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Lester W, Bent C, Alikhan R, Roberts L, Gordon-Walker T, Trenfield S, White R, Forde C, Arachchillage DJ. A British Society for Haematology guideline on the assessment and management of bleeding risk prior to invasive procedures. Br J Haematol 2024; 204:1697-1713. [PMID: 38517351 DOI: 10.1111/bjh.19360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 03/23/2024]
Affiliation(s)
- Will Lester
- Department of Haematology, University Hospitals Birmingham, Birmingham, UK
| | - Clare Bent
- Department of Radiology, University Hospitals Dorset, Dorset, UK
| | - Raza Alikhan
- Department of Haematology, University Hospitals of Cardiff, Cardiff, UK
| | - Lara Roberts
- Department of Haematology, King College London, London, UK
| | - Tim Gordon-Walker
- Scottish Liver Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Sarah Trenfield
- Department of Anaesthesia and Critical Care, Royal Brompton Hospital, London, UK
| | - Richard White
- Department of Radiology, Cardiff and Vale UHB, Cardiff, UK
| | - Colm Forde
- Department of Radiology, University Hospitals Birmingham, Birmingham, UK
| | - Deepa J Arachchillage
- Department of Immunology and Inflammation, Centre for Haematology, Imperial College London, London, UK
- Department of Haematology, Imperial College Healthcare NHS Trust, London, UK
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2
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Platton S, Baker P, Bowyer A, Keenan C, Lawrence C, Lester W, Riddell A, Sutherland M. Guideline for laboratory diagnosis and monitoring of von Willebrand disease: A joint guideline from the United Kingdom Haemophilia Centre Doctors' Organisation and the British Society for Haematology. Br J Haematol 2024; 204:1714-1731. [PMID: 38532595 DOI: 10.1111/bjh.19385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/20/2024] [Accepted: 02/23/2024] [Indexed: 03/28/2024]
Affiliation(s)
- Sean Platton
- Royal London Hospital Haemophilia Centre, London, UK
| | - Peter Baker
- Oxford Haemophilia and Thrombosis Centre, Nuffield Orthopaedic Hospital, Oxford, UK
| | - Annette Bowyer
- Department of Coagulation, Royal Hallamshire Hospital, Sheffield, UK
| | - Catriona Keenan
- Department of Haematology & the National Coagulation Centre, St. James's Hospital, Dublin, Ireland
| | | | - Will Lester
- Haemophilia Unit, University Hospitals, Birmingham, UK
| | - Anne Riddell
- Katharine Dormandy Haemophilia Centre, Royal Free Hospital, London, UK
| | - Megan Sutherland
- North West Genomic Laboratory Hub, Manchester University NHS Foundation Trust, Manchester, UK
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3
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Mistry J, Lowe GC, Lester W, Percy CL. Sustained good response to rituximab in acquired von Willebrand syndrome. Blood Coagul Fibrinolysis 2024; 35:147-149. [PMID: 38557934 DOI: 10.1097/mbc.0000000000001278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Affiliation(s)
- Jayna Mistry
- West Midlands Adult Comprehensive Care Haemophilia & Thrombosis Centre, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK
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Symington E, Rangarajan S, Lester W, Madan B, Pierce GF, Raheja P, Robinson TM, Osmond D, Russell CB, Vettermann C, Agarwal SK, Li M, Wong WY, Laffan M. Long-term safety and efficacy outcomes of valoctocogene roxaparvovec gene transfer up to 6 years post-treatment. Haemophilia 2024; 30:320-330. [PMID: 38317480 DOI: 10.1111/hae.14936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 12/07/2023] [Accepted: 12/30/2023] [Indexed: 02/07/2024]
Abstract
INTRODUCTION Valoctocogene roxaparvovec uses an adeno-associated virus serotype 5 (AAV5) vector to transfer a factor VIII (FVIII) coding sequence to individuals with severe haemophilia A, providing bleeding protection. AIM To assess safety and efficacy of valoctocogene roxaparvovec 5-6 years post-treatment. METHODS In a phase 1/2 trial, adult male participants with severe haemophilia A (FVIII ≤1 IU/dL) without FVIII inhibitors or anti-AAV5 antibodies received valoctocogene roxaparvovec and were followed for 6 (6 × 1013 vg/kg; n = 7) and 5 (4 × 1013 vg/kg; n = 6) years. Safety, including investigation of potential associations between a malignancy and gene therapy, and efficacy are reported. RESULTS No new treatment-related safety signals emerged. During year 6, a participant in the 6 × 1013 vg/kg cohort was diagnosed with grade 2 parotid gland acinar cell carcinoma; definitive treatment was uncomplicated parotidectomy with lymph node dissection. Target enrichment sequencing of tumour and adjacent healthy tissue revealed low vector integration (8.25 × 10-5 per diploid cell). Integrations were not elevated in tumour samples, no insertions appeared to drive tumorigenesis, and no clonal expansion of integration-containing cells occurred. During all follow-ups, >90% decreases from baseline in annualised treated bleeds and FVIII infusion rates were maintained. At the end of years 6 and 5, mean FVIII activity (chromogenic assay) was 9.8 IU/dL (median, 5.6 IU/dL) and 7.6 IU/dL (median, 7.1 IU/dL) for the 6 × 1013 and 4 × 1013 vg/kg cohorts, respectively, representing proportionally smaller year-over-year declines than earlier timepoints. CONCLUSIONS Valoctocogene roxaparvovec safety and efficacy profiles remain largely unchanged; genomic investigations showed no association with a parotid tumour.
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Affiliation(s)
- Emily Symington
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Will Lester
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Bella Madan
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Priyanka Raheja
- Haemophilia Centre Royal London Hospital, Barts Health NHS Trust, London, UK
| | | | - Dane Osmond
- BioMarin Pharmaceutical Inc., Novato, California, USA
| | | | | | | | - Mingjin Li
- BioMarin Pharmaceutical Inc., Novato, California, USA
| | - Wing Yen Wong
- BioMarin Pharmaceutical Inc., Novato, California, USA
| | - Michael Laffan
- Centre for Haematology, Imperial College London, London, UK
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5
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Lester W. Immune thrombotic thrombocytopenic purpura in patients over 60 years of age: Diagnostic pitfalls and treatment strategy. Br J Haematol 2023; 203:704-705. [PMID: 37749067 DOI: 10.1111/bjh.19123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 09/12/2023] [Indexed: 09/27/2023]
Abstract
Real-world registry studies of older patients with iTTP highlight diagnostic difficulties in comparison to patients less than 60 years of age with greater risk of renal injury, atypical neurological features and less profound cytopenia, which can result in diagnostic delays. However, there is no clear signal of significantly increased toxicity from full active treatment. Commentary on: Gómez-Seguí et al. Immune thrombotic thrombocytopenic purpura in older patients: results from the Spanish TTP Registry (REPTT). Br J Haematol 2023;203:860-871.
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Affiliation(s)
- Will Lester
- University Hospitals Birmingham, Birmingham, UK
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6
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Scully M, Rayment R, Clark A, Westwood JP, Cranfield T, Gooding R, Bagot CN, Taylor A, Sankar V, Gale D, Dutt T, McIntyre J, Lester W. A British Society for Haematology Guideline: Diagnosis and management of thrombotic thrombocytopenic purpura and thrombotic microangiopathies. Br J Haematol 2023; 203:546-563. [PMID: 37586700 DOI: 10.1111/bjh.19026] [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: 04/25/2023] [Revised: 07/21/2023] [Accepted: 07/26/2023] [Indexed: 08/18/2023]
Abstract
The objective of this guideline is to provide healthcare professionals with clear, up-to-date and practical guidance on the management of thrombotic thrombocytopenic purpura (TTP) and related thrombotic microangiopathies (TMAs), including complement-mediated haemolytic uraemic syndrome (CM HUS); these are defined by thrombocytopenia, microangiopathic haemolytic anaemia (MAHA) and small vessel thrombosis. Within England, all TTP cases should be managed within designated regional centres as per NHSE commissioning for highly specialised services.
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Affiliation(s)
- M Scully
- Department of Haematology, UCLH and Haematology Programme, University College London Hospitals Biomedical Research Centre, National Institute for Health Research, London, UK
| | - R Rayment
- Department of Haematology, University Hospital of Wales, Cardiff, UK
| | - A Clark
- Department of Haematology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | | | - T Cranfield
- Department of Haematology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - R Gooding
- Haematology Department, Belfast City Hospital, Belfast H&SC Trust, Belfast, UK
| | - C N Bagot
- Glasgow Royal Infirmary, Glasgow, UK
| | - A Taylor
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - V Sankar
- Department of Critical Care Medicine, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - D Gale
- Department of Renal Medicine, University College London, London, UK
| | - T Dutt
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | | | - W Lester
- Department of Haematology, University Hospitals Birmingham, Birmingham, UK
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Platton S, Hill C, Lester W, Yartey N, MacCallum P. Effect of argatroban on laboratory measurement of fibrinogen activity in ex vivo samples - Potential for errors in clinical decision-making. Int J Lab Hematol 2023; 45:781-783. [PMID: 36941797 DOI: 10.1111/ijlh.14061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 03/11/2023] [Indexed: 03/23/2023]
Affiliation(s)
- Sean Platton
- Royal London Hospital Haemophilia Centre, Barts Health NHS Trust, London, UK
| | - Charlotte Hill
- Haemostasis Laboratory, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Will Lester
- Haemophilia Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Nada Yartey
- Department of Haematology, Barts Health NHS Trust, London, UK
- NHS East and South East London Pathology Partnership, Barts Health NHS Trust, London, UK
| | - Peter MacCallum
- Department of Haematology, Barts Health NHS Trust, London, UK
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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8
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Pavord S, Lester W. Reassurance on bleeding and thrombotic events following second dose BNT162b2 and ChAdOx1 COVID-19 vaccines. Lancet Reg Health Eur 2023; 32:100708. [PMID: 37671126 PMCID: PMC10477033 DOI: 10.1016/j.lanepe.2023.100708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 07/19/2023] [Indexed: 09/07/2023]
Affiliation(s)
- Sue Pavord
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Will Lester
- Department of Haematology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
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9
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Jennings I, Lester W, Gray E, Reilly-Stitt C, Gomez K, Williams S, Kitchen S, Walker I. Effect of direct thrombin inhibitors on laboratory measurement of fibrinogen: Potential for errors in clinical decision-making. Int J Lab Hematol 2023; 45:599-602. [PMID: 36793181 DOI: 10.1111/ijlh.14040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/03/2023] [Indexed: 02/17/2023]
Affiliation(s)
| | - Will Lester
- Centre for Clinical Haematology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Elaine Gray
- South Mimms Laboratories, Medicines and Healthcare Products Regulatory Agency, Potters Bar, UK
| | | | - Keith Gomez
- Haemophilia Centre and Thrombosis Unit, Royal Free London NHS Foundation Trust, UK
| | - Stella Williams
- South Mimms Laboratories, Medicines and Healthcare Products Regulatory Agency, Potters Bar, UK
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Singh NK, Lester W, Al-Mulaabed S, Ruoss JL, Li N, De La Cruz D, Gurka M, Neu J. ANTIBIOTICS USE AND ITS EFFECTS ON THE ESTABLISHMENT OF FEEDING TOLERANCE IN PRETERM NEONATES. Am J Perinatol 2023. [PMID: 37308133 DOI: 10.1055/a-2108-1960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Introduction Antibiotics are one of the most widely used medications in today's neonatal intensive care units. Indiscriminate antibiotic usage persists in preterm newborns who are symptomatic due to factors linked to prematurity rather than being septic. Previous studies in older infants suggest that prior antibiotic administration is associated with possible dysmotility and microbial dysbiosis in the intestinal tract. We hypothesize that early antibiotic administration impacts high-risk preterm infants' tolerance to enteral feeding advancement. Methods & Results As part of the Routine Early Antibiotic Use in SymptOmatic Preterm Neonates (REASON) study, symptomatic preterm newborns without maternal infection risk factors were randomized to receive or not receive antibiotics, with C1 receiving antibiotics and C2 not. Of the 55 newborns that underwent pragmatic randomization, 28 preterm neonates in group C1 received antibiotics. The premature neonates in the randomized groups who received antibiotics and those who did not showed no differences in sustained feeding tolerance. Conclusion Our investigation of the risk of feeding issues in babies who get antibiotics early in life revealed no differences between neonates who received antibiotics and those who did not when the randomized controlled trial (RCT) data alone was reviewed. Given the sample sizes, it is uncertain if the preceding analysis is powerful enough to detect differences (a significant percentage of neonates who were randomly assigned to NOT get antibiotics subsequently received early treatment due to changing clinical conditions). This affirms the requirement for a meticulously designed prospective randomized study.
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Affiliation(s)
| | - Will Lester
- Pediatrics, University of Florida, Gainesville, United States
| | | | | | - Nan Li
- Pediatrics-Neonatology, University of Florida, Gainesville, United States
| | | | - Matthew Gurka
- Pediatrics, University of Florida, Gainesville, United States
| | - Josef Neu
- Pediatrics, University of Florida, Gainesville, United States
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Lester W, Walker N, Ciantar E, Banerjee A, Trinder J, Anderson J, Hodson K, Swan L, Bradbury C, Anderson-Brookes J, Bhatia K. Response to Knight and Nelson-Piercy 'Clarity of guidelines concerning the care of pregnant women is lost by the use of de-sexed language'. Br J Haematol 2023. [PMID: 37221821 DOI: 10.1111/bjh.18858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 05/01/2023] [Indexed: 05/25/2023]
Affiliation(s)
- Will Lester
- Centre for Clinical Haematology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Niki Walker
- Cardiology, Golden Jubilee National Hospital West of Scotland Regional Heart and Lung Centre, Glasgow, UK
| | - Etienne Ciantar
- Department of Obstetrics & Gynaecology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Anita Banerjee
- Women's Services, Guy's and Saint Thomas' NHS Foundation Trust, London, UK
| | - Johanna Trinder
- Obstetrics, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | | | - Kenneth Hodson
- Maternity, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Lorna Swan
- Cardiology, Golden Jubilee National Hospital West of Scotland Regional Heart and Lung Centre, Glasgow, UK
| | - Charlotte Bradbury
- Cellular and Molecular Medicine, Bristol Haematology and Oncology Centre, University of Bristol, Bristol, UK
| | | | - Kailash Bhatia
- Anaesthetics, Manchester University NHS Foundation Trust, Manchester, UK
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12
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Lester W, Walker N, Bhatia K, Ciantar E, Banerjee A, Trinder J, Anderson J, Hodson K, Swan L, Bradbury C, Webster J, Tower C. British Society for Haematology guideline for anticoagulant management of pregnant individuals with mechanical heart valves. Br J Haematol 2023. [PMID: 37487690 DOI: 10.1111/bjh.18781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Affiliation(s)
- Will Lester
- Centre for Clinical Haematology, University Hospitals Birmingham NHS Foundation Trust Birmingham UK
| | - Niki Walker
- Department of Cardiology Golden Jubilee National Hospital West of Scotland Regional Heart and Lung Centre Clydebank UK
| | - Kailash Bhatia
- Department of Anaesthetics Manchester University NHS Foundation Trust Manchester UK
| | - Etienne Ciantar
- Department of Obstetrics & Gynaecology Leeds Teaching Hospitals NHS Trust Leeds UK
| | - Anita Banerjee
- Guy's and Saint Thomas' NHS Foundation Trust, Women's Services London UK
| | - Joanna Trinder
- Department of Obstetrics University Hospitals Bristol NHS Foundation Trust Bristol UK
| | | | - Kenneth Hodson
- Department of Maternity Newcastle Upon Tyne Hospitals NHS Foundation Trust Newcastle Upon Tyne UK
| | - Lorna Swan
- Department of Cardiology Golden Jubilee National Hospital West of Scotland Regional Heart and Lung Centre Clydebank UK
| | - Charlotte Bradbury
- Cellular and Molecular Medicine, University of Bristol Bristol UK
- Bristol Haematology and Oncology Centre Bristol UK
| | - Juliette Webster
- Department of Maternity Birmingham Women's and Children's NHS Foundation Trust Birmingham UK
| | - Clare Tower
- Department of Obstetric and Maternal and Fetal Medicine Manchester University NHS Foundation Trust Manchester UK
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13
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Atia J, Evison F, Gallier S, Pettler S, Garrick M, Ball S, Lester W, Morton S, Coleman J, Pankhurst T. Effectiveness of clinical decision support in controlling inappropriate red blood cell and platelet transfusions, speciality specific responses and behavioural change. BMC Med Inform Decis Mak 2022; 22:342. [PMID: 36581868 PMCID: PMC9798655 DOI: 10.1186/s12911-022-02045-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 10/10/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Electronic clinical decision support (CDS) within Electronic Health Records has been used to improve patient safety, including reducing unnecessary blood product transfusions. We assessed the effectiveness of CDS in controlling inappropriate red blood cell (RBC) and platelet transfusion in a large acute hospital and how speciality specific behaviours changed in response. METHODS We used segmented linear regression of interrupted time series models to analyse the instantaneous and long term effect of introducing blood product electronic warnings to prescribers. We studied the impact on transfusions for patients in critical care (CC), haematology/oncology (HO) and elsewhere. RESULTS In non-CC or HO, there was significant and sustained decrease in the numbers of RBC transfusions after introduction of alerts. In CC the alerts reduced transfusions but this was not sustained, and in HO there was no impact on RBC transfusion. For platelet transfusions outside of CC and HO, the introduction of alerts stopped a rising trend of administration of platelets above recommended targets. In CC, alerts reduced platelet transfusions, but in HO alerts had little impact on clinician prescribing. CONCLUSION The findings suggest that CDS can result in immediate change in user behaviour which is more obvious outside specialist settings of CC and HO. It is important that this is then sustained. In CC and HO, blood transfusion practices differ. CDS thus needs to take specific circumstances into account. In this case there are acceptable reasons to transfuse outside of these crude targets and CDS should take these into account.
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Affiliation(s)
- Jolene Atia
- grid.412563.70000 0004 0376 6589University Hospital Birmingham NHS Foundation Trust, Edgbaston, Birmingham, B15 2GW UK ,grid.412563.70000 0004 0376 6589Department of Health Informatics, University Hospital Birmingham NHS Foundation Trust, Edgbaston, Birmingham, B15 2GW UK
| | - Felicity Evison
- grid.412563.70000 0004 0376 6589University Hospital Birmingham NHS Foundation Trust, Edgbaston, Birmingham, B15 2GW UK ,grid.412563.70000 0004 0376 6589Department of Health Informatics, University Hospital Birmingham NHS Foundation Trust, Edgbaston, Birmingham, B15 2GW UK
| | - Suzy Gallier
- grid.412563.70000 0004 0376 6589University Hospital Birmingham NHS Foundation Trust, Edgbaston, Birmingham, B15 2GW UK ,grid.6572.60000 0004 1936 7486PIONEER: HDR-UK Health Data Research Hub for Acute Care, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2GW UK
| | - Sophie Pettler
- grid.412563.70000 0004 0376 6589University Hospital Birmingham NHS Foundation Trust, Edgbaston, Birmingham, B15 2GW UK ,grid.6572.60000 0004 1936 7486School of Medicine, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Mark Garrick
- grid.412563.70000 0004 0376 6589University Hospital Birmingham NHS Foundation Trust, Edgbaston, Birmingham, B15 2GW UK
| | - Simon Ball
- grid.412563.70000 0004 0376 6589University Hospital Birmingham NHS Foundation Trust, Edgbaston, Birmingham, B15 2GW UK ,grid.6572.60000 0004 1936 7486HDRUK Better Care Science Priority and Health Data Research UK Midlands, University of Birmingham, Birmingham, UK
| | - Will Lester
- grid.412563.70000 0004 0376 6589University Hospital Birmingham NHS Foundation Trust, Edgbaston, Birmingham, B15 2GW UK
| | - Suzanne Morton
- grid.412563.70000 0004 0376 6589University Hospital Birmingham NHS Foundation Trust, Edgbaston, Birmingham, B15 2GW UK ,grid.436365.10000 0000 8685 6563NHS Blood and Transplant, Vincent Drive, Edgbaston, Birmingham, B15 2SG UK
| | - Jamie Coleman
- grid.412563.70000 0004 0376 6589University Hospital Birmingham NHS Foundation Trust, Edgbaston, Birmingham, B15 2GW UK ,grid.6572.60000 0004 1936 7486School of Medicine, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Tanya Pankhurst
- grid.412563.70000 0004 0376 6589University Hospital Birmingham NHS Foundation Trust, Edgbaston, Birmingham, B15 2GW UK
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Wang X, Mobley AR, Tica O, Okoth K, Ghosh RE, Myles P, Williams T, Haynes S, Nirantharakumar K, Shukla D, Kotecha D, Mehta S, Breeze S, Lancaster K, Fordyce S, Allen N, Calvert M, Denniston A, Gkoutos G, Jayawardana S, Ball S, Baigent C, Brocklehurst P, Lester W, McManus R, Seri S, Valentine J, Camm AJ, Haynes S, Moore DJ, Rogers A, Stanbury M, Flather M, Walker S, Wang D. Systematic approach to outcome assessment from coded electronic healthcare records in the DaRe2THINK NHS-embedded randomized trial . Eur Heart J Digit Health 2022; 3:426-436. [PMID: 36712153 PMCID: PMC9708037 DOI: 10.1093/ehjdh/ztac046] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 08/15/2022] [Indexed: 02/01/2023]
Abstract
Aims Improving the efficiency of clinical trials is key to their continued importance in directing evidence-based patient care. Digital innovations, in particular the use of electronic healthcare records (EHRs), allow for large-scale screening and follow up of participants. However, it is critical these developments are accompanied by robust and transparent methods that can support high-quality and high clinical value research. Methods and results The DaRe2THINK trial includes a series of novel processes, including nationwide pseudonymized pre screening of the primary-care EHR across England, digital enrolment, remote e-consent, and 'no-visit' follow up by linking all primary- and secondary-care health data with patient-reported outcomes. DaRe2THINK is a pragmatic, healthcare-embedded randomized trial testing whether earlier use of direct oral anticoagulants in patients with prior or current atrial fibrillation can prevent thromboembolic events and cognitive decline (www.birmingham.ac.uk/dare2think). This study outlines the systematic approach and methodology employed to define patient information and outcome events. This includes transparency on all medical code lists and phenotypes used in the trial across a variety of national data sources, including Clinical Practice Research Datalink Aurum (primary care), Hospital Episode Statistics (secondary care), and the Office for National Statistics (mortality). Conclusion Co-designed by a patient and public involvement team, DaRe2THINK presents an opportunity to transform the approach to randomized trials in the setting of routine healthcare, providing high-quality evidence generation in populations representative of the community at risk.
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Affiliation(s)
- Xiaoxia Wang
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK,Health Data Research UK Midlands, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Alastair R Mobley
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK,Health Data Research UK Midlands, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Otilia Tica
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Kelvin Okoth
- Institute of Applied Health Sciences, University of Birmingham, Birmingham, UK
| | - Rebecca E Ghosh
- Clinical Practice Research Datalink, Medicines and Healthcare products Regulatory Agency, London, UK
| | - Puja Myles
- Clinical Practice Research Datalink, Medicines and Healthcare products Regulatory Agency, London, UK
| | - Tim Williams
- Clinical Practice Research Datalink, Medicines and Healthcare products Regulatory Agency, London, UK
| | | | | | - David Shukla
- Institute of Applied Health Sciences, University of Birmingham, Birmingham, UK,Primary Care Clinical Research, NIHR Clinical Research Network West Midlands, Birmingham, UK
| | - Dipak Kotecha
- Corresponding author. Heritage Building, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, B15 2GW, UK. Tel: +44 121 3718122,
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Scully M, Dutt T, Lester W, Farrington E, Lockwood S, Perry R, Holmes S. Unmet needs in the management of immune-mediated thrombotic thrombocytopenic purpura and the potential role of caplacizumab in the UK-A modified-Delphi study. EJHaem 2022; 3:619-627. [PMID: 36051029 PMCID: PMC9422011 DOI: 10.1002/jha2.435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/18/2022] [Accepted: 03/23/2022] [Indexed: 06/15/2023]
Abstract
Immune-mediated thrombotic thrombocytopenic purpura (iTTP) is an ultra-rare, blood-clotting disorder. Management historically relies on plasma exchange and immunosuppression; however, a 10%-20% mortality rate is still observed. Caplacizumab binds to von Willebrand factor and directly inhibits platelet aggregation; addition of caplacizumab to historical treatment induced faster resolution of platelet count in clinical trials. In 2019, a modified-Delphi study was conducted with UK experts, to develop consensus statements on management of acute TTP and the potential role of caplacizumab. An unmet need was acknowledged, and areas requiring improvement included: time to diagnosis and treatment initiation; time to platelet normalisation (TTPN) during which patients remain at risk of persistent microvascular thrombosis and organ damage; and incidence of subsequent exacerbations and relapses. Caplacizumab addition to historical treatment within 24 h (after confirmatory ADAMTS13 [a disintegrin and metalloproteinase with thrombospondin type 1 motif, member 13] assay) would significantly reduce TTPN, which directly influences acute outcomes, with manageable bleeding risk and reduced burden on healthcare systems. Expert panellists agree that poor outcomes in iTTP largely result from failure to rapidly control microvascular thrombosis. Use of caplacizumab during a confirmed iTTP episode could offer better control and may plausibly improve long-term outcomes. However, this consensus must be validated with further clinical trials and robust real-world evidence.
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Affiliation(s)
- Marie Scully
- Department of HaematologyUniversity College London HospitalLondonUK
| | - Tina Dutt
- Liverpool University Hospitals, NHS Foundation TrustLiverpoolUK
| | - Will Lester
- Centre for Clinical HaematologyNHS Foundation TrustUniversity Hospitals BirminghamBirminghamUK
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16
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Bull TP, McCulloch R, Nicolson PL, Doyle AJ, Shaw RJ, Langridge A, Sayar Z, Tucker DL, Pettit M, Perry R, Thomas W, Page C, Whalley I, Dutt T, Garth L, Lester W, Buka RJ, Subhan M, Ware V, Rayment R, Castle D, Etherington A, Carter‐Brzezinski L, Peters J, Corrigan C, Sharma N, Benson G, Challenor S, Skinner TS, Zhao R, McLeod‐Kennedy LA, Douglas K, Knott A, Smith S, Wolf J, Todd SA, McDonald V, Rampotas A, Dean C, Sangha G, Pavord S, Denny N, Jaafar S, McLaughlin DP, Ross JE, Karanth M, Beverstock SL, Mansonso L, Burrows SH, McLaughlin DP, Tauro S, Shenouda A, Bailiff BM, Kajita D, Hermans J, Goradia H, Finan EM, Alford S, Pickard K, Greystoke B, Fail T, Abdussalam A, Roberts LN, Clark JB, Heeney N, Young J, Maddox J, Srinath S, Khawaja J, Parkes J, Babiker S, Hunt BJ, Wheeldon SL, Kerr P, Tahhan M, Vickers M, Pike AC, Hill Q, Mustafa N, Almaremi A, Hughes E, McGoldrick SJ, Loizou E, James I, Boyce SR, Farmer I, Thanigaikumar M, Wheeldon SL, Kerr P, Wickenden K, Gooding R, Thornton K, Kane C, Cole A, Griffin J, Docherty S, Dixon KI, Crowe J, Sheridan M, De Lord C, Sud A, Austin A, Coooper N, Bailey C, Attwell L, Hall R, Gray B, Chauhan SR, Lokare A, Gudger A, Horgan C, Venkatadasari I, Kaddam I, Mapplebeck CL, Van Veen J, Raj M, De Abrew K, Belsham E, Gyansah C, Sadullah S, Salhan B, Murrin R, Williams RL, Stewart A, Cornish N, Otton S, Khan Z, Ackroyd S, Chen LY, Lafferty NP, Leonforte F, Pemberton N, Rawi E, Triantafyllopoulou D, Adiyodi J, Yong J, Jones E, Davies D, Peck RC, Philip R, Seddon T, Cahalin P, Prodger C, Dutton DA, Sternberg AJ, Chengal R, Polzella P, Scully M. Diagnostic uncertainty presented barriers to the timely management of acute thrombotic thrombocytopenic purpura in the United Kingdom between 2014 and 2019. J Thromb Haemost 2022; 20:1428-1436. [PMID: 35189012 PMCID: PMC9314944 DOI: 10.1111/jth.15681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/24/2022] [Accepted: 02/16/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Acute thrombotic thrombocytopenic purpura (TTP) is a life-threatening emergency and plasma exchange (PEX) is the initial treatment shown to reduce acute mortality. OBJECTIVES To compare current practice in the United Kingdom (UK) against the standards set out in the 2012 British Society of Haematology guideline, and to better understand the issues affecting prompt initiation of PEX. PATIENTS/METHODS The trainee research network HaemSTAR conducted a retrospective nationwide review of adults presenting to UK hospitals with a first episode of acute TTP. RESULTS Data on 148 patients treated at 80 UK hospitals between 2014 and 2019 demonstrated that 64.8% of patients received PEX within 24 h. Diagnostic uncertainty was the most commonly cited reason for delayed treatment. Conversely, a shorter time to PEX occurred in patients who had red cell fragments or severe thrombocytopenia identified on their first complete blood count. Availability of on-site PEX was associated with a greater proportion of patients receiving PEX within 8 h compared to patients transferred, but by 24 h there was no difference between the two groups and two-thirds of all patients had received their first PEX. The mortality rate for patients that received PEX was 9.2%, with 27.8% of deaths linked to delayed treatment initiation. CONCLUSIONS This is the first multi-center evaluation of treatment delays in acute TTP and it will inform targeted pathways to improve prompt access to life-saving intervention.
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17
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Doyle AJ, Stubbs MJ, Lester W, Thomas W, Westwood J, Thomas M, Percy C, Prasannan N, Scully M. The use of obinutuzumab and ofatumumab in the treatment of immune thrombotic thrombocytopenic purpura. Br J Haematol 2022; 198:391-396. [DOI: 10.1111/bjh.18192] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/21/2022] [Accepted: 03/25/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Andrew J. Doyle
- Department of Haematology University College Hospitals London NHS Foundation Trust London UK
| | - Matthew J. Stubbs
- Department of Haematology University College Hospitals London NHS Foundation Trust London UK
- Cardiometabolic Programme University College London Hospitals Biomedical Research Centre, National Institute for Health Research London UK
| | - Will Lester
- Department of Haematology University Hospitals Birmingham Birmingham UK
| | - Will Thomas
- Department of Haematology Cambridge University Hospitals NHS Foundation Trust Cambridge UK
| | - John‐Paul Westwood
- Department of Haematology University College Hospitals London NHS Foundation Trust London UK
| | - Mari Thomas
- Department of Haematology University College Hospitals London NHS Foundation Trust London UK
- Cardiometabolic Programme University College London Hospitals Biomedical Research Centre, National Institute for Health Research London UK
| | - Charles Percy
- Department of Haematology University Hospitals Birmingham Birmingham UK
| | - Nithya Prasannan
- Department of Haematology University College Hospitals London NHS Foundation Trust London UK
| | - Marie Scully
- Department of Haematology University College Hospitals London NHS Foundation Trust London UK
- Cardiometabolic Programme University College London Hospitals Biomedical Research Centre, National Institute for Health Research London UK
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18
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Bowyer A, Gray E, Lowe A, Murphy P, Platton S, Riddell A, Chowdary P, Lester W, Jenkins PV. Laboratory coagulation tests and recombinant porcine factor VIII: A United Kingdom Haemophilia Centre Doctors’ Organisation guideline. Haemophilia 2022; 28:515-519. [DOI: 10.1111/hae.14536] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 02/18/2022] [Accepted: 02/25/2022] [Indexed: 01/19/2023]
Affiliation(s)
- Annette Bowyer
- Department of Coagulation Royal Hallamshire Hospital Sheffield UK
| | - Elaine Gray
- Haemostasis Section National Institute for Biological Standards and Control Potters Bar UK
| | - Anna Lowe
- UK National External Quality Assurance Scheme for Blood Coagulation Sheffield UK
| | - Paul Murphy
- Department of Haematology Newcastle Upon Tyne Hospitals Newcastle upon Tyne UK
| | - Sean Platton
- The Royal London Hospital Haemophilia Centre Barts Health NHS Trust London UK
| | - Anne Riddell
- Katharine Dormandy Haemophilia Centre Royal Free Hospital London UK
| | - Pratima Chowdary
- Katharine Dormandy Haemophilia Centre Royal Free Hospital London UK
| | - Will Lester
- Haemophilia Unit University Hospitals Birmingham Birmingham UK
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19
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Doyle AJ, Springell D, Dutt T, Kenworthy J, Ling G, Desborough M, Thomas W, Hermans J, Vanveen J, Cranfield T, Belsham E, Hill QA, Lester W, Scully M. Acquired thrombotic thrombocytopenic purpura: A rare disease associated with BNT162b2 vaccine: Comment from Doyle et al. J Thromb Haemost 2022; 20:781-783. [PMID: 35220653 PMCID: PMC9115209 DOI: 10.1111/jth.15632] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 12/16/2021] [Indexed: 01/17/2023]
Affiliation(s)
- Andrew J Doyle
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Deborah Springell
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Tina Dutt
- Department of Haematology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Jessica Kenworthy
- Department of Haematology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Gavin Ling
- Thrombosis & Haemostasis Centre, Guy's & St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Michael Desborough
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - William Thomas
- Department of Haematology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Joannes Hermans
- Department of Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Joost Vanveen
- Department of Haematology, Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK
| | - Tanya Cranfield
- Department of Haematology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Edward Belsham
- Department of Haematology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Quentin A Hill
- Department of Haematology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Will Lester
- Department of Haematology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Marie Scully
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
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20
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Hann A, Hartog H, Nutu A, Quist K, Sanabria-Mateos R, Greenhall GHB, Ushiro-Lumb I, Nicolson PLR, Cain O, Oo YH, Chauhan A, Lester W, Pollok JM, Prachalias A, Isaac JR, Thorburn D, Forsythe J, Sharif K, Neil DAH, Mirza DF, Perera MTPR. Liver graft outcomes from donors with vaccine induced thrombosis and thrombocytopenia (VITT): United Kingdom multicenter experience. Am J Transplant 2022; 22:996-998. [PMID: 34662508 DOI: 10.1111/ajt.16869] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/06/2021] [Accepted: 10/12/2021] [Indexed: 01/25/2023]
Affiliation(s)
- Angus Hann
- Liver Unit, Queen Elizabeth Hospital, Birmingham, UK.,Centre for liver and gastrointestinal research, Institute of Immunology and Immunotherapy, NIHR Birmingham BRC, University of Birmingham, Birmingham, UK
| | - Hermien Hartog
- Liver Unit, Queen Elizabeth Hospital, Birmingham, UK.,Birmingham Children's Hospital, Birmingham, UK
| | - Anisa Nutu
- Liver Unit, Queen Elizabeth Hospital, Birmingham, UK
| | | | | | | | - Ines Ushiro-Lumb
- National Health Service Blood and Transplant Service, Bristol, UK
| | | | - Owen Cain
- Department of Pathology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Ye H Oo
- Liver Unit, Queen Elizabeth Hospital, Birmingham, UK.,Centre for liver and gastrointestinal research, Institute of Immunology and Immunotherapy, NIHR Birmingham BRC, University of Birmingham, Birmingham, UK
| | - Abhishek Chauhan
- Liver Unit, Queen Elizabeth Hospital, Birmingham, UK.,Centre for liver and gastrointestinal research, Institute of Immunology and Immunotherapy, NIHR Birmingham BRC, University of Birmingham, Birmingham, UK
| | - Will Lester
- Department of Haematology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Joerg-Matthias Pollok
- Liver Unit, Royal Free Hospital, London, UK.,Department of surgery & Interventional Science, University College London, London, UK
| | | | - John R Isaac
- Liver Unit, Queen Elizabeth Hospital, Birmingham, UK
| | - Douglas Thorburn
- Liver Unit, Royal Free Hospital, London, UK.,National Health Service Blood and Transplant Service, Bristol, UK
| | - John Forsythe
- National Health Service Blood and Transplant Service, Bristol, UK
| | | | - Desley A H Neil
- Centre for liver and gastrointestinal research, Institute of Immunology and Immunotherapy, NIHR Birmingham BRC, University of Birmingham, Birmingham, UK.,Department of Haematology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Darius F Mirza
- Liver Unit, Queen Elizabeth Hospital, Birmingham, UK.,Centre for liver and gastrointestinal research, Institute of Immunology and Immunotherapy, NIHR Birmingham BRC, University of Birmingham, Birmingham, UK.,Birmingham Children's Hospital, Birmingham, UK
| | - M Thamara P R Perera
- Liver Unit, Queen Elizabeth Hospital, Birmingham, UK.,Birmingham Children's Hospital, Birmingham, UK
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21
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Stapley RJ, Poulter NS, Khan AO, Smith CW, Bignell P, Fratter C, Lester W, Lowe G, Morgan NV. Rare missense variants in Tropomyosin-4 (TPM4) are associated with platelet dysfunction, cytoskeletal defects, and excessive bleeding. J Thromb Haemost 2022; 20:478-485. [PMID: 34758189 DOI: 10.1111/jth.15584] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/01/2021] [Accepted: 11/05/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND A significant challenge is faced for the genetic diagnosis of inherited platelet disorders in which candidate genetic variants can be found in more than 100 bleeding, thrombotic, and platelet disorder genes, especially within families in which there are both normal and low platelet counts. Genetic variants of unknown clinical significance (VUS) are found in a significant proportion of such patients in which functional studies are required to prove pathogenicity. OBJECTIVE To identify the genetic cause in patients with a suspected platelet disorder and subsequently perform a detailed functional analysis of the candidate genetic variants found. METHODS Genetic and functional studies were undertaken in three patients in two unrelated families with a suspected platelet disorder and excessive bleeding. A targeted gene panel of previously known bleeding and platelet genes was used to identify plausible genetic variants. Deep platelet phenotyping was performed using platelet spreading analysis, transmission electron microscopy, immunofluorescence, and platelet function testing using lumiaggregometry and flow cytometry. RESULTS We report rare conserved missense variants (p.R182C and p.A183V) in TPM4 encoding tromomyosin-4 in 3 patients. Deep platelet phenotyping studies revealed similar platelet function defects across the 3 patients including reduced platelet secretion, and aggregation and spreading defects suggesting that TPM4 missense variants impact platelet function and show a disordered pattern of tropomyosin staining. CONCLUSIONS Genetic and functional TPM4 defects are reported making TPM4 a diagnostic grade tier 1 gene and highlights the importance of including TPM4 in diagnostic genetic screening for patients with significant bleeding and undiagnosed platelet disorders, particularly for those with a normal platelet count.
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Affiliation(s)
- Rachel J Stapley
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Natalie S Poulter
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Centre of Membrane Proteins and Receptors (COMPARE), Universities of Birmingham and Nottingham, Midlands, UK
| | - Abdullah O Khan
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Christopher W Smith
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Patricia Bignell
- Oxford Genetics Laboratories, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Carl Fratter
- Oxford Genetics Laboratories, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Will Lester
- Comprehensive Care Haemophilia Centre, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Gillian Lowe
- Comprehensive Care Haemophilia Centre, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Neil V Morgan
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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22
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Affiliation(s)
- Sue Pavord
- Department of Haematology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK.
| | - Marie Scully
- Department of Haematology, University College London Hospitals NHS Foundation Trust and Cardiometabolic Programme-NIHR UCLH/UC BRC, London, UK
| | - Will Lester
- Department of Haematology, University Hospitals Birmingham, Birmingham, UK
| | - Mike Makris
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Beverley J Hunt
- Thrombosis & Haemophilia Centre, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
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23
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Veitch AM, Radaelli F, Alikhan R, Dumonceau JM, Eaton D, Jerrome J, Lester W, Nylander D, Thoufeeq M, Vanbiervliet G, Wilkinson JR, Van Hooft JE. Endoscopy in patients on antiplatelet or anticoagulant therapy: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guideline update. Gut 2021; 70:1611-1628. [PMID: 34362780 PMCID: PMC8355884 DOI: 10.1136/gutjnl-2021-325184] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 06/20/2021] [Indexed: 12/17/2022]
Abstract
This is a collaboration between the British Society of Gastroenterology (BSG) and the European Society of Gastrointestinal Endoscopy (ESGE), and is a scheduled update of their 2016 guideline on endoscopy in patients on antiplatelet or anticoagulant therapy. The guideline development committee included representatives from the British Society of Haematology, the British Cardiovascular Intervention Society, and two patient representatives from the charities Anticoagulation UK and Thrombosis UK, as well as gastroenterologists. The process conformed to AGREE II principles and the quality of evidence and strength of recommendations were derived using GRADE methodology. Prior to submission for publication, consultation was made with all member societies of ESGE, including BSG. Evidence-based revisions have been made to the risk categories for endoscopic procedures, and to the categories for risks of thrombosis. In particular a more detailed risk analysis for atrial fibrillation has been employed, and the recommendations for direct oral anticoagulants have been strengthened in light of trial data published since the previous version. A section has been added on the management of patients presenting with acute GI haemorrhage. Important patient considerations are highlighted. Recommendations are based on the risk balance between thrombosis and haemorrhage in given situations.
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Affiliation(s)
- Andrew M Veitch
- Gastroenterology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | | | - Raza Alikhan
- Haematology, Cardiff and Vale University Health Board, Cardiff, UK
| | | | | | | | - Will Lester
- Department of Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | - David Nylander
- Gastroenterology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Mo Thoufeeq
- Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - James R Wilkinson
- Interventional Cardiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Jeanin E Van Hooft
- Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, The Netherlands
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24
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Veitch AM, Radaelli F, Alikhan R, Dumonceau JM, Eaton D, Jerrome J, Lester W, Nylander D, Thoufeeq M, Vanbiervliet G, Wilkinson JR, van Hooft JE. Endoscopy in patients on antiplatelet or anticoagulant therapy: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guideline update. Endoscopy 2021; 53:947-969. [PMID: 34359080 PMCID: PMC8390296 DOI: 10.1055/a-1547-2282] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This is a collaboration between the British Society of Gastroenterology (BSG) and the European Society of Gastrointestinal Endoscopy (ESGE), and is a scheduled update of their 2016 guideline on endoscopy in patients on antiplatelet or anticoagulant therapy. The guideline development committee included representatives from the British Society of Haematology, the British Cardiovascular Intervention Society, and two patient representatives from the charities Anticoagulation UK and Thrombosis UK, as well as gastroenterologists. The process conformed to AGREE II principles, and the quality of evidence and strength of recommendations were derived using GRADE methodology. Prior to submission for publication, consultation was made with all member societies of ESGE, including BSG. Evidence-based revisions have been made to the risk categories for endoscopic procedures, and to the categories for risks of thrombosis. In particular a more detailed risk analysis for atrial fibrillation has been employed, and the recommendations for direct oral anticoagulants have been strengthened in light of trial data published since the previous version. A section has been added on the management of patients presenting with acute GI haemorrhage. Important patient considerations are highlighted. Recommendations are based on the risk balance between thrombosis and haemorrhage in given situations.
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Affiliation(s)
- Andrew M. Veitch
- Department of Gastroenterology, Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
| | | | - Raza Alikhan
- Department of Haematology Cardiff and Vale University Health Board, Cardiff, United Kingdom
| | - Jean-Marc Dumonceau
- Department of Gastroenterology, Charleroi University Hospitals, Charleroi, Belgium
| | | | | | - Will Lester
- Department of Haematology University Hospitals Birmingham NHS Foundation Trust, Birmingham,
| | - David Nylander
- Department of Gastroenterology, The Newcastle-upon-Tyne NHS Foundation Trust, Newcastle-upon-Tyne
| | - Mo Thoufeeq
- Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield
| | | | - James R. Wilkinson
- Department of Interventional Cardiology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Jeanin E. van Hooft
- Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, Netherlands
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25
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Green C, Nadir A, Lester W, Dosanjh D. Coronary artery thrombus resulting in ST-elevation myocardial infarction in a patient with COVID-19. BMJ Case Rep 2021; 14:14/8/e243811. [PMID: 34433529 PMCID: PMC8388305 DOI: 10.1136/bcr-2021-243811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
COVID-19 is a prothrombotic condition that is also associated with raised troponin levels and myocardial damage. We present a case of a 54-year-old man who was admitted with respiratory failure due to COVID-19 and developed a ST-elevation myocardial infarction (STEMI) during his admission. His coronary angiogram did not show any significant coronary artery disease other than a heavily thrombosed right coronary artery. In view of heavy thrombus burden, the right coronary artery was treated with thrombus retrieval using a distal embolic protection device in addition to manual thrombectomy and direct (intracoronary) thrombolysis without the need for implantation of a coronary stent. After successful revascularisation, triple antithrombotic therapy was instituted with an oral anticoagulant in addition to dual antiplatelets. This case illustrates the association of COVID-19 with coronary artery thrombosis, which may require disparate management of a STEMI than that resulting from atherosclerotic coronary artery disease.
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Affiliation(s)
- Clara Green
- Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Adnan Nadir
- Cardiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Will Lester
- Haematology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Davinder Dosanjh
- Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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26
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Pasi KJ, Laffan M, Rangarajan S, Robinson TM, Mitchell N, Lester W, Symington E, Madan B, Yang X, Kim B, Pierce GF, Wong WY. Persistence of haemostatic response following gene therapy with valoctocogene roxaparvovec in severe haemophilia A. Haemophilia 2021; 27:947-956. [PMID: 34378280 PMCID: PMC9291073 DOI: 10.1111/hae.14391] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/30/2021] [Accepted: 07/25/2021] [Indexed: 12/17/2022]
Abstract
Introduction Valoctocogene roxaparvovec is an investigational AAV5‐based factor VIII (FVIII) gene therapy that has demonstrated sustained clinical benefit in people with severe haemophilia A. Aim To report safety, tolerability, efficacy, and quality of life (QOL) among participants who received valoctocogene roxaparvovec in a phase 1/2 clinical study (NCT02576795). Methods Men ≥18 years of age with severe haemophilia A (FVIII ≤1 IU/dl) without history of FVIII inhibitors or anti‐AAV5 antibodies received a single infusion of valoctocogene roxaparvovec and were followed for 5 years (6 × 1013 vg/kg dose, n = 7) and 4 years (4 × 1013 vg/kg dose, n = 6). Results Over the past 2 years, few adverse events and no FVIII inhibitors were reported. Per chromogenic substrate (CSA) assay at years 5 and 4, four of seven and three of six participants in the 6 × 1013 and 4 × 1013 vg/kg cohorts, respectively, maintained median FVIII levels >5 IU/dl, corresponding to mild haemophilia. By regression analysis, rate of change in FVIII activity was ‐0.14 (95% confidence interval [CI]: ‐.32 to .03) IU/dl/wk in the 6 × 1013 vg/kg cohort in year 5 and ‐.06 (95% CI: ‐.14 to .01) IU/dl/wk in the 4 × 1013 vg/kg cohort in year 4. No participants resumed FVIII prophylaxis, and eight of 13 participants reported zero bleeds in the past 2 years. Improved QOL from baseline persisted in the 6 × 1013 vg/kg cohort; all six Haemo‐QOL‐A domain scores increased. For the 4 × 1013 vg/kg cohort, high baseline Haemo‐QOL‐A scores persisted. Conclusion These results demonstrate transgene expression and haemostatic response for up to 5 years in individuals with haemophilia A.
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Affiliation(s)
- K John Pasi
- Barts and the London School of Medicine and Dentistry, London, UK
| | - Michael Laffan
- Centre for Haematology, Imperial College London, London, UK
| | | | | | - Nina Mitchell
- BioMarin Pharmaceutical Inc., Novato, California, USA
| | - Will Lester
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Emily Symington
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Bella Madan
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Xinqun Yang
- BioMarin Pharmaceutical Inc., Novato, California, USA
| | - Benjamin Kim
- BioMarin Pharmaceutical Inc., Novato, California, USA
| | | | - Wing Yen Wong
- BioMarin Pharmaceutical Inc., Novato, California, USA
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Schofield J, Shaw RJ, Lester W, Thomas W, Toh CH, Dutt T. Intracranial hemorrhage in immune thrombotic thrombocytopenic purpura treated with caplacizumab. J Thromb Haemost 2021; 19:1922-1925. [PMID: 33974343 DOI: 10.1111/jth.15363] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 05/03/2021] [Indexed: 12/18/2022]
Affiliation(s)
- Jeremy Schofield
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Rebecca J Shaw
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, UK
| | - Will Lester
- Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Will Thomas
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Cheng-Hock Toh
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, UK
| | - Tina Dutt
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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Al-Lawati K, Osheiba M, Lester W, Khan SQ. Management of acute myocardial infarction in a patient with idiopathic thrombocytopenic purpura, the value of optical coherence tomography: a case report. Eur Heart J Case Rep 2020; 4:1-5. [PMID: 33442592 PMCID: PMC7793035 DOI: 10.1093/ehjcr/ytaa460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 08/11/2020] [Accepted: 11/05/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Treating myocardial infarction in the setting of immune thrombocytopenic purpura (ITP) is always a challenge especially if the platelet count is labile. Cardiologists dealing with such patients should keep a delicate balance between thrombotic and bleeding complications. CASE SUMMARY A 50-year-old gentleman with treatment-challenging ITP presented with acute inferior ST elevation myocardial infarction after receiving recent intravenous immunoglobulin. Using optical coherence tomography (OCT) guidance, it was decided to treat him with percutaneous old balloon angioplasty especially with the labile nature of his platelet count. Subsequently, dual antiplatelet therapy was a challenge and he remained on clopidogrel for a period of only 10 weeks. CONCLUSION This case highlights the rare presentation of patients with ITP with thrombotic complications and the usefulness of OCT in formulating a management plan.
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Affiliation(s)
- Kumayl Al-Lawati
- Department of Cardiology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Edgbaston, B15 2TH Birmingham, UK
- Royal Hospital, National Heart Centre, Ministry of Health, Al-Ghubrah, Muscat, Oman
| | - Mohammed Osheiba
- Department of Cardiology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Edgbaston, B15 2TH Birmingham, UK
- Cardiology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Will Lester
- Department of Haematology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Edgbaston, B15 2TH Birmingham, UK
| | - Sohail Q Khan
- Department of Cardiology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Edgbaston, B15 2TH Birmingham, UK
- Institute of Cardiovascular Sciences, University of Birmingham, B15 2TT, UK
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29
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Ozelo M, Pasi K, Rangarajan S, Mitchell N, Lester W, Symington E, Madan B, Laffan M, Russell C, Li M, Kim B, Pierce G, Wong W. A FIRST-IN-HUMAN FOUR-YEAR FOLLOW-UP STUDY OF DURABLE THERAPEUTIC EFFICACY AND SAFETY OF AAV GENE THERAPY WITH VALOCTOCOGENE ROXAPARVOVEC FOR SEVERE HEMOPHILIA A. Hematol Transfus Cell Ther 2020. [DOI: 10.1016/j.htct.2020.10.099] [Citation(s) in RCA: 1] [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: 11/27/2022] Open
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30
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Neuberger J, Patel J, Caldwell H, Davies S, Hebditch V, Hollywood C, Hubscher S, Karkhanis S, Lester W, Roslund N, West R, Wyatt JI, Heydtmann M. Guidelines on the use of liver biopsy in clinical practice from the British Society of Gastroenterology, the Royal College of Radiologists and the Royal College of Pathology. Gut 2020; 69:1382-1403. [PMID: 32467090 PMCID: PMC7398479 DOI: 10.1136/gutjnl-2020-321299] [Citation(s) in RCA: 131] [Impact Index Per Article: 32.8] [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: 04/02/2020] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 12/11/2022]
Abstract
Liver biopsy is required when clinically important information about the diagnosis, prognosis or management of a patient cannot be obtained by safer means, or for research purposes. There are several approaches to liver biopsy but predominantly percutaneous or transvenous approaches are used. A wide choice of needles is available and the approach and type of needle used will depend on the clinical state of the patient and local expertise but, for non-lesional biopsies, a 16-gauge needle is recommended. Many patients with liver disease will have abnormal laboratory coagulation tests or receive anticoagulation or antiplatelet medication. A greater understanding of the changes in haemostasis in liver disease allows for a more rational, evidence-based approach to peri-biopsy management. Overall, liver biopsy is safe but there is a small morbidity and a very small mortality so patients must be fully counselled. The specimen must be of sufficient size for histopathological interpretation. Communication with the histopathologist, with access to relevant clinical information and the results of other investigations, is essential for the generation of a clinically useful report.
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Affiliation(s)
- James Neuberger
- Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jai Patel
- Department of Vascular Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Helen Caldwell
- Liver Unit, Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, UK
| | - Susan Davies
- Department of Histopathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Coral Hollywood
- Department of Gastroenterology, Gloucestershire Royal Hospital, Gloucester, UK
| | - Stefan Hubscher
- Department of Pathology, University of Birmingham, Birmingham, UK
| | - Salil Karkhanis
- Department of Radiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Will Lester
- Department of Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | | | | | - Judith I Wyatt
- Department of Pathology, St James University Hospital, Leeds, UK
| | - Mathis Heydtmann
- Department of Gastroenterology, Royal Alexandra Hospital, Glasgow, UK
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31
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Chandra D, Dabhi K, Lester W. Are we assessing venous thromboembolism (VTE) risk appropriately for hospitalised medical patients? The National VTE Risk Assessment Tool versus Padua Prediction Score. Br J Haematol 2020; 189:e16-e18. [PMID: 31978942 DOI: 10.1111/bjh.16411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Deepak Chandra
- Haematology, University Hospital of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Keval Dabhi
- Health Informatics, University Hospital Birminmgham NHS Foundation Trust, Birmingham, UK
| | - Will Lester
- Haematology, University Hospital Birminmgham NHS Foundation Trust, Birmingham, UK
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32
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Arachchillage DRJ, Gomez K, Alikhan R, Anderson JAM, Lester W, Laffan M. Addendum to British Society for Haematology Guidelines on Investigation and Management of Antiphospholipid syndrome, 2012 (
Br. J.
Haematol
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2012; 157: 47–58): use of direct acting oral anticoagulants. Br J Haematol 2020; 189:212-215. [DOI: 10.1111/bjh.16308] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 09/26/2019] [Indexed: 12/31/2022]
Affiliation(s)
- Deepa R. J. Arachchillage
- Department of Haematology Imperial College Healthcare NHS Trust London UK
- Centre for Haematology Imperial College London London UK
| | - Keith Gomez
- Katherine Dormandy Haemophilia Centre and Thrombosis Unit Royal Free London NHS Foundation Trust London UK
| | - Raza Alikhan
- Haemophilia and Thrombosis Centre University Hospital of Wales Cardiff UK
| | | | - Will Lester
- Centre for Clinical Haematology University Hospitals Birmingham NHS Foundation Trust Birmingham UK
| | - Mike Laffan
- Department of Haematology Imperial College Healthcare NHS Trust London UK
- Centre for Haematology Imperial College London London UK
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33
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Pasi KJ, Rangarajan S, Mitchell N, Lester W, Symington E, Madan B, Laffan M, Russell CB, Li M, Pierce GF, Wong WY. Multiyear Follow-up of AAV5-hFVIII-SQ Gene Therapy for Hemophilia A. N Engl J Med 2020; 382:29-40. [PMID: 31893514 DOI: 10.1056/nejmoa1908490] [Citation(s) in RCA: 270] [Impact Index Per Article: 67.5] [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: 11/19/2022]
Abstract
BACKGROUND Adeno-associated virus (AAV)-mediated gene therapy is under investigation as a therapeutic option for persons with hemophilia A. Efficacy and safety data include 3 years of follow-up after a single administration of AAV5-hFVIII-SQ. METHODS We report durable efficacy, long-term safety, and clinical and biologic results in 15 adults with severe hemophilia A (factor VIII level, ≤1 IU per deciliter) who had received a single infusion of AAV5-hFVIII-SQ at various dose levels. We evaluated the factor VIII level, annualized rate of bleeding events, use of factor VIII, safety, expression kinetics, and biologic markers of AAV transduction for up to 3 years. RESULTS Three years after infusion, two participants (one who had received 6×1012 vector genomes [vg] per kilogram of body weight and one who had received 2×1013 vg per kilogram) had factor VIII expression of less than 1 IU per deciliter, as assessed on chromogenic assay. Seven participants (who had received 6×1013 vg per kilogram) had a median factor VIII expression of 20 IU per deciliter; the median number of annualized treated bleeding events was 0, and the median use of exogenous factor VIII was reduced from 138.5 infusions to 0 infusions per year. Bleeding in all target joints (major joints with ≥3 bleeding events within 6 months) in this cohort resolved (≤2 bleeding events within 12 months). Two years after infusion, six participants (who had received 4×1013 vg per kilogram) had a median factor VIII expression of 13 IU per deciliter; the median annualized rate of bleeding events was 0, and the median use of factor VIII was reduced from 155.5 infusions to 0.5 infusions per year. Bleeding in target joints resolved in five of six participants. The factor VIII pharmacodynamic profiles reflected cellular turnover in the blood and molecular events leading to episomal DNA stabilization for persistent expression, findings that are consistent with previous observations in two model systems. Transgene-derived human factor VIII (hFVIII) protein activity mirrored native hFVIII in hemostatic ability. No inhibitor development, thromboses, deaths, or persistent changes in liver-function tests were observed. CONCLUSIONS Gene therapy with AAV5-hFVIII-SQ vector in participants with hemophilia A resulted in sustained, clinically relevant benefit, as measured by a substantial reduction in annualized rates of bleeding events and complete cessation of prophylactic factor VIII use in all participants who had received 4×1013 vg per kilogram or 6×1013 vg per kilogram of the gene therapy. (Funded by BioMarin Pharmaceutical; ClinicalTrials.gov number, NCT02576795; EudraCT number, 2014-003880-38.).
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Affiliation(s)
- K John Pasi
- From Barts and the London School of Medicine and Dentistry (K.J.P.), Guy's and St. Thomas' NHS Foundation Trust (B.M.), and the Centre for Haematology, Imperial College London (M. Laffan), London, University Hospital Southampton, Southampton (S.R.), University Hospitals Birmingham NHS Foundation Trust, Birmingham (W.L.), and Cambridge University Hospitals NHS Foundation Trust, Cambridge (E.S.) - all in the United Kingdom; and BioMarin Pharmaceutical, Novato (N.M., C.B.R., M. Li, W.Y.W.), and private consultant, La Jolla (G.F.P.) - both in California
| | - Savita Rangarajan
- From Barts and the London School of Medicine and Dentistry (K.J.P.), Guy's and St. Thomas' NHS Foundation Trust (B.M.), and the Centre for Haematology, Imperial College London (M. Laffan), London, University Hospital Southampton, Southampton (S.R.), University Hospitals Birmingham NHS Foundation Trust, Birmingham (W.L.), and Cambridge University Hospitals NHS Foundation Trust, Cambridge (E.S.) - all in the United Kingdom; and BioMarin Pharmaceutical, Novato (N.M., C.B.R., M. Li, W.Y.W.), and private consultant, La Jolla (G.F.P.) - both in California
| | - Nina Mitchell
- From Barts and the London School of Medicine and Dentistry (K.J.P.), Guy's and St. Thomas' NHS Foundation Trust (B.M.), and the Centre for Haematology, Imperial College London (M. Laffan), London, University Hospital Southampton, Southampton (S.R.), University Hospitals Birmingham NHS Foundation Trust, Birmingham (W.L.), and Cambridge University Hospitals NHS Foundation Trust, Cambridge (E.S.) - all in the United Kingdom; and BioMarin Pharmaceutical, Novato (N.M., C.B.R., M. Li, W.Y.W.), and private consultant, La Jolla (G.F.P.) - both in California
| | - Will Lester
- From Barts and the London School of Medicine and Dentistry (K.J.P.), Guy's and St. Thomas' NHS Foundation Trust (B.M.), and the Centre for Haematology, Imperial College London (M. Laffan), London, University Hospital Southampton, Southampton (S.R.), University Hospitals Birmingham NHS Foundation Trust, Birmingham (W.L.), and Cambridge University Hospitals NHS Foundation Trust, Cambridge (E.S.) - all in the United Kingdom; and BioMarin Pharmaceutical, Novato (N.M., C.B.R., M. Li, W.Y.W.), and private consultant, La Jolla (G.F.P.) - both in California
| | - Emily Symington
- From Barts and the London School of Medicine and Dentistry (K.J.P.), Guy's and St. Thomas' NHS Foundation Trust (B.M.), and the Centre for Haematology, Imperial College London (M. Laffan), London, University Hospital Southampton, Southampton (S.R.), University Hospitals Birmingham NHS Foundation Trust, Birmingham (W.L.), and Cambridge University Hospitals NHS Foundation Trust, Cambridge (E.S.) - all in the United Kingdom; and BioMarin Pharmaceutical, Novato (N.M., C.B.R., M. Li, W.Y.W.), and private consultant, La Jolla (G.F.P.) - both in California
| | - Bella Madan
- From Barts and the London School of Medicine and Dentistry (K.J.P.), Guy's and St. Thomas' NHS Foundation Trust (B.M.), and the Centre for Haematology, Imperial College London (M. Laffan), London, University Hospital Southampton, Southampton (S.R.), University Hospitals Birmingham NHS Foundation Trust, Birmingham (W.L.), and Cambridge University Hospitals NHS Foundation Trust, Cambridge (E.S.) - all in the United Kingdom; and BioMarin Pharmaceutical, Novato (N.M., C.B.R., M. Li, W.Y.W.), and private consultant, La Jolla (G.F.P.) - both in California
| | - Michael Laffan
- From Barts and the London School of Medicine and Dentistry (K.J.P.), Guy's and St. Thomas' NHS Foundation Trust (B.M.), and the Centre for Haematology, Imperial College London (M. Laffan), London, University Hospital Southampton, Southampton (S.R.), University Hospitals Birmingham NHS Foundation Trust, Birmingham (W.L.), and Cambridge University Hospitals NHS Foundation Trust, Cambridge (E.S.) - all in the United Kingdom; and BioMarin Pharmaceutical, Novato (N.M., C.B.R., M. Li, W.Y.W.), and private consultant, La Jolla (G.F.P.) - both in California
| | - Chris B Russell
- From Barts and the London School of Medicine and Dentistry (K.J.P.), Guy's and St. Thomas' NHS Foundation Trust (B.M.), and the Centre for Haematology, Imperial College London (M. Laffan), London, University Hospital Southampton, Southampton (S.R.), University Hospitals Birmingham NHS Foundation Trust, Birmingham (W.L.), and Cambridge University Hospitals NHS Foundation Trust, Cambridge (E.S.) - all in the United Kingdom; and BioMarin Pharmaceutical, Novato (N.M., C.B.R., M. Li, W.Y.W.), and private consultant, La Jolla (G.F.P.) - both in California
| | - Mingjin Li
- From Barts and the London School of Medicine and Dentistry (K.J.P.), Guy's and St. Thomas' NHS Foundation Trust (B.M.), and the Centre for Haematology, Imperial College London (M. Laffan), London, University Hospital Southampton, Southampton (S.R.), University Hospitals Birmingham NHS Foundation Trust, Birmingham (W.L.), and Cambridge University Hospitals NHS Foundation Trust, Cambridge (E.S.) - all in the United Kingdom; and BioMarin Pharmaceutical, Novato (N.M., C.B.R., M. Li, W.Y.W.), and private consultant, La Jolla (G.F.P.) - both in California
| | - Glenn F Pierce
- From Barts and the London School of Medicine and Dentistry (K.J.P.), Guy's and St. Thomas' NHS Foundation Trust (B.M.), and the Centre for Haematology, Imperial College London (M. Laffan), London, University Hospital Southampton, Southampton (S.R.), University Hospitals Birmingham NHS Foundation Trust, Birmingham (W.L.), and Cambridge University Hospitals NHS Foundation Trust, Cambridge (E.S.) - all in the United Kingdom; and BioMarin Pharmaceutical, Novato (N.M., C.B.R., M. Li, W.Y.W.), and private consultant, La Jolla (G.F.P.) - both in California
| | - Wing Y Wong
- From Barts and the London School of Medicine and Dentistry (K.J.P.), Guy's and St. Thomas' NHS Foundation Trust (B.M.), and the Centre for Haematology, Imperial College London (M. Laffan), London, University Hospital Southampton, Southampton (S.R.), University Hospitals Birmingham NHS Foundation Trust, Birmingham (W.L.), and Cambridge University Hospitals NHS Foundation Trust, Cambridge (E.S.) - all in the United Kingdom; and BioMarin Pharmaceutical, Novato (N.M., C.B.R., M. Li, W.Y.W.), and private consultant, La Jolla (G.F.P.) - both in California
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34
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Jenkins PV, Bowyer A, Burgess C, Gray E, Kitchen S, Murphy P, Platton S, Riddell A, Chowdary P, Lester W. Laboratory coagulation tests and emicizumab treatment A United Kingdom Haemophilia Centre Doctors' Organisation guideline. Haemophilia 2019; 26:151-155. [DOI: 10.1111/hae.13903] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 11/21/2019] [Accepted: 11/25/2019] [Indexed: 12/16/2022]
Affiliation(s)
- P. Vincent Jenkins
- Haemostasis and Thrombosis Haematology Department University Hospital of Wales Cardiff UK
| | - Annette Bowyer
- Department of Coagulation Royal Hallamshire Hospital Sheffield UK
| | - Clive Burgess
- Coagulation Laboratory Great Ormond Street Hospital for Children NHS Trust London UK
| | - Elaine Gray
- Haemostasis Section National Institute for Biological Standards and Control Potters Bar UK
| | - Steve Kitchen
- Department of Coagulation Royal Hallamshire Hospital Sheffield UK
| | - Paul Murphy
- Department of Haematology Newcastle Upon Tyne Hospitals Newcastle upon Tyne Newcastle upon Tyne UK
| | - Sean Platton
- The Royal London Hospital Haemophilia Centre Royal London Hospital London UK
| | - Anne Riddell
- Katharine Dormandy Haemophilia Centre Royal Free Hospital London UK
| | - Pratima Chowdary
- Katharine Dormandy Haemophilia Centre Royal Free Hospital London UK
| | - Will Lester
- Haemophilia Unit University Hospitals Birmingham Birmingham UK
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Gray E, Kitchen S, Bowyer A, Chowdary P, Jenkins PV, Murphy P, Platton S, Riddell A, Lester W. Laboratory measurement of factor replacement therapies in the treatment of congenital haemophilia: A United Kingdom Haemophilia Centre Doctors’ Organisation guideline. Haemophilia 2019; 26:6-16. [DOI: 10.1111/hae.13907] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 11/26/2019] [Accepted: 11/26/2019] [Indexed: 02/03/2023]
Affiliation(s)
- Elaine Gray
- Haemostasis Section, Biotherapeutics Group National Institute for Biological Standards and Control Potters Bar UK
| | - Steve Kitchen
- Department of Coagulation Royal Hallamshire Hospital Sheffield UK
| | - Annette Bowyer
- Department of Coagulation Royal Hallamshire Hospital Sheffield UK
| | - Pratima Chowdary
- Katharine Dormandy Haemophilia and Thrombosis Centre Royal Free Hospital London UK
| | - P. Vincent Jenkins
- Haematology Department Haemostasis Laboratory University Hospital of Wales Cardiff UK
| | - Paul Murphy
- Haemostasis Department Newcastle Upon Tyne Hospitals Newcastle upon Tyne UK
| | - Sean Platton
- The Royal London Hospital Haemophilia Centre The Royal London Hospital London UK
| | - Anne Riddell
- Katharine Dormandy Haemophilia and Thrombosis Centre Royal Free Hospital London UK
| | - Will Lester
- Haemophilia Unit University Hospitals Birmingham Birmingham UK
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36
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Lester W, Gomez K, Shapiro S, Dabhi K, Laffan M. NICE NG89 recommendations for extended pharmacological thromboprophylaxis - is it justified and is it cost effective: a rebuttal from the British Society for Haematology. Br J Haematol 2019; 186:790-791. [PMID: 31168789 DOI: 10.1111/bjh.16007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Will Lester
- Centre for Clinical Haematology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Keith Gomez
- Katherine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London, UK
| | - Susie Shapiro
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Keval Dabhi
- Health Informatics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Mike Laffan
- Department of Haematology, Imperial College Academic Health Sciences Centre, Hammersmith Hospital, London, UK
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Lester W, Andrews L, Nellhaus EM, Murray S, Loudin S, Davies TH. Symptomology Associated with in Utero Exposures to Polysubstance in an Appalachian Population. Marshall Journal of Medicine 2019. [DOI: 10.33470/2379-9536.1212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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38
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Lowe GC, Fickowska R, Al Ghaithi R, Maclachlan A, Harrison P, Lester W, Watson SP, Myers B, Clark J, Morgan NV. Investigation of the contribution of an underlying platelet defect in women with unexplained heavy menstrual bleeding. Platelets 2018; 30:56-65. [PMID: 30520671 PMCID: PMC6406209 DOI: 10.1080/09537104.2018.1543865] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Heavy menstrual bleeding (HMB) is often undiagnosed in women and can cause discomfort and distress. A haemostatic cause for excessive bleeding is often not routinely investigated and can lead to hysterectomy at an early age. A prospective cohort study was carried out to determine whether certain patients with unexplained HMB have an underlying platelet function defect (PFD). The Genotyping and Phenotyping of Platelets (GAPP) study recruited 175 women with HMB and 44 unrelated volunteers from 25 Haemophilia Centres across the UK, and a tertiary gynaecology service. Bleeding history was assessed using the International Society on Thrombosis and Haemostasis Bleeding Assessment Tool (ISTH-BAT). Platelet count, platelet size, haemoglobin and mean corpuscular volume were measured in whole blood using the Sysmex XN-1000 Haematology Analyzer. Platelet function testing using lumiaggregometry and flow cytometry was performed in patients included in this study. A PFD was identified in 47% (82/175) of patients with HMB. Cutaneous bleeding was the most frequent additional bleeding symptom (89% in PFD and 83% with no PFD). Whole blood platelet count was significantly lower (P < 0.0001) between the PFD group and no PFD group. The prevalence of anaemia did not differ between patients and healthy volunteers. Clinical evaluation alone is insufficient to determine presence of an underlying PFD in patients with HMB. Platelet function tests may be considered and clinical guidelines may include them in their algorithms. An appropriate diagnosis and subsequent tailored management of HMB may prevent unnecessary surgery and help manage future haemostatic challenges.
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Affiliation(s)
- Gillian C Lowe
- a Comprehensive Care Haemophilia Centre , University Hospital Birmingham NHS Foundation Trust , Birmingham , UK
| | - Roksana Fickowska
- b Institute of Cardiovascular Sciences, College of Medical and Dental Sciences , University of Birmingham , Birmingham , UK
| | - Rashid Al Ghaithi
- c Institute of Inflammation and Ageing, College of Medical and Dental Sciences , University of Birmingham , Birmingham , UK
| | - Annabel Maclachlan
- b Institute of Cardiovascular Sciences, College of Medical and Dental Sciences , University of Birmingham , Birmingham , UK
| | - Paul Harrison
- c Institute of Inflammation and Ageing, College of Medical and Dental Sciences , University of Birmingham , Birmingham , UK
| | - Will Lester
- a Comprehensive Care Haemophilia Centre , University Hospital Birmingham NHS Foundation Trust , Birmingham , UK
| | - Steve P Watson
- b Institute of Cardiovascular Sciences, College of Medical and Dental Sciences , University of Birmingham , Birmingham , UK
| | - Bethan Myers
- d Department of Haematology , Lincoln County Hospital , Lincoln , UK.,e Haemostasis & Thrombosis Unit, Leicester Royal Infirmary , University Hospitals Of Leicester NHS Trust , Leicester , UK
| | - Justin Clark
- f Department of Gynaecology , Birmingham Women's and Children's NHS Foundation Trust , Birmingham , UK
| | - Neil V Morgan
- b Institute of Cardiovascular Sciences, College of Medical and Dental Sciences , University of Birmingham , Birmingham , UK
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39
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Lester W. The Obstetric Hematology Manual, 2nd edition Edited by SuePavord & BeverleyHunt, Cambridge University Press, 2018. Br J Haematol 2018. [DOI: 10.1111/bjh.15550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Will Lester
- Centre for Clinical Haematology; University Hospitals Birmingham; Queen Elizabeth Edgbaston, Birmingham B152TH UK
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40
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Affiliation(s)
- Alok Tiwari
- Department of Vascular Surgery, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Will Lester
- Department of Hematology, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Tjun Yip Tang
- Department of Vascular Surgery, Singapore General Hospital, Singapore
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Rangarajan S, Walsh L, Lester W, Perry D, Madan B, Laffan M, Yu H, Vettermann C, Pierce GF, Wong WY, Pasi KJ. AAV5-Factor VIII Gene Transfer in Severe Hemophilia A. N Engl J Med 2017; 377:2519-2530. [PMID: 29224506 DOI: 10.1056/nejmoa1708483] [Citation(s) in RCA: 455] [Impact Index Per Article: 65.0] [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: 11/19/2022]
Abstract
BACKGROUND Patients with hemophilia A rely on exogenous factor VIII to prevent bleeding in joints, soft tissue, and the central nervous system. Although successful gene transfer has been reported in patients with hemophilia B, the large size of the factor VIII coding region has precluded improved outcomes with gene therapy in patients with hemophilia A. METHODS We infused a single intravenous dose of a codon-optimized adeno-associated virus serotype 5 (AAV5) vector encoding a B-domain-deleted human factor VIII (AAV5-hFVIII-SQ) in nine men with severe hemophilia A. Participants were enrolled sequentially into one of three dose cohorts (low dose [one participant], intermediate dose [one participant], and high dose [seven participants]) and were followed through 52 weeks. RESULTS Factor VIII activity levels remained at 3 IU or less per deciliter in the recipients of the low or intermediate dose. In the high-dose cohort, the factor VIII activity level was more than 5 IU per deciliter between weeks 2 and 9 after gene transfer in all seven participants, and the level in six participants increased to a normal value (>50 IU per deciliter) that was maintained at 1 year after receipt of the dose. In the high-dose cohort, the median annualized bleeding rate among participants who had previously received prophylactic therapy decreased from 16 events before the study to 1 event after gene transfer, and factor VIII use for participant-reported bleeding ceased in all the participants in this cohort by week 22. The primary adverse event was an elevation in the serum alanine aminotransferase level to 1.5 times the upper limit of the normal range or less. Progression of preexisting chronic arthropathy in one participant was the only serious adverse event. No neutralizing antibodies to factor VIII were detected. CONCLUSIONS The infusion of AAV5-hFVIII-SQ was associated with the sustained normalization of factor VIII activity level over a period of 1 year in six of seven participants who received a high dose, with stabilization of hemostasis and a profound reduction in factor VIII use in all seven participants. In this small study, no safety events were noted, but no safety conclusions can be drawn. (Funded by BioMarin Pharmaceutical; ClinicalTrials.gov number, NCT02576795 ; EudraCT number, 2014-003880-38 .).
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Affiliation(s)
- Savita Rangarajan
- From Hampshire Hospitals NHS Foundation Trust, Basingstoke (S.R.), University Hospitals Birmingham NHS Foundation Trust, Edgbaston (W.L.), Cambridge University Hospital NHS Foundation Trust, Addenbrooke's Hospital, Cambridge (D.P.), and the Centre for Haemostasis and Thrombosis, St. Thomas' Hospital (B.M.), Imperial College London and NIHR Clinical Research Facility at Imperial College Healthcare NHS Trust (M.L.), and Barts and the London School of Medicine and Dentistry (K.J.P.), London - all in the United Kingdom; and BioMarin Pharmaceutical, Novato (L.W., H.Y., C.V., W.Y.W.), and private consultant, La Jolla (G.F.P.) - both in California
| | - Liron Walsh
- From Hampshire Hospitals NHS Foundation Trust, Basingstoke (S.R.), University Hospitals Birmingham NHS Foundation Trust, Edgbaston (W.L.), Cambridge University Hospital NHS Foundation Trust, Addenbrooke's Hospital, Cambridge (D.P.), and the Centre for Haemostasis and Thrombosis, St. Thomas' Hospital (B.M.), Imperial College London and NIHR Clinical Research Facility at Imperial College Healthcare NHS Trust (M.L.), and Barts and the London School of Medicine and Dentistry (K.J.P.), London - all in the United Kingdom; and BioMarin Pharmaceutical, Novato (L.W., H.Y., C.V., W.Y.W.), and private consultant, La Jolla (G.F.P.) - both in California
| | - Will Lester
- From Hampshire Hospitals NHS Foundation Trust, Basingstoke (S.R.), University Hospitals Birmingham NHS Foundation Trust, Edgbaston (W.L.), Cambridge University Hospital NHS Foundation Trust, Addenbrooke's Hospital, Cambridge (D.P.), and the Centre for Haemostasis and Thrombosis, St. Thomas' Hospital (B.M.), Imperial College London and NIHR Clinical Research Facility at Imperial College Healthcare NHS Trust (M.L.), and Barts and the London School of Medicine and Dentistry (K.J.P.), London - all in the United Kingdom; and BioMarin Pharmaceutical, Novato (L.W., H.Y., C.V., W.Y.W.), and private consultant, La Jolla (G.F.P.) - both in California
| | - David Perry
- From Hampshire Hospitals NHS Foundation Trust, Basingstoke (S.R.), University Hospitals Birmingham NHS Foundation Trust, Edgbaston (W.L.), Cambridge University Hospital NHS Foundation Trust, Addenbrooke's Hospital, Cambridge (D.P.), and the Centre for Haemostasis and Thrombosis, St. Thomas' Hospital (B.M.), Imperial College London and NIHR Clinical Research Facility at Imperial College Healthcare NHS Trust (M.L.), and Barts and the London School of Medicine and Dentistry (K.J.P.), London - all in the United Kingdom; and BioMarin Pharmaceutical, Novato (L.W., H.Y., C.V., W.Y.W.), and private consultant, La Jolla (G.F.P.) - both in California
| | - Bella Madan
- From Hampshire Hospitals NHS Foundation Trust, Basingstoke (S.R.), University Hospitals Birmingham NHS Foundation Trust, Edgbaston (W.L.), Cambridge University Hospital NHS Foundation Trust, Addenbrooke's Hospital, Cambridge (D.P.), and the Centre for Haemostasis and Thrombosis, St. Thomas' Hospital (B.M.), Imperial College London and NIHR Clinical Research Facility at Imperial College Healthcare NHS Trust (M.L.), and Barts and the London School of Medicine and Dentistry (K.J.P.), London - all in the United Kingdom; and BioMarin Pharmaceutical, Novato (L.W., H.Y., C.V., W.Y.W.), and private consultant, La Jolla (G.F.P.) - both in California
| | - Michael Laffan
- From Hampshire Hospitals NHS Foundation Trust, Basingstoke (S.R.), University Hospitals Birmingham NHS Foundation Trust, Edgbaston (W.L.), Cambridge University Hospital NHS Foundation Trust, Addenbrooke's Hospital, Cambridge (D.P.), and the Centre for Haemostasis and Thrombosis, St. Thomas' Hospital (B.M.), Imperial College London and NIHR Clinical Research Facility at Imperial College Healthcare NHS Trust (M.L.), and Barts and the London School of Medicine and Dentistry (K.J.P.), London - all in the United Kingdom; and BioMarin Pharmaceutical, Novato (L.W., H.Y., C.V., W.Y.W.), and private consultant, La Jolla (G.F.P.) - both in California
| | - Hua Yu
- From Hampshire Hospitals NHS Foundation Trust, Basingstoke (S.R.), University Hospitals Birmingham NHS Foundation Trust, Edgbaston (W.L.), Cambridge University Hospital NHS Foundation Trust, Addenbrooke's Hospital, Cambridge (D.P.), and the Centre for Haemostasis and Thrombosis, St. Thomas' Hospital (B.M.), Imperial College London and NIHR Clinical Research Facility at Imperial College Healthcare NHS Trust (M.L.), and Barts and the London School of Medicine and Dentistry (K.J.P.), London - all in the United Kingdom; and BioMarin Pharmaceutical, Novato (L.W., H.Y., C.V., W.Y.W.), and private consultant, La Jolla (G.F.P.) - both in California
| | - Christian Vettermann
- From Hampshire Hospitals NHS Foundation Trust, Basingstoke (S.R.), University Hospitals Birmingham NHS Foundation Trust, Edgbaston (W.L.), Cambridge University Hospital NHS Foundation Trust, Addenbrooke's Hospital, Cambridge (D.P.), and the Centre for Haemostasis and Thrombosis, St. Thomas' Hospital (B.M.), Imperial College London and NIHR Clinical Research Facility at Imperial College Healthcare NHS Trust (M.L.), and Barts and the London School of Medicine and Dentistry (K.J.P.), London - all in the United Kingdom; and BioMarin Pharmaceutical, Novato (L.W., H.Y., C.V., W.Y.W.), and private consultant, La Jolla (G.F.P.) - both in California
| | - Glenn F Pierce
- From Hampshire Hospitals NHS Foundation Trust, Basingstoke (S.R.), University Hospitals Birmingham NHS Foundation Trust, Edgbaston (W.L.), Cambridge University Hospital NHS Foundation Trust, Addenbrooke's Hospital, Cambridge (D.P.), and the Centre for Haemostasis and Thrombosis, St. Thomas' Hospital (B.M.), Imperial College London and NIHR Clinical Research Facility at Imperial College Healthcare NHS Trust (M.L.), and Barts and the London School of Medicine and Dentistry (K.J.P.), London - all in the United Kingdom; and BioMarin Pharmaceutical, Novato (L.W., H.Y., C.V., W.Y.W.), and private consultant, La Jolla (G.F.P.) - both in California
| | - Wing Y Wong
- From Hampshire Hospitals NHS Foundation Trust, Basingstoke (S.R.), University Hospitals Birmingham NHS Foundation Trust, Edgbaston (W.L.), Cambridge University Hospital NHS Foundation Trust, Addenbrooke's Hospital, Cambridge (D.P.), and the Centre for Haemostasis and Thrombosis, St. Thomas' Hospital (B.M.), Imperial College London and NIHR Clinical Research Facility at Imperial College Healthcare NHS Trust (M.L.), and Barts and the London School of Medicine and Dentistry (K.J.P.), London - all in the United Kingdom; and BioMarin Pharmaceutical, Novato (L.W., H.Y., C.V., W.Y.W.), and private consultant, La Jolla (G.F.P.) - both in California
| | - K John Pasi
- From Hampshire Hospitals NHS Foundation Trust, Basingstoke (S.R.), University Hospitals Birmingham NHS Foundation Trust, Edgbaston (W.L.), Cambridge University Hospital NHS Foundation Trust, Addenbrooke's Hospital, Cambridge (D.P.), and the Centre for Haemostasis and Thrombosis, St. Thomas' Hospital (B.M.), Imperial College London and NIHR Clinical Research Facility at Imperial College Healthcare NHS Trust (M.L.), and Barts and the London School of Medicine and Dentistry (K.J.P.), London - all in the United Kingdom; and BioMarin Pharmaceutical, Novato (L.W., H.Y., C.V., W.Y.W.), and private consultant, La Jolla (G.F.P.) - both in California
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Khan F, Rowe I, Martin B, Knox E, Johnston T, Elliot C, Lester W, Chen F, Olliff S, Mehrzad H, Zia Z, Tripathi D. Outcomes of pregnancy in patients with known Budd-Chiari syndrome. World J Hepatol 2017; 9:945-952. [PMID: 28824745 PMCID: PMC5545139 DOI: 10.4254/wjh.v9.i21.945] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 04/14/2017] [Accepted: 07/03/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To analyse the risk of pregnancy (a prothrombotic state) in patients with Budd-Chiari Syndrome (BCS).
METHODS Retrospective study of pregnancy in women with known BCS at single center from January 2001 to December 2015.
RESULTS Out of 53 females with BCS, 7 women had 16 pregnancies. Median age at diagnosis of BCS in these women was 25 years (range 21-34 years). At least one causal factor for BCS was identified in 6 women (86%). Six women had undergone radiological decompressive treatment. All patients had anticoagulation. Six fetuses were lost before 20 wk gestation in 2 women. There were 9 deliveries over 32 wk gestation and one delivery at 27 wk. All infants did well. Seven babies were born by emergency caesarean section. There were no cases of thrombosis. Two patients had notable vaginal (PV) bleeding in 3 pregnancies. None of the patients had variceal haemorrhage. Two patients were diagnosed with pulmonary hypertension, one during pregnancy and the other in the post-partum period. There was no maternal mortality.
CONCLUSION Maternal outcomes in patients with treated BCS are favourable and fetal outcomes beyond 20 wk gestation are good. There has been increased rate of caesarean section. Pulmonary hypertension is an important finding that needs further validation. These patients should be managed in centers experienced in treating high-risk pregnancies.
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Thachil J, Bagot C, Bradbury C, Cooper N, Lester W, Grainger JD, Lowe G, Evans G, Talks K, Sibson K, Garg M, Murphy MF, Watson HG, Bolton-Maggs PHB, Watson S, Scully M, Provan D, Newland A, Hill QA. A United Kingdom Immune Thrombocytopenia (ITP) Forum review of practice: thrombopoietin receptor agonists. Br J Haematol 2016; 180:591-594. [PMID: 27879997 DOI: 10.1111/bjh.14395] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Jecko Thachil
- Department of Haematology, Manchester Royal Infirmary, Manchester, UK
| | - Catherine Bagot
- Department of Haematology, Glasgow Royal Infirmary, Glasgow, UK
| | | | - Nichola Cooper
- Department of Haematology, Hammersmith Hospital, London, UK
| | - Will Lester
- Department of Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | | | - Gillian Lowe
- Department of Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | - Gillian Evans
- Department of Haematology, Kent and Canterbury Hospital, Canterbury, UK
| | - Kate Talks
- Department of Haematology, Royal Victoria Infirmary, Newcastle, UK
| | - Keith Sibson
- Department of Haematology, Great Ormond Street Hospital, London, UK
| | - Mamta Garg
- Department of Haematology, Leicester Royal Infirmary, Leicester, UK
| | - Michael F Murphy
- National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford University Hospitals and the University of Oxford, Oxford, UK.,NHS Blood & Transplant, Oxford, UK
| | - Henry G Watson
- Department of Haematology, Aberdeen Royal Infirmary, Aberdeen, UK
| | | | - Shirley Watson
- ITP Support Association, The Platelet Mission, Bolnhurst, UK
| | - Marie Scully
- Department of Haematology, University College London Hospitals, London, UK
| | - Drew Provan
- Department of Haematology, The Royal London Hospital, London, UK
| | - Adrian Newland
- Department of Haematology, The Royal London Hospital, London, UK
| | - Quentin A Hill
- Department of Haematology, St James's University Hospital, Leeds, UK
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Murthy V, Murray D, Hebballi S, Bramhall S, Lester W, Mutimer D, Wilde J. Outcome of liver transplantation in patients with hereditary bleeding disorders: a single centre UK experience. Haemophilia 2016; 22:e139-44. [PMID: 26931744 DOI: 10.1111/hae.12877] [Citation(s) in RCA: 4] [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] [Accepted: 11/22/2015] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Patients with hereditary bleeding disorders who have developed end-stage liver disease as a consequence of hepatitis C infection (HCV) acquired from factor concentrates prior to the introduction of viral inactivation continue to be referred for liver transplantation. METHODS A retrospective review of case notes and electronic records was performed on all patients with bleeding disorders who have undergone liver transplantation at the University Hospital Birmingham (UHB). RESULTS Between 1990 and 2014, 35 liver transplants have been performed in 33 patients with hereditary bleeding disorders. The indication for transplantation was mainly end-stage liver disease secondary to HCV. Five patients had human immunodeficiency virus (HIV) co-infection. No excess mortality due to bleeding occurred in the peri or postoperative period. Median overall survival post transplant is 9.7 years. Overall survival rates at 1, 3 and 5 years are 90%, 72% and 64% respectively. The predominant cause of mortality was liver failure secondary to either recurrent HCV or recurrent hepatocellular carcinoma (HCC). The median overall survival in patients with HIV co-infection is shorter than in those with mono-infection but this is not statistically significant. Patients with a pre-existing HCC had a statistically significant shorter survival (2.4 years vs. 13.6 years, P = 0.007). CONCLUSION Liver transplantation has become an accepted treatment option for patients with hereditary bleeding disorders and HCV associated end-stage liver disease with survival rates similar to non-bleeding disorder patients.
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Affiliation(s)
- V Murthy
- West Midlands Adult Haemophilia Comprehensive Care Centre and Liver Unit, Queen Elizabeth Hospital, Birmingham, UK
| | - D Murray
- West Midlands Adult Haemophilia Comprehensive Care Centre and Liver Unit, Queen Elizabeth Hospital, Birmingham, UK
| | - S Hebballi
- West Midlands Adult Haemophilia Comprehensive Care Centre and Liver Unit, Queen Elizabeth Hospital, Birmingham, UK
| | - S Bramhall
- West Midlands Adult Haemophilia Comprehensive Care Centre and Liver Unit, Queen Elizabeth Hospital, Birmingham, UK
| | - W Lester
- West Midlands Adult Haemophilia Comprehensive Care Centre and Liver Unit, Queen Elizabeth Hospital, Birmingham, UK
| | - D Mutimer
- West Midlands Adult Haemophilia Comprehensive Care Centre and Liver Unit, Queen Elizabeth Hospital, Birmingham, UK
| | - J Wilde
- West Midlands Adult Haemophilia Comprehensive Care Centre and Liver Unit, Queen Elizabeth Hospital, Birmingham, UK
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Laffan MA, Lester W, O'Donnell JS, Will A, Tait RC, Goodeve A, Millar CM, Keeling DM. The diagnosis and management of von Willebrand disease: a United Kingdom Haemophilia Centre Doctors Organization guideline approved by the British Committee for Standards in Haematology. Br J Haematol 2014; 167:453-65. [PMID: 25113304 DOI: 10.1111/bjh.13064] [Citation(s) in RCA: 226] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Mike A Laffan
- Centre for Haematology, Imperial College London, London, UK
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Lester W, Freemantle N, Begaj I, Ray D, Wood J, Pagano D. Fatal venous thromboembolism associated with hospital admission: a cohort study to assess the impact of a national risk assessment target. Heart 2013; 99:1734-9. [DOI: 10.1136/heartjnl-2013-304479] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Tullett J, Murray E, Nichols L, Holder R, Lester W, Rose P, Hobbs FDR, Fitzmaurice D. Trial Protocol: a randomised controlled trial of extended anticoagulation treatment versus routine anticoagulation treatment for the prevention of recurrent VTE and post thrombotic syndrome in patients being treated for a first episode of unprovoked VTE (The ExACT Study). BMC Cardiovasc Disord 2013; 13:16. [PMID: 23497371 PMCID: PMC3602651 DOI: 10.1186/1471-2261-13-16] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 02/01/2013] [Indexed: 11/22/2022] Open
Abstract
Background Venous thromboembolism comprising pulmonary embolism and deep vein thrombosis is a common condition with an incidence of approximately 1 per 1,000 per annum causing both mortality and serious morbidity. The principal aim of treatment of a venous thromboembolism with heparin and warfarin is to prevent extension or recurrence of clot. However, the recurrence rate following a deep vein thrombosis remains approximately 10% per annum following treatment cessation irrespective of the duration of anticoagulation therapy. Patients with raised D-dimer levels after discontinuing oral anticoagulation treatment have also been shown to be at high risk of recurrence. Post thrombotic syndrome is a complication of a deep vein thrombosis which can lead to chronic venous insufficiency and ulceration. It has a cumulative incidence after 2 years of around 25% and it has been suggested that extended oral anticoagulation should be investigated as a possible preventative measure. Methods/design Patients with a first idiopathic venous thromboembolism will be recruited through anticoagulation clinics and randomly allocated to either continuing or discontinuing warfarin treatment for a further 2 years and followed up on a six monthly basis. At each visit D-dimer levels will be measured using a Roche Cobas h 232 POC device. In addition a venous sample will be taken for laboratory D-dimer analysis at the end of the study. Patients will be examined for signs and symptoms of PTS using the Villalta scale and complete VEINES and EQ5D quality of life questionnaires. Discussion The primary aim of the study is to investigate whether extending oral anticoagulation treatment (prior to discontinuing treatment) beyond 3–6 months for patients with a first unprovoked proximal deep vein thrombosis or pulmonary embolism prevents recurrence. The study will also determine the role of extending anticoagulation for patients with elevated D-dimer levels prior to discontinuing treatment and identify the potential of D-dimer point of care testing for identification of high risk patients within a primary care setting. Trial registration ISRCTN73819751
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Affiliation(s)
- Jayne Tullett
- Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
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Gregg R, Lester W, Bramhall S, Wilde J. Orthotopic liver transplantation in a patient with severe haemophilia A and a high-titre factor VIII inhibitor from an antithrombin-deficient cadaveric donor. Haemophilia 2013; 19:e96-7. [PMID: 23419109 DOI: 10.1111/hae.12086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2012] [Indexed: 11/28/2022]
Affiliation(s)
- R. Gregg
- West Midlands Adult Haemostasis and Thrombosis Centre; Queen Elizabeth Hospital; Birmingham; UK
| | - W. Lester
- West Midlands Adult Haemostasis and Thrombosis Centre; Queen Elizabeth Hospital; Birmingham; UK
| | - S. Bramhall
- Liver Transplant Unit; Queen Elizabeth Hospital; Birmingham; UK
| | - J. Wilde
- West Midlands Adult Haemostasis and Thrombosis Centre; Queen Elizabeth Hospital; Birmingham; UK
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Lester W, Begaj I, Ray D, Pagano D. OC-15 Venous thromboembolism after delivery: Trends in national readmission rates between 2002 and 2012. Thromb Res 2013. [DOI: 10.1016/s0049-3848(13)70041-0] [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: 11/30/2022]
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Affiliation(s)
- Clarisa T P Choh
- Department of Vascular Surgery, University Hospitals Birmingham NHS Foundation Trust, Selly Oak, Birmingham B29 6JD.
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