focus on the costs of treatment. In order to assess the current management of inhibitor patients and use of immune tolerance induction therapy (ITI) in Europe, we performed a survey within a European network of 21 comprehensive care centres from 14 countries (the European Haemophilia Therapy Standardisation Board). The survey identified a total of 381 patients with inhibitors attending the centres, 211 (55.4%) of whom had never been exposed to ITI. Between 1998 and 2003, the centres performed 233 procedures and 114 (48.9%) were successful. The survey demonstrated that dosing, which is the time to start and stop the ITI, the type of concentrate to use and the definition of success varied among the centres. Well-designed trials are warranted to guide decision-making, but in the absence of these studies we have developed consensus guidance for the management of inhibitor patients based on current clinical practice, as identified by the survey, and review of the literature.
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Affiliation(s)
- J Astermark
- Department for Coagulation Disorders, Malmö University Hospital, Malmö, Sweden
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9
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Srámek A, Bucciarelli P, Federici AB, Mannucci PM, De Rosa V, Castaman G, Morfini M, Mazzucconi MG, Rocino A, Schiavoni M, Scaraggi FA, Reiber JHC, Rosendaal FR. Patients With Type 3 Severe von Willebrand Disease Are Not Protected Against Atherosclerosis. Circulation 2004; 109:740-4. [PMID: 14970109 DOI: 10.1161/01.cir.0000112567.53841.10] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
The results of a number of studies in pigs and mice suggest that absence of von Willebrand factor (vWF) protects against the development of atherosclerosis. We studied whether patients with a complete deficiency of vWF (type 3 von Willebrand disease [vWD]) develop fewer atherosclerotic vessel wall changes than healthy controls.
Methods and Results—
This study included 47 individuals with type 3 vWD and 84 healthy controls. Early atherosclerotic changes were assessed by measuring the thickness of the intima-media in the carotid and femoral arteries by B-mode ultrasonography. Advanced atherosclerotic changes were quantified by summing the maximal thickness of atherosclerotic plaques in the carotid and femoral arteries and were expressed as a plaque score. Established risk factors were determined to adjust for possible differences between the groups. We found no substantial difference in intima-media thickness between vWD patients and controls (adjusted difference for carotid artery 0.007 mm, 95% CI −0.022 to 0.036 mm; femoral artery 0.069 mm, 95% CI −0.056 to 0.19 mm). Similar proportions of patients and controls had atherosclerotic plaques (19% and 17%, respectively). No difference was found in the plaque score between groups (adjusted difference −0.22 mm, 95% CI −0.69 to 0.26). Among vWD patients, we found no effect of treatment with vWF concentrates on intima-media thickness or plaque score.
Conclusions—
The results of this study indicate that vWF does not play a substantial role in human atherogenesis.
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Affiliation(s)
- A Srámek
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
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10
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Di Bona E, Schiavoni M, Castaman G, Ciavarella N, Rodeghiero F. Acquired haemophilia: experience of two Italian centres with 17 new cases. Haemophilia 2003; 3:183-8. [DOI: 10.1046/j.1365-2516.1997.00102.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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11
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Schiavoni M, Sanchez-Palencia L, Renzoni F, Grynberg G. Phase control of directed diffusion in a symmetric optical lattice. Phys Rev Lett 2003; 90:094101. [PMID: 12689222 DOI: 10.1103/physrevlett.90.094101] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2002] [Indexed: 05/24/2023]
Abstract
We demonstrate the phenomenon of directed diffusion in a symmetric periodic potential. This has been realized with cold atoms in a one-dimensional dissipative optical lattice. The stochastic process of optical pumping leads to a diffusive dynamics of the atoms through the periodic structure, while a zero-mean force which breaks the temporal symmetry of the system is applied by phase modulating one of the lattice beams. The atoms are set into directed motion as a result of the breaking of the temporal symmetry of the system.
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Affiliation(s)
- M Schiavoni
- Laboratoire Kastler Brossel, Département de Physique de l'Ecole Normale Supérieure, 24, rue Lhomond, 75231, Paris Cedex 05, France
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12
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Carminati FR, Sanchez-Palencia L, Schiavoni M, Renzoni F, Grynberg G. Rayleigh scattering and atomic dynamics in dissipative optical lattices. Phys Rev Lett 2003; 90:043901. [PMID: 12570423 DOI: 10.1103/physrevlett.90.043901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2002] [Revised: 10/23/2002] [Indexed: 05/24/2023]
Abstract
We investigate Rayleigh scattering in dissipative optical lattices. In particular, following recent proposals [S. Guibal, Phys. Rev. Lett. 78, 4709 (1997)]; C. Jurczak, Phys. Rev. Lett. 77, 1727 (1996)]], we study whether the Rayleigh resonance originates from the diffraction on a density grating and is therefore a probe of transport of atoms in optical lattices. It turns out that this is not the case: the Rayleigh line is instead a measure of the cooling rate, while spatial diffusion contributes to the scattering spectrum with a much broader resonance.
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Affiliation(s)
- F R Carminati
- Laboratoire Kastler Brossel, Département de Physique de l'Ecole Normale Supérieure, 24 rue Lhomond, 75231, Paris Cedex 05, France
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13
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Sanchez-Palencia L, Carminati FR, Schiavoni M, Renzoni F, Grynberg G. Brillouin propagation modes in optical lattices: interpretation in terms of nonconventional stochastic resonance. Phys Rev Lett 2002; 88:133903. [PMID: 11955099 DOI: 10.1103/physrevlett.88.133903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2001] [Indexed: 05/23/2023]
Abstract
We report the first direct observation of Brillouin-like propagation modes in a dissipative periodic optical lattice. This has been done by observing a resonant behavior of the spatial diffusion coefficient in the direction corresponding to the propagation mode with the phase velocity of the moving intensity modulation used to excite these propagation modes. Furthermore, we show theoretically that the amplitude of the Brillouin mode is a nonmonotonic function of the strength of the noise corresponding to the optical pumping, and discuss this behavior in terms of nonconventional stochastic resonance.
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Affiliation(s)
- L Sanchez-Palencia
- Laboratoire Kastler-Brossel, Département de Physique de l'Ecole Normale Supérieure, 24 rue Lhomond, 75231, Paris Cedex 05, France
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14
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Berrettini M, Mariani G, Schiavoni M, Rocino A, Di Paolantonio T, Longo G, Morfini M. Pharmacokinetic evaluation of recombinant, activated factor VII in patients with inherited factor VII deficiency. Haematologica 2001; 86:640-5. [PMID: 11418374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Recombinant factor VIIa (rFVIIa) has been widely used in the treatment of bleedings occurring in hemophiliacs with inhibitors. Very few reports exist on the use of rFVIIa in patients with inherited FVII deficiency. Pharmacokinetic studies on rFVIIa have been performed exclusively in hemophiliacs, patients with cirrhosis or volunteers pretreated with acenocoumarol. The aim of this study was to evaluate the kinetics of rFVIIa in patients naturally deficient of FVII. DESIGN AND METHODS A single dose kinetic study with rFVIIa was performed in 5 patients affected by severe congenital deficiency of factor VII in order to evaluate the true kinetic parameters of rFVIIa without the interference of FVII. Two dosages, 15 and 30 microg/kg, were used in a crossover schedule. FVII:C and FVIIa concentration/time curves were analyzed by a model-independent method. Antithrombin (AT), prothombin fragment 1+2 (F1+2) and tissue factor pathway inhibitor (TFPI) were assayed. RESULTS No differences emerged between the dosages with respect to dose-independent parameters [total body clearance (CL), volume of distribution area (VdArea), mean residence time (MRT)]. No significant changes of AT, TFPI, and F1+2 were observed. Comparing the results with those of other studies performed in adult hemophiliacs, in patients affected by cirrhosis or in volunteers on oral anticoagulant therapy (OAT), CL and VdArea of rFVIIa were definitely higher and in vivo recovery was lower. INTERPRETATION AND CONCLUSIONS These findings suggest that the kinetics of rFVIIa are not dose-dependent. In the absence of FVII, the changes of VdArea and CL may be in agreement with a mechanism of competition between FVII and rFVIIa for tissue factor binding.
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15
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Holmlin RE, Schiavoni M, Chen CY, Smith SP, Prentiss MG, Whitesides GM. Light-Driven Microfabrication: Assembly of Multicomponent, Three-Dimensional Structures by Using Optical Tweezers This work was supported by DARPA (G.M.W.), the NIH (G.M.W.), and MRSEC (G.M.W., M.G.P.). R.E.H. thanks the NIH for a postdoctoral fellowship. We thank Emanuele Ostuni and Dr. Shuichi Takayama for helpful discussions. Angew Chem Int Ed Engl 2000; 39:3503-3506. [PMID: 11091403 DOI: 10.1002/1521-3773(20001002)39:19<3503::aid-anie3503>3.0.co;2-m] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- RE Holmlin
- Department of Chemistry and Chemical Biology Harvard University, 12 Oxford Street Cambridge, MA 02138 (USA)
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16
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Santagostino E, Mannucci PM, Gringeri A, Azzi A, Morfini M, Musso R, Santoro R, Schiavoni M. Transmission of parvovirus B19 by coagulation factor concentrates exposed to 100 degrees C heat after lyophilization. Transfusion 1997; 37:517-22. [PMID: 9149778 DOI: 10.1046/j.1537-2995.1997.37597293884.x] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Double inactivation by solvent/detergent treatment plus heating at 100 degrees C for 30 minutes after lyophilization has been adopted to improve viral safety of factor VIII and factor IX concentrates, particularly with respect to non-lipid-enveloped viruses. The aim of this study was to evaluate the safety of concentrates exposed to these virucidal methods. STUDY DESIGN AND METHODS Twenty-six previously untreated hemophiliacs, 19 with factor VIII deficiency and 7 with factor IX deficiency, were investigated in a prospective multicenter study over a 12-month follow-up period by the use of serologic and virologic markers for lipid- and non-lipid-enveloped viruses (human immunodeficiency virus types 1 and 2; hepatitis A, B, and C viruses; B19 parvovirus antibodies; and B19 DNA). Overall, 270,000 U of factor VIII and 102,000 U of factor IX concentrate were administered during the study period. RESULTS None of the 26 patients seroconverted for human immunodeficiency virus or hepatitis C virus. Hepatitis B virus markers remained negative in the 10 unvaccinated hemophiliacs. No hepatitis A virus seroconversion occurred among 17 susceptible patients. B19 seroconversion (IgM) and B19 viremia were observed within 2 weeks of the first concentrate infusion in 8 of 15 susceptible patients, 5 of 11 treated with factor VIII and 3 of 4 with factor IX concentrate. CONCLUSION This prospective study indicates that very high temperatures applied to lyophilized concentrates appear to prevent the transmission of hepatitis A virus to hemophiliacs. However, B19 parvovirus still contaminates concentrates despite the use of this robust virucidal method.
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Affiliation(s)
- E Santagostino
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Maggiore Hospital, Milan, Italy
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17
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Ciavarella N, Schiavoni M, Fasano A, Giliberti MG, Ettorre C, Stefanile C. Immune Tolerance in Two High Responder, Severe Hemophilia A Patients with Inhibitors: The Importance of High Doses and the Duration of the Treatment. Vox Sang 1996. [DOI: 10.1111/j.1423-0410.1996.tb01355.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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18
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Hay CR, Lozier JN, Lee CA, Laffan M, Tradati F, Santagostino E, Ciavarella N, Schiavoni M, Fukui H, Yoshioka A, Teitel J, Mannucci PM, Kasper CK. Safety profile of porcine factor VIII and its use as hospital and home-therapy for patients with haemophilia-A and inhibitors: the results of an international survey. Thromb Haemost 1996; 75:25-9. [PMID: 8713775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
A multicentre retrospective survey was conducted to re-assess the use of porcine factor VIII (HYATE:C), its side effects and the selection of patients for regular or home-therapy. 15,152,000 units of HYATE:C were used by 154 patients. The median inhibitor cross-reactivity to porcine VIIIC of 137 patients was 15%, 27% of patients lacking cross-reactivity. An absent, intermediate or brisk specific antiporcine anamnestic response was observed in 29, 40 and 31% of patients respectively. Seven patients were treated on-demand as home-therapy for a median 6.2, range 1.5-13 years, 23 further patients were treated regularly in hospital for a median of 3, range 2-7 years. This group used 8,319,000 U of porcine VIIIC for 2,000 bleeding episodes. The incidence of transfusion reactions was 0.001%, 0.64% and 2.3%, for domiciliary infusions, infusions in multiply treated in-patients, and unselected in-patient infusions, respectively. The risk of reactions was dose-related. A post-infusion fall in platelet count was common, but usually transient and clinically insignificant. This was also dose-related (r = -0.64, p = 0.002). Marked reductions in platelet count were occasionally seen, usually with intensive replacement therapy. The relative lack of side effects observed amongst patients treated at home is attributable to the low, median 33 U/kg, dose used by this group. A subgroup of inhibitor patients, identifiable by their absent or modest anamnestic response to porcine factor VIII may be treated regularly and safely with this product in small doses, over a period of years.
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Affiliation(s)
- C R Hay
- University Dept of Haematology, Royal Liverpool University Hospital, UK
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Ciavarella N, Schiavoni M, Valenzano E, Mangini F, Inchingolo F. Use of recombinant factor VIIa (NovoSeven) in the treatment of two patients with type III von Willebrand's disease and an inhibitor against von Willebrand factor. Haemostasis 1996; 26 Suppl 1:150-4. [PMID: 8904191 DOI: 10.1159/000217258] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Two siblings affected by type III von Willebrand's disease with precipitating alloantibodies against von Willebrand's factor (vWF) and not susceptible to treatment with factor VIII/vWF concentrates received recombinant activated factor VII for oral surgery. This therapy, combined with antifibrinolytic drugs and local application of fibrin glue, seems to be effective and safe. It may be considered a promising approach to the management of this rare condition.
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Affiliation(s)
- N Ciavarella
- Servizio di Coagulazione, Centro Emofilia, Policlinico-Universita, Bari, Italy
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20
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Morfini M, Mannucci PM, Ciavarella N, Schiavoni M, Gringeri A, Rafanelli D, Di Bona E, Chistolini A, Tagliaferri A, Rodorigo G. Prevalence of infection with the hepatitis C virus among Italian hemophiliacs before and after the introduction of virally inactivated clotting factor concentrates: a retrospective evaluation. Vox Sang 1994; 67:178-82. [PMID: 7801608 DOI: 10.1111/j.1423-0410.1994.tb01655.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
In July 1985, all coagulation factor concentrates were withdrawn from the market in Italy and replaced with virally inactivated concentrates. A retrospective survey comparing the prevalence of the antibody to the hepatitis C virus (anti-HCV) in hemophiliacs multitransfused with nonvirally inactivated concentrates until 1985 with that in previously untreated hemophiliacs transfused exclusively with virally inactivated concentrates since 1985 has been conducted in 9 Italian hemophilia centers. The centers, which follow about one-fourth of all the Italian hemophiliacs, provided information about 708 patients infused for the first time before 1985 (group A) and 80 patients infused for the first time between 1985 and 1991 (group B). The prevalence of anti-HCV was 83% (591/708) in group A and 6% (5/80) in group B. For the 5 anti-HCV-seropositive patients from group B, dry heating, hydrophobic interaction chromatography plus dry heating (2 patients), hot vapor and pasteurization were the virucidal methods used for the concentrates implicated in HCV transmission. In the case associated with pasteurization, there is the possibility of intrafamilial transmission of HCV. It appears from this retrospective analysis that there has been a substantial reduction in the risk of HCV transmission since the adoption of virucidal methods. However, these methods do not eliminate completely the risk, which might be further reduced by the recent adoption of anti-HCV screening for plasma donations used to manufacture concentrates.
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Affiliation(s)
- M Morfini
- Department of Hematology and Hemophilia Center, Careggi Hospital, Firenze, Italy
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21
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Mannucci P, Santagostino E, Bona E, Gentili G, Ghirardini A, Mele A, Schiavoni M. The Outbreak of Hepatitis A in Italian Patients with Hemophilia: Facts and Fancies. Vox Sang 1994. [DOI: 10.1111/j.1423-0410.1994.tb00972.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hay CR, Lozier JN, Lee CA, Lafan M, Tradati H, Santagostino E, Ciavarella N, Schiavoni M, Fukui H, Yoshioka A. Porcine factor VIII therapy in patients with congenital hemophilia and inhibitors: efficacy, patient selection, and side effects. Semin Hematol 1994; 31:20-5. [PMID: 7939768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- C R Hay
- Department of Haematology, University of Liverpool, Royal Liverpool University Hospital, UK
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23
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Mannucci P, Ciavarella N, Schiavoni M, Gringeri A, Rafanelli D, Di Bona E, Chistolini A, Tagliaferri A, Rodorigo G, Baudo F, Gamba G, Morfini M. Prevalence of Infection with the Hepatitis C Virus among Italian Hemophiliacs before and after the Introduction of Virally Inactivated Clotting Factor Concentrates:
A Retrospective Evaluation. Vox Sang 1994. [DOI: 10.1159/000462585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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24
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Santagostino E, Mannucci PM, Gringeri A, Rumi MG, Rafanelli D, Rocino A, Schiavoni M, Chistolini A, Di Bona E, Muleo G. Accelerated schedule of hepatitis B vaccination in patients with hemophilia. J Med Virol 1993; 41:95-8. [PMID: 8283182 DOI: 10.1002/jmv.1890410202] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Early development of immunity after hepatitis B vaccination is particularly important for patients such as hemophiliacs, at high risk for acquiring hepatitis B from potentially infectious plasma-derived concentrates. The purpose of this study was to evaluate whether or not protective antibody titers could be achieved quickly and maintained in hemophiliacs by an accelerated vaccination schedule. A yeast-recombinant hepatitis B vaccine (Engerix B, SKF Ritt) was given subcutaneously in the deltoid region and repeated 2 and 6 weeks later to 85 hemophiliacs negative for hepatitis B virus (HBV) markers. After the first 22 patients had been enrolled, a modification of the schedule involving a fourth booster dose 24 weeks after the first dose of vaccine was applied to the next 63 consecutive vaccines. Fifty-three percent of vaccinees had antibody titers to hepatitis B surface antigen (anti-HBs > or = 10 mlU/ml) by week 6, even though the mean titers of anti-HBs were somewhat lower than those achieved historically in normal individuals. The protection rate had increased to 87% by week 10, one month after the third dose of vaccine, and to 93% by week 24. One year after starting vaccination, the rate for the vaccinees who did not receive the fourth booster dose was 71%, and 96% for those who did receive the fourth dose, with only 2 patients not responding despite the booster dose. It is concluded that even though the accelerated schedule of immunization produced rapidly high rates of protective antibody titers, a booster dose is required to obtain higher titers and provide more persistent immunity.
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Affiliation(s)
- E Santagostino
- Study Group of the Fondazione dell'Emofilia, Milan, Italy
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25
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Schiavoni M, Ettorre C, Basso O, Ciavarella N. Intravenous immunoglobulins were effective in the suppression of inhibitors in a patient with acquired hemophilia. Thromb Res 1993. [DOI: 10.1016/0049-3848(93)90487-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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26
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Ciavarella N, Schiavoni M. Frequency of inhibitors in haemophiliacs. Lancet 1992; 339:1301. [PMID: 1349699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
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27
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Di Paolantonio T, Mariani G, Ghirardini A, Gringeri A, Mannucci PM, Mastrullo L, De Biasi R, Giustarini G, Morfini M, Schiavoni M. Low risk of transmission of the human immunodeficiency virus by a solvent-detergent-treated commercial factor VIII concentrate. J Med Virol 1992; 36:71-4. [PMID: 1583469 DOI: 10.1002/jmv.1890360202] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A study evaluating the risk of a commercial factor VIII (FVIII) concentrate's transmitting the human immunodeficiency virus (HIV) was carried out on hemophiliacs, by using multiple serological markers and the polymerase chain reaction (PCR). Twenty-nine hemophiliacs, negative for HIV antibodies, were treated for 18 months with a concentrate that had been inactivated by solvent-detergent. HIV-1 antibodies and antigen were assayed during the follow-up period. At the end of the study, all patients were also tested by the HIV 1 + 2 combined antibody assay; Western blot (WB) antibody analysis; and in eight cases, by an HIV-1 PCR technique. Patients received a yearly median FVIII dose of 35,330 IU (range 3,300-306,000); the median number of lots given to each patient was 6 (1-45). During the follow-up period and at the end of the study, HIV-1 antibodies and antigen were not detected in any of the subjects. The HIV 1 + 2 combined assay and WB analysis carried out only at the end of the study were negative. HIV-1 PCR was negative in all the tested patients. This study has shown that this solvent-detergent-treated FVIII concentrate did not transmit HIV.
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Affiliation(s)
- T Di Paolantonio
- Department of Human Biopathology, University of Rome La Sapienza, Italy
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Marchetti G, Patracchini P, Volinia S, Aiello V, Schiavoni M, Ciavarella N, Calzolari E, Schwienbacher C, Bernardi F. Characterization of the pseudogenic and genic homologous regions of von Willebrand factor. Br J Haematol 1991; 78:71-9. [PMID: 2043485 DOI: 10.1111/j.1365-2141.1991.tb04385.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The homologous pseudogenic and genic regions of von Willebrand factor (vWF) were studied in DNA from a patient with homozygous deletion of vWF genes and compared with a normal control. This analysis indicates informative restriction patterns for the investigation of restriction fragment length polymorphisms (RFLPs) and gene lesions, and for molecular cloning. A useful new genic XbaI RFLP was found and characterized. A large BgIII fragment of the pseudogenic region was cloned and mapped, and single sequences (9 kb) were used as probes. Corresponding genic and pseudogenic fragments, which contain exons 23-28, and specific restriction patterns were identified, including a new polymorphic TaqI site that was mapped in the gene. A cloned fragment contains the 5' boundary of the pseudogene and recognizes an additional and unknown homologous sequence in the genome. The chromosomal localization of the vWF pseudogene and of the breakpoint cluster region (BCR) gene were compared by 'in situ' hybridization: overlapping patterns were detected. The cloning, characterization and mapping of the pseudogenic region improves the analysis of this portion of chromosome 22 affected by several somatic and constitutional alterations, and also of the corresponding genic region on chromosome 12.
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Affiliation(s)
- G Marchetti
- Centro Studi Biochimici delle Patologie del Genoma Umano-Istituto Chimica Biologica, Università di Ferrara, Italy
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29
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Schiavoni M, Ettorre C, Giliberti M, Ricco G, Ciavarella N. Clinical and laboratory aspects in 80 subjects with antiphospholipid syndrome (APS). Thromb Res 1991. [DOI: 10.1016/0049-3848(91)90538-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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30
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Schiavoni M, Nitti M, Di Monte D, Ciavarella N. High prevalence of anti-HCV antibodies in a cohort of hemophiliacs from Apulia region: Low risk in patients treated with virus inactivated FVIII concentrates. Thromb Res 1991. [DOI: 10.1016/0049-3848(91)90414-r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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31
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Lattarulo M, Schiavoni M, Calamia T, Ettorre C, Garzone M, Console G, Ciavarella N. Preliminary retrospective pharmacokinetic study on 6 severe hemophiliacs A with inhibitor treated with porcine factor VIII (Hyate:C). Thromb Res 1991. [DOI: 10.1016/0049-3848(91)90424-u] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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32
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Ciavarella N, Schiavoni M, Ettorre C, Del Vecchio G, De Mattia O, Schettini F. The treatment of hemophiliacs with inhibitor: 8 years experience in the hemophilia centre of Bari. Thromb Res 1991. [DOI: 10.1016/0049-3848(91)90418-v] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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33
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Ettorre C, Federico F, Di Turi N, Lamberti P, Giliberti M, Schiavoni M, Ciavarella N. Antiphospholipid syndrome (APS) in juvenile ischemic stroke: Retrospective study. Thromb Res 1991. [DOI: 10.1016/0049-3848(91)90562-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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34
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Ciavarella N, Ettorre C, Schiavoni M, Schonauer S, Cicinelli E, Cagnazzo G. Effectiveness of defibrotide for prophylaxis of deep venous thrombosis in gynecological surgery: a double-blind, placebo-controlled clinical trial. Haemostasis 1986; 16 Suppl 1:39-41. [PMID: 3754834 DOI: 10.1159/000215339] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Defibrotide, a new antithrombotic compound without anticoagulant activity, has been tested for prevention of deep venous thrombosis (DVT) in patients undergoing gynecological surgery (mainly hysterectomy). Eighty-nine women (mean age 48.5) were randomly allocated to defibrotide (44 patients) or placebo (45 patients). 800 mg defibrotide was given daily (200 mg intravenously 4 times a day), starting on the day before operation and then for the next 7 days. DVT were detected by the conventional 125I-fibrinogen test. The two groups were homogeneous for known risk factors (age, varicosities, obesity, neoplasia and previous thromboembolic episodes). The results showed a statistically significant reduction of DVT incidence in patients on defibrotide, as compared with those on placebo: 4/44 = 9% vs. 13/45 = 28.8% (p less than 0.05). There were no side effects, including hemorrhagic complications. The numbers of units transfused were comparable for the 2 groups. In conclusion, the trial shows that defibrotide is an effective and safe drug for the prevention of DVT in gynecological surgery.
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Schiavoni M, Parato M, Ciavarella-Berlingerio R, Frontera T, Cicolella A. Impaired Blood and Tissue Fibrinolysis in Patients With Recurrent Venous Thrombosis. Thromb Haemost 1979. [DOI: 10.1055/s-0039-1687229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Blood and tissue fibrinolysis were studied in 70 patients(p.) with recurrent venous thrombosis. The fibrinolytic activity and the release of plasminogen activators “fibrinolytic capacity” by 10 min. venous occlusion were detected by using acetate-buffered diluted clot lysis time, euglobulin lysis time and resuspended euglobulin precipitate on unheated fibrin plates. Plasminogen activator content in the wall of superficiel hand veins in 40 p, was measured by Pandolfi’s modified histochemical technique. Our studies showed a significantly low content of plasminogen activators in the vessel walls in, more then 60% of p. in good correlation with blood defective fibrinolytic activity and/or capacity.
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