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Association of primary and secondary hemostasis biomarkers with acute ischemic stroke outcome in patients undergoing thrombectomy, with or without thrombolytics: Post-hoc analysis of the MR CLEAN-NOIV randomized clinical trial. 接受或未接受溶栓治疗的血栓切除术患者的主要和次要止血生物标志物与急性缺血性中风预后的关系:MR CLEAN-NOIV 随机临床试验的事后分析。
IF 5.5 2区 医学 Q1 HEMATOLOGY Pub Date : 2024-10-21 DOI: 10.1016/j.jtha.2024.10.008
Aarazo Barakzie, Gerard A J Jansen, Fabiano Cavalcante, Magdolna Nagy, Diederik W J Dippel, Aad van der Lugt, Yvo B W E M Roos, Charles B L M Majoie, Hugo Ten Cate, Moniek P M de Maat

Background: Intravenous thrombolysis (IVT) using recombinant tissue plasminogen activator (r-tPA) prior to endovascular thrombectomy (EVT) failed to improve treatment effect in acute ischemic stroke (AIS) patients compared to EVT alone.

Objectives: We investigated whether primary and secondary hemostasis biomarkers are associated with the effect of IV thrombolytics on clinical and radiological outcomes after EVT.

Patients/methods: In MR CLEAN-NOIV study, AIS patients were randomized to receive IVT plus EVT or EVT alone. We measured hemostatic biomarkers before and 24h post-reperfusion, to determine changes in biomarkers and to determine the association of the biomarkers with short-time stroke severity (National Institutes of Health Stroke Scale (NIHSS) score), long-term functional outcome (modified Rankin scale (mRS) score), post-EVT extended thrombolysis in cerebral infarction (eTICI) score, and final infarct size.

Results: This substudy included 214 of the 539 AIS patients who underwent IVT+EVT (N=108/266) or EVT alone (N=106/273). In the EVT group, low soluble glycoprotein VI (sGPVI) and high factor (F)VIII levels before treatment were associated with severe NIHSS-score at 24h and poor mRS-score at 90-day post-treatment, respectively. Also in this group, sGPVI levels 24h after treatment were negatively associated with final infarct size. In the IVT+EVT group, high fibrinogen before treatment was associated with good eTICI-score and low ADAMTS13 activity 24h post-treatment was associated with unfavorable mRS-score at 90-day.

Conclusion: Our findings suggest that patients with high FVIII and fibrinogen and low sGPVI levels might be most suitable candidates for IVT+EVT, and that patients with low ADAMTS13 activity might be suitable for EVT alone.

背景:在血管内血栓切除术(EVT)前使用重组组织浆细胞酶原激活剂(r-tPA)进行静脉溶栓(IVT)与单独使用EVT相比,未能改善急性缺血性卒中(AIS)患者的治疗效果:我们研究了主要和次要止血生物标志物是否与静脉溶栓药物对EVT后临床和放射学结果的影响有关:在 MR CLEAN-NOIV 研究中,AIS 患者被随机分配接受静脉溶栓加 EVT 或单纯 EVT。我们测量了再灌注前和再灌注后24小时的止血生物标志物,以确定生物标志物的变化,并确定生物标志物与短期卒中严重程度(美国国立卫生研究院卒中量表(NIHSS)评分)、长期功能预后(改良Rankin量表(mRS)评分)、EVT后脑梗死扩大溶栓(eTICI)评分和最终梗死面积的关系:这项子研究纳入了539例AIS患者中的214例,这些患者接受了IVT+EVT(108/266)或单纯EVT(106/273)治疗。在 EVT 组中,治疗前的低可溶性糖蛋白 VI (sGPVI) 和高因子 (F)VIII 水平分别与治疗后 24 小时的严重 NIHSS 评分和 90 天的不良 mRS 评分相关。同样在该组中,治疗后 24 小时的 sGPVI 水平与最终梗死面积呈负相关。在IVT+EVT组中,治疗前高纤维蛋白原与良好的eTICI评分相关,而治疗后24小时低ADAMTS13活性与90天不良的mRS评分相关:我们的研究结果表明,高 FVIII 和纤维蛋白原以及低 sGPVI 水平的患者可能最适合 IVT+EVT 治疗,而低 ADAMTS13 活性的患者可能适合单纯 EVT 治疗。
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引用次数: 0
Comparative effectiveness and safety of rivaroxaban with other oral anticoagulants in older adults with nonvalvular atrial fibrillation: Population-based analysis in response to updated Beers criteria. 利伐沙班与其他口服抗凝药对患有非瓣膜性心房颤动的老年人的有效性和安全性比较:根据更新后的 Beers 标准进行的人群分析。
IF 5.5 2区 医学 Q1 HEMATOLOGY Pub Date : 2024-10-21 DOI: 10.1016/j.jtha.2024.10.009
Ghadeer K Dawwas, Adam Cuker

Objective: Given recent concerns regarding the updated Beers Criteria, we sought to compare the effectiveness and safety of rivaroxaban with oral anticoagulants in older adults with nonvalvular atrial fibrillation (AF).

Methods: We used an administrative healthcare database and included AF patients ≥ 65 years who were new users of rivaroxaban or the comparators. We created three pairwise comparisons: rivaroxaban vs. warfarin; rivaroxaban vs. dabigatran; and rivaroxaban vs. apixaban. Study outcomes included stroke or systemic embolism (effectiveness), and gastrointestinal or intracranial bleeding (safety). In the propensity score matched sample, we used Cox proportional hazards regression to estimate hazard ratios [HRs] and 95% confidence intervals [CIs].

Results: In the matched cohorts, use of rivaroxaban (vs. warfarin) increased risk of bleeding (HR 1.13; CI 1.03 to 1.23) with no difference in ischemic stroke or systemic embolism (HR 0.90; CI 0.79 to 1.02); use of rivaroxaban (vs. dabigatran) increased risk of bleeding (HR 1.18; CI 1.03 to 1.35) with no difference in ischemic stroke and systemic embolism (HR 1.00; CI 0.83 to 1.22); and use of rivaroxaban (vs. apixaban) increased risk of stroke and systemic embolism (HR 1.23; CI 1.08 to 1.40) and bleeding (HR 1.60; CI 1.45 to 1.76).

Conclusion: In this comparative effectiveness and safety study of older patients with nonvalvular AF, use of rivaroxaban was associated with a significantly increased risk of ischemic stroke and systemic embolism compared with apixaban, and bleeding compared with warfarin, dabigatran, and apixaban. Our findings may inform anticoagulant selection in older adults with nonvalvular AF.

目的:鉴于最近对更新后的比尔斯标准的担忧,我们试图比较利伐沙班与口服抗凝药对患有非瓣膜性心房颤动(房颤)的老年人的有效性和安全性:我们使用了一个行政医疗数据库,纳入了年龄≥ 65 岁、新使用利伐沙班或比较药的房颤患者。我们建立了三个配对比较:利伐沙班与华法林;利伐沙班与达比加群;利伐沙班与阿哌沙班。研究结果包括中风或全身性栓塞(有效性)以及胃肠道或颅内出血(安全性)。在倾向评分匹配样本中,我们使用 Cox 比例危险回归估算危险比 [HRs] 和 95% 置信区间 [CIs]:在配对队列中,使用利伐沙班(与华法林相比)会增加出血风险(HR 1.13;CI 1.03 至 1.23),但缺血性卒中或全身性栓塞的风险没有差异(HR 0.90;CI 0.79 至 1.02);使用利伐沙班(与达比加群相比)会增加出血风险(HR 1.18;CI 1.03至1.35),缺血性卒中和全身性栓塞无差异(HR 1.00;CI 0.83至1.22);使用利伐沙班(与阿哌沙班相比)会增加卒中和全身性栓塞(HR 1.23;CI 1.08至1.40)以及出血(HR 1.60;CI 1.45至1.76)的风险:在这项针对老年非瓣膜性房颤患者的有效性和安全性比较研究中,与阿哌沙班相比,使用利伐沙班会显著增加缺血性中风和全身性栓塞的风险;与华法林、达比加群和阿哌沙班相比,使用利伐沙班会显著增加出血的风险。我们的研究结果可为患有非瓣膜性房颤的老年人选择抗凝药物提供参考。
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引用次数: 0
Impact of limited language proficiency on participation in venous thromboembolism research: a retrospective analysis. 语言能力有限对参与静脉血栓栓塞症研究的影响:回顾性分析。
IF 5.5 2区 医学 Q1 HEMATOLOGY Pub Date : 2024-10-21 DOI: 10.1016/j.jtha.2024.09.014
Desmond Anuku, Marc Carrier, Grégoire Le Gal, Lana Castellucci, Philip Wells, Deborah Siegal, Tzu-Fei Wang, Lisa Duffett, Miriam Kimpton, Joseph Shaw, Tamara L Morgan, Jude-Mary Cénat, Aurélien Delluc, Yan Xu

Background: Limited language proficiency is an established barrier to research participation among racialized populations. While prior studies have highlighted the underrepresentation of racialized populations in venous thromboembolism (VTE) research, the impact of limited language proficiency as a reason for nonconsent among eligible patients is unknown.

Objectives: To determine the impact of language barrier as the primary reason for VTE research non-participation.

Methods: We reviewed all prospective VTE studies conducted at a research-intensive academic thrombosis research program in Canada between 2014 and 2024. Studies with screening logs that systematically and consecutively captured eligibility assessment and reasons for nonconsent were included. Primary outcome was nonconsent of a screen-eligible patient due to limited language proficiency as the reported reason. We derived pooled estimates of nonconsent due to limited language proficiency as a proportion of consented participants and determined subgroup rates by phase of VTE management, associated medical conditions, and recruitment settings.

Results: Screening logs of 28 studies with 22 057 screening events, 8317 screen-eligible patients, and 3320 consented participants were included. For every 100 consented participants, 3.2 (95% CI, 2.0-5.3) screen-eligible individuals were unable to provide consent due to limited language proficiency. Rates of nonconsent were highest in studies involving cancer (5.6 per 100 participants; 95% CI, 2.9-10.4) and in studies recruiting patients from ambulatory settings outside of the thrombosis clinic (10.8 per 100 participants; 95% CI, 4.8-22.6).

Conclusion: Language proficiency is a key barrier to VTE research participation. Urgent implementation of targeted interventions aimed at mitigating linguistic barriers is essential to ensure equitable opportunities for VTE research participation for racialized patients disproportionately affected by language proficiency.

背景:语言能力有限是种族化人群参与研究的一个既定障碍。虽然之前的研究已经强调了种族化人群在静脉血栓栓塞症(VTE)研究中的代表性不足,但语言能力有限作为合格患者不同意研究的原因所产生的影响尚不清楚:我们回顾了 2014 年至 2024 年期间在加拿大一个研究密集型学术血栓研究项目中开展的所有前瞻性 VTE 研究。我们纳入了具有筛选日志的研究,这些日志系统、连续地记录了资格评估和未同意的原因。主要结果是符合筛查条件的患者因语言能力有限作为报告原因而未同意筛查。我们得出了因语言能力有限而未同意的参与者占同意参与者比例的汇总估计值,并根据 VTE 管理阶段、相关医疗条件和招募环境确定了亚组比率:共纳入了 28 项研究的筛查日志,涉及 22,057 个筛查事件、8,317 名符合筛查条件的患者和 3,320 名同意参与者。每 100 名同意的参与者中,就有 3.2 名(95% CI 2.0 - 5.3)符合筛查条件的人因语言能力有限而无法同意。在涉及癌症的研究(每 100 名参与者中有 5.6 人,95% CI 2.9 - 10.4)和招募血栓诊所以外流动环境患者的研究(每 100 名参与者中有 10.8 人,95% CI 4.8 - 22.6)中,未获同意的比例最高:语言能力是 VTE 研究参与的主要障碍。结论:语言能力是 VTE 研究参与的主要障碍。紧急实施旨在缓解语言障碍的针对性干预措施,对于确保受语言能力影响过大的种族化患者获得 VTE 研究参与的公平机会至关重要。
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引用次数: 0
Splanchnic vein thrombosis: management for the thrombosis specialist. 脾静脉血栓形成:血栓形成专科医生的处理方法。
IF 5.5 2区 医学 Q1 HEMATOLOGY Pub Date : 2024-10-21 DOI: 10.1016/j.jtha.2024.10.012
Kevin J Barnum, Rushad Patell, Jonathan Berry, Kenneth A Bauer

Splanchnic vein thrombosis (SpVT) is an uncommon site of venous thrombosis that is associated with complications including portal hypertension and hepatic dysfunction. The evaluation and management of this patient population has evolved in recent years, but there is limited data from clinical trials to guide management. Given the various acquired and biologic risk factors leading to the development of SpVT and the potential complications that can arise from it, input from a multidisciplinary team can be valuable in managing such patients, including thrombosis specialists or hematologists, gastroenterologists or hepatologists, interventional radiologists, and surgeons. In this manuscript, we present four cases that highlight important issues and considerations in the evaluation of SpVT including: initial diagnostic approach in a patient with a new diagnosis of SpVT, considerations for anticoagulant therapy, management of SpVT in patients with myeloproliferative neoplasms, and the role of interventional vascular procedures in the management of SpVT. By reviewing the current literature, we address clinically relevant questions that are posed to clinicians managing patients with SpVT; we also point out gaps in our current knowledge that merit future investigation.

脾静脉血栓形成(SpVT)是一种不常见的静脉血栓形成部位,与门静脉高压和肝功能异常等并发症有关。近年来,对这类患者的评估和管理不断发展,但用于指导管理的临床试验数据却很有限。鉴于导致 SpVT 发生的各种获得性和生物性风险因素以及可能引发的潜在并发症,多学科团队(包括血栓专家或血液专家、胃肠病专家或肝病专家、介入放射专家和外科医生)的参与对此类患者的管理非常重要。在本手稿中,我们介绍了四个病例,突出强调了评估 SpVT 的重要问题和注意事项,包括:新诊断为 SpVT 患者的初步诊断方法、抗凝治疗的注意事项、骨髓增生性肿瘤患者 SpVT 的管理以及介入血管手术在 SpVT 管理中的作用。通过回顾现有文献,我们解决了临床医生在管理 SpVT 患者时遇到的临床相关问题;我们还指出了现有知识中存在的不足之处,这些不足之处值得我们在未来进行研究。
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引用次数: 0
Phosphatidylserine-blocking nanoparticles inhibit thrombosis without increased bleeding in mice. 磷脂酰丝氨酸阻断纳米粒子可抑制小鼠血栓形成,但不会增加出血量。
IF 5.5 2区 医学 Q1 HEMATOLOGY Pub Date : 2024-10-17 DOI: 10.1016/j.jtha.2024.10.007
Jeremy G T Wurtzel, Brian D Gray, Koon Y Pak, Xuefei Zhao, Peisong Ma, Steven E McKenzie, Michelle Tanujaya, Victor Rizzo, Fabiola Del Carpio-Cano, A Koneti Rao, Parkson Lee-Gau Chong, Lawrence E Goldfinger

Background: Phosphatidylserine (PS) is a procoagulant phospholipid enriched on surfaces of activated vascular cells including platelets, endothelium, monocytes, and microvesicles. As a molecular driver of thrombosis accessible to drug blockade, PS is an attractive pharmacologic target for modulating thrombogenesis, with potentially reduced bleeding risk compared to anticoagulant and antiplatelet therapies.

Objectives: Test antithrombotic capabilities of a liposomal formulation, Zn-dipicolylamine cyanine-3[22,22]/1-palmitoyl-2-oleoyl-sn-glycero-3-phosphocholine (molar ratio, 3:97), designated as DPAL, which we previously described binds selectively to PS-enriched cell surfaces, compared with effects on bleeding, in mouse models.

Methods: PS-dependent DPAL binding to human and murine platelets was tested in vitro. Thrombosis and bleeding after DPAL intravenous administration were tested in C57Bl/6J mice following FeCl3 carotid arterial injury and tail tip amputation, respectively. Incorporation in hemostatic clots was investigated in the cremaster muscle laser injury model. Toxicity was tested by direct exposure to human endothelial cell cultures.

Results: DPAL bound agonist-stimulated, PS-positive human and murine platelets, blocked by Annexin V or Ano6 deletion, which ablate PS exposure. DPAL prolonged prothrombin time, but did not prevent thrombin-induced fibrinogen receptor activation or aggregation, nor alter blood cell counts including platelets. Following arteriolar laser injury, DPAL bound wound surfaces and edges without destabilizing plugs. DPAL dose-dependently blocked FeCl3-induced arterial thrombosis but did not substantially increase bleeding, or induce endothelial cell death.

Conclusion: DPAL reduces thrombogenesis with minimal effects on bleeding in mouse models via selective binding to PS. DPAL may support novel approaches to modulate pathogenic thrombin generation with improved safety profiles in multiple contexts.

背景:磷脂酰丝氨酸(PS)是一种促凝血磷脂,富含于活化的血管细胞表面,包括血小板、内皮细胞、单核细胞和微囊泡。PS 是可被药物阻断的血栓形成的分子驱动因素,是调节血栓形成的一个有吸引力的药理学靶点,与抗凝剂和抗血小板疗法相比,PS 有可能降低出血风险:目的:在小鼠模型中测试一种脂质体制剂 Zn-二二甲胺基氰-3[22,22]/1-棕榈酰-2-油酰-sn-甘油-3-磷酸胆碱 POPC(摩尔比 3:97)的抗血栓能力:方法:在体外测试了 DPAL 与人类和小鼠血小板的 PS 依赖性结合。在 C57Bl/6J 小鼠中分别测试了氯化铁颈动脉损伤和尾尖截肢后静脉注射 DPAL 后的血栓形成和出血情况。在绉肌激光损伤模型中研究了止血凝块的掺入情况。通过直接接触人内皮细胞培养物测试了其毒性:结果:DPAL 与受激动剂刺激的 PS 阳性人类和鼠类血小板结合,但被 Annexin V 或 Ano6 缺失阻断,因为它们会减弱 PS 暴露。DPAL 可延长凝血酶原时间,但不能阻止凝血酶诱导的纤维蛋白原受体活化或聚集,也不能改变包括血小板在内的血细胞计数。动脉激光损伤后,DPAL 可结合伤口表面和边缘,而不会破坏血栓的稳定性。DPAL剂量依赖性地阻断了FeCl3诱导的动脉血栓形成,但没有显著增加出血量,也没有诱导内皮细胞死亡:结论:在小鼠模型中,DPAL通过与PS的选择性结合减少血栓形成,而对出血的影响极小。DPAL可支持在多种情况下调节致病性凝血酶生成的新方法,并改善安全性。
{"title":"Phosphatidylserine-blocking nanoparticles inhibit thrombosis without increased bleeding in mice.","authors":"Jeremy G T Wurtzel, Brian D Gray, Koon Y Pak, Xuefei Zhao, Peisong Ma, Steven E McKenzie, Michelle Tanujaya, Victor Rizzo, Fabiola Del Carpio-Cano, A Koneti Rao, Parkson Lee-Gau Chong, Lawrence E Goldfinger","doi":"10.1016/j.jtha.2024.10.007","DOIUrl":"10.1016/j.jtha.2024.10.007","url":null,"abstract":"<p><strong>Background: </strong>Phosphatidylserine (PS) is a procoagulant phospholipid enriched on surfaces of activated vascular cells including platelets, endothelium, monocytes, and microvesicles. As a molecular driver of thrombosis accessible to drug blockade, PS is an attractive pharmacologic target for modulating thrombogenesis, with potentially reduced bleeding risk compared to anticoagulant and antiplatelet therapies.</p><p><strong>Objectives: </strong>Test antithrombotic capabilities of a liposomal formulation, Zn-dipicolylamine cyanine-3[22,22]/1-palmitoyl-2-oleoyl-sn-glycero-3-phosphocholine (molar ratio, 3:97), designated as DPAL, which we previously described binds selectively to PS-enriched cell surfaces, compared with effects on bleeding, in mouse models.</p><p><strong>Methods: </strong>PS-dependent DPAL binding to human and murine platelets was tested in vitro. Thrombosis and bleeding after DPAL intravenous administration were tested in C57Bl/6J mice following FeCl<sub>3</sub> carotid arterial injury and tail tip amputation, respectively. Incorporation in hemostatic clots was investigated in the cremaster muscle laser injury model. Toxicity was tested by direct exposure to human endothelial cell cultures.</p><p><strong>Results: </strong>DPAL bound agonist-stimulated, PS-positive human and murine platelets, blocked by Annexin V or Ano6 deletion, which ablate PS exposure. DPAL prolonged prothrombin time, but did not prevent thrombin-induced fibrinogen receptor activation or aggregation, nor alter blood cell counts including platelets. Following arteriolar laser injury, DPAL bound wound surfaces and edges without destabilizing plugs. DPAL dose-dependently blocked FeCl<sub>3</sub>-induced arterial thrombosis but did not substantially increase bleeding, or induce endothelial cell death.</p><p><strong>Conclusion: </strong>DPAL reduces thrombogenesis with minimal effects on bleeding in mouse models via selective binding to PS. DPAL may support novel approaches to modulate pathogenic thrombin generation with improved safety profiles in multiple contexts.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":null,"pages":null},"PeriodicalIF":5.5,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Novel insights into Antithrombin Deficiency enabled by Mass Spectrometry-based Precision Diagnostics. 基于质谱的精准诊断技术为抗凝血酶缺乏症提供了新见解。
IF 5.5 2区 医学 Q1 HEMATOLOGY Pub Date : 2024-10-16 DOI: 10.1016/j.jtha.2024.10.005
Mirjam Kruijt, Maria Eugenia de la Morena-Barrio, Javier Corral, Christa M Cobbaert, L Renee Ruhaak

Background: Although P5 (preventive, personalized, predictive, participatory, psychocognitive) medicine and patient focused healthcare are gaining ground in various healthcare areas, the diagnosis of antithrombin deficiency (ATD) is still based on crude diagnostic tests clustering patients into clinically heterogeneous subgroups whereby relevant thrombophilia phenotypes may go unnoticed. Clinical pathways and the majority of evidence are based on these tests, therefore generic treatment is still the norm.

Objectives: To unravel the heterogeneity of ATD, a mass spectrometry (LC-MRM-MS)-based test for antithrombin was developed allowing molecular characterization of the antithrombin proteoforms in patient plasma. This study provides the first insight into the tests' clinical performance.

Methods: Plasma from 91 unrelated ATD patients and 41 patients with a congenital disorder of glycosylation affecting antithrombin glycosylation were characterized functionally, genetically, and analyzed by LC-MRM-MS. An established data analysis strategy was applied for quantitation and molecular characterization of antithrombin proteoforms.

Results: The test recognized patients with a quantitative defect, discriminated between type I and type II ATD, and identified variant proteoforms. Overall, the diagnostic sensitivity for ATD was 100% for LC-MRM-MS compared to 81.1% by the functional test. Type II ATD, a subtype prone to misdiagnosis, revealed an even larger difference of 100% identification by LC-MRM-MS versus 56.8% by functional test.

Conclusions: The qualitative and quantitative MS-based AT-test can serve as a platform for investigating the molecular basis of the clinical heterogeneity of ATD. This Precision Diagnostics approach for ATD can lower diagnostic uncertainty and modernize the ATD diagnostic and clinical pathways.

背景:尽管五常法(预防性、个性化、预测性、参与性、心理认知)医学和以患者为中心的医疗保健在各个医疗保健领域日益普及,但抗凝血酶缺乏症(ATD)的诊断仍以粗略的诊断测试为基础,将患者分为临床异质性亚组,相关的血栓性表型可能因此而被忽视。临床路径和大多数证据都以这些测试为基础,因此普通治疗仍是常态:为了揭示 ATD 的异质性,我们开发了一种基于质谱(LC-MRM-MS)的抗凝血酶检测方法,可对患者血浆中的抗凝血酶蛋白形式进行分子鉴定。本研究首次揭示了该检测方法的临床性能:方法:91 名无血缘关系的 ATD 患者和 41 名患有影响抗凝血酶糖基化的先天性糖基化紊乱的患者的血浆进行了功能和基因表征,并通过 LC-MRM-MS 进行了分析。采用既定的数据分析策略对抗凝血酶蛋白形式进行定量和分子鉴定:结果:该检测能识别存在定量缺陷的患者,区分 I 型和 II 型 ATD,并识别出变异蛋白形式。总体而言,LC-MRM-MS 对 ATD 的诊断灵敏度为 100%,而功能测试的灵敏度为 81.1%。II 型 ATD 是一种容易误诊的亚型,LC-MRM-MS 与功能测试的识别率差异更大,前者为 100%,后者为 56.8%:基于 MS 的定性和定量 AT 测试可作为研究 ATD 临床异质性分子基础的平台。这种针对 ATD 的精准诊断方法可以降低诊断的不确定性,并使 ATD 诊断和临床路径现代化。
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引用次数: 0
Rivaroxaban, in combination with low-dose aspirin, is associated with a reduction in proinflammatory and prothrombotic circulating vesicle signatures in patients with cardiovascular disease. 利伐沙班联合小剂量阿司匹林可减少心血管疾病患者的促炎症和促血栓形成循环囊泡特征。
IF 5.5 2区 医学 Q1 HEMATOLOGY Pub Date : 2024-10-15 DOI: 10.1016/j.jtha.2024.09.030
Luisa Weiss, Aideen O'Doherty, Wido Uhrig, Paulina B Szklanna, Molly Hong-Minh, Kieran Wynne, Alfonso Blanco, Jan Zivny, Valeria Lima Passos, Barry Kevane, Seán Murphy, Fionnuala Ní Áinle, Martin O'Donnell, Patricia B Maguire

Background: Despite secondary prevention with aspirin, patients with stable cardiovascular disease (CVD) remain at elevated long-term risk of major adverse cardiovascular events. The Cardiovascular Outcomes in People Using Anticoagulant Strategies (COMPASS) double-blind, randomized clinical trial demonstrated that aspirin plus low-dose rivaroxaban (COMPASS regime) significantly decreased the incidence of major adverse cardiovascular events by 24% compared with aspirin alone. However, the mechanisms underlying these potential synergistic/nonantithrombotic effects remain elusive. Extracellular vesicles (EVs) are crucial messengers regulating a myriad of biological/pathological processes and are highly implicated in CVD.

Objectives: We hypothesized that circulating EV profiles reflect the cardioprotective properties of the COMPASS regime.

Methods: A cohort of stable CVD patients (N = 40) who participated in the COMPASS trial and were previously randomized to receive aspirin were prospectively recruited and assigned a revised regimen of open-label aspirin plus rivaroxaban. Blood samples were obtained at baseline (aspirin only) and 6-month follow-up. Plasma EV concentration, size, and origin were analyzed by nanoparticle tracking analysis and flow cytometry. EVs were enriched by ultracentrifugation for proteomic analysis.

Results: The COMPASS regime fundamentally altered small (<200 nm) and large (200-1000 nm) EV concentration and size compared with aspirin alone. Crucially, levels of platelet-derived and myeloperoxidase-positive EVs became significantly decreased at follow-up. Comparative proteomic characterization further revealed a significant decrease in highly proinflammatory protein expression at follow-up.

Conclusion: The observed changes in EV subpopulations, together with the differential protein expression profiles, suggest amelioration of an underlying proinflammatory and prothrombotic state upon dual therapy, which may be of clinical relevance toward understanding the fundamental mechanism underlying the reported superior cardiovascular outcomes associated with this antithrombotic regimen.

背景:尽管使用了阿司匹林进行二级预防,但病情稳定的心血管疾病(CVD)患者发生重大心血管事件(MACE)的长期风险仍然很高。COMPASS 双盲随机临床试验表明,与单用阿司匹林相比,阿司匹林加小剂量利伐沙班(COMPASS 方案)可将 MACE 发生率显著降低 24%。然而,这些潜在的协同/非抗血栓作用的机制仍然难以捉摸。细胞外囊泡(EVs)是调节无数生物/病理过程的重要信使,与心血管疾病有很大关系。我们假设循环中的EV能反映COMPASS疗法的心脏保护特性:我们前瞻性地招募了一批参与 COMPASS 试验的稳定型心血管疾病患者(40 人),这些患者之前被随机分配接受阿司匹林治疗,现在他们又被分配接受了开放标签阿司匹林加利伐沙班的修订治疗方案。在基线(仅服用阿司匹林)和6个月随访时采集血样。通过 NTA 和流式细胞术分析血浆 EV 的浓度、大小和来源。通过超速离心法富集 EVs 进行蛋白质组分析:结果:COMPASS 方案从根本上改变了小EV(结论:观察到的 EV 亚群的变化以及不同的蛋白质表达谱表明,双重疗法改善了潜在的促炎症和促血栓形成状态,这可能与临床相关,有助于理解与这种抗血栓治疗方案相关的卓越心血管疗效的基本机制。
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引用次数: 0
Recognizing the 11th Year of World Thrombosis Day: A Call to Action for Health Care Professionals with a Focus on Women and Thrombosis 纪念第 11 个 "世界血栓日":呼吁医护人员采取行动,关注妇女与血栓形成。
IF 5.5 2区 医学 Q1 HEMATOLOGY Pub Date : 2024-10-13 DOI: 10.1016/j.jtha.2024.10.001
Lana A. Castellucci M.D. MSc , Louise St. Germain
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引用次数: 0
Management and outcomes in patients with tumor thrombus: a retrospective cohort study. 肿瘤血栓患者的管理和预后:回顾性队列研究
IF 5.5 2区 医学 Q1 HEMATOLOGY Pub Date : 2024-10-12 DOI: 10.1016/j.jtha.2024.10.002
Sean Hui, Khalid Zeid, Roger Kou, Ranjeeta Mallick, Marc Carrier, Tzu-Fei Wang

Background: Tumor thrombus can be associated with an increased risk of venous thromboembolism (VTE) and poor prognosis. The risks and benefits of anticoagulation remain unclear.

Objectives: To evaluate the role of anticoagulation and associated outcomes in patients with tumor thrombus.

Methods: We conducted a single-center retrospective cohort study in patients with tumor thrombus from 2019 to 2022. All patients were followed for 12 months from the diagnosis of tumor thrombus or until death if death occurred earlier. The primary outcome was the percentage of patients prescribed any dose of anticoagulation for tumor thrombus (or concurrent bland thrombus/VTE). The secondary outcomes included new thrombosis, major bleeding, clinically relevant nonmajor bleeding, and mortality. We calculated the 6- and 12-month cumulative incidence of outcomes with 95% CI and compared those given anticoagulation vs not, considering death as a competing risk.

Results: We included 211 patients, among whom 106 (50.2%; 95% CI, 47.9%-52.6%) were given anticoagulation for tumor thrombus or concurrent VTE (present in 21.8%). The most common type of cancer was hepatocellular carcinoma (28%). Splanchnic veins were the most commonly involved (49.3%). Anticoagulation was more likely used if tumor thrombus involved the inferior vena cava and/or the heart, with concurrent VTE, or if thrombosis service was consulted. The overall 12-month incidence of new VTE was 11.4% (95% CI, 7.3%-16.5%), that of major bleeding + clinically relevant nonmajor bleeding was 36.6% (95% CI, 29.6%-43.5%), and mortality of 52.5% (95% CI, 44.8%-59.6%), with no significant differences among groups given anticoagulation or not.

Conclusion: Patients with tumor thrombus carry high risks of VTE, bleeding, and mortality. The impact of anticoagulation remains unclear.

背景:肿瘤血栓可导致静脉血栓栓塞症(VTE)风险增加和预后不良。抗凝治疗的风险和益处尚不明确:我们在2019-2022年对肿瘤血栓患者进行了一项单中心回顾性队列研究。所有患者自肿瘤血栓确诊起随访 12 个月,如果死亡时间较早,则随访至死亡。主要结果是因肿瘤血栓(或并发白血栓/VTE)而被处以任何剂量抗凝治疗的患者比例。次要结果包括新的血栓形成、大出血(MB)、临床相关性非大出血(CRNMB)和死亡率。我们计算了结果的 6 个月和 12 个月累积发生率及 95% 的置信区间 (CI),并比较了给予抗凝治疗与未给予抗凝治疗的患者,将死亡视为竞争风险:我们纳入了 211 名患者,其中 106 人(50.2%)(95% CI:47.9-52.6)因肿瘤血栓或并发 VTE(21.8%)而接受了抗凝治疗。最常见的癌症类型是肝细胞癌(28%)。最常累及的是脾静脉(49.3%)。如果肿瘤血栓累及下腔静脉、心脏、并发 VTE 或咨询过血栓服务,则更有可能使用抗凝治疗。12个月内新发VTE的总发生率为11.4%(95% CI 7.3-16.5),MB + CRNMB的发生率为36.6%(95% CI 29.6-43.5),死亡率为52.5%(95% CI 44.8-59.6),抗凝与否在各组间无显著差异:结论:肿瘤血栓患者发生 VTE、出血和死亡的风险很高。结论:肿瘤血栓患者具有很高的 VTE、出血和死亡风险,抗凝治疗的影响仍不明确。
{"title":"Management and outcomes in patients with tumor thrombus: a retrospective cohort study.","authors":"Sean Hui, Khalid Zeid, Roger Kou, Ranjeeta Mallick, Marc Carrier, Tzu-Fei Wang","doi":"10.1016/j.jtha.2024.10.002","DOIUrl":"10.1016/j.jtha.2024.10.002","url":null,"abstract":"<p><strong>Background: </strong>Tumor thrombus can be associated with an increased risk of venous thromboembolism (VTE) and poor prognosis. The risks and benefits of anticoagulation remain unclear.</p><p><strong>Objectives: </strong>To evaluate the role of anticoagulation and associated outcomes in patients with tumor thrombus.</p><p><strong>Methods: </strong>We conducted a single-center retrospective cohort study in patients with tumor thrombus from 2019 to 2022. All patients were followed for 12 months from the diagnosis of tumor thrombus or until death if death occurred earlier. The primary outcome was the percentage of patients prescribed any dose of anticoagulation for tumor thrombus (or concurrent bland thrombus/VTE). The secondary outcomes included new thrombosis, major bleeding, clinically relevant nonmajor bleeding, and mortality. We calculated the 6- and 12-month cumulative incidence of outcomes with 95% CI and compared those given anticoagulation vs not, considering death as a competing risk.</p><p><strong>Results: </strong>We included 211 patients, among whom 106 (50.2%; 95% CI, 47.9%-52.6%) were given anticoagulation for tumor thrombus or concurrent VTE (present in 21.8%). The most common type of cancer was hepatocellular carcinoma (28%). Splanchnic veins were the most commonly involved (49.3%). Anticoagulation was more likely used if tumor thrombus involved the inferior vena cava and/or the heart, with concurrent VTE, or if thrombosis service was consulted. The overall 12-month incidence of new VTE was 11.4% (95% CI, 7.3%-16.5%), that of major bleeding + clinically relevant nonmajor bleeding was 36.6% (95% CI, 29.6%-43.5%), and mortality of 52.5% (95% CI, 44.8%-59.6%), with no significant differences among groups given anticoagulation or not.</p><p><strong>Conclusion: </strong>Patients with tumor thrombus carry high risks of VTE, bleeding, and mortality. The impact of anticoagulation remains unclear.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":null,"pages":null},"PeriodicalIF":5.5,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Comprehensive Evaluation of Anti-Emicizumab Antibodies in Acquired Hemophilia A: A Detailed Case Study and Methodological Evaluation. 全面评估获得性血友病 A 的抗伊米珠单抗抗体:详细病例研究与方法评估
IF 5.5 2区 医学 Q1 HEMATOLOGY Pub Date : 2024-10-12 DOI: 10.1016/j.jtha.2024.10.003
Behnaz Pezeshkpoor, Nadja Sereda, Janine Becker-Gotot, Ann-Cristin Berkemeier, Isabell Matuschek, Jens Müller, Samhitha Urs Ramaraje Urs, Sneha Singh, Claudia Klein, Natascha Marquardt, Johannes Oldenburg

Background: Acquired hemophilia A (AHA) is a rare and severe bleeding disorder characterized by autoantibodies inhibiting coagulation factor VIII (FVIII). Current treatment of AHA involves bypassing agents, or FVIII replacement therapy, yet their efficacy is limited in cases of high inhibitor titers. Emicizumab, a humanized bispecific monoclonal antibody, has shown promising hemostatic effectiveness in congenital hemophilia A (HA) patients and AHA, but a minority of patients developed anti-drug antibodies (ADAs), compromising its efficacy.

Materials and methods: We present a comprehensive characterization of anti-emicizumab antibodies in a patient with AHA experiencing diminished emicizumab efficacy from week 10 of treatment. We developed a method for analysis of anti-emicizumab antibodies, distinguishing immunoglobulin subclasses and IgG subtype profiling. ADAs' neutralizing activity was evaluated using a modified clotting assay.

Results: The Luminex-based assay demonstrated the presence of anti-emicizumab antibodies, confirmed through competitive analysis. We detected anti-emicizumab IgG antibodies in the patient's plasma between week 16 and 29. IgG1 and IgG2 subclasses were identified. Longitudinal analysis showed IgG isotype antibodies against both emicizumab and FVIII. Anti-emicizumab antibodies exhibited non-inhibitory activity, confirmed by a modified Bethesda assay. Moreover, no accelerated clearance of emicizumab was observed in plasma samples from the patient.

Conclusions: This study presents the first documented case of anti-emicizumab antibodies in AHA. Our study provides insights into ADA development against emicizumab, emphasizing the need for monitoring tools. The developed method enables comprehensive evaluation of ADAs, aiding in personalized treatment strategies. These findings contribute to understanding emicizumab's immunogenicity profile in AHA, facilitating its optimized clinical use.

背景:获得性血友病 A(AHA)是一种罕见的严重出血性疾病,其特点是自身抗体抑制凝血因子 VIII(FVIII)。目前治疗 AHA 的方法包括旁路药物或 FVIII 替代疗法,但在抑制剂滴度较高的情况下,其疗效有限。Emicizumab是一种人源化双特异性单克隆抗体,在先天性A型血友病(HA)患者和AHA患者中显示出良好的止血效果,但少数患者产生了抗药性抗体(ADA),影响了其疗效:我们对一名从治疗第 10 周起埃米珠单抗疗效下降的 AHA 患者体内的抗埃米珠单抗抗体进行了全面鉴定。我们开发了一种分析抗伊米珠单抗抗体的方法,可区分免疫球蛋白亚类和IgG亚型。我们使用改良的凝血试验评估了 ADAs 的中和活性:结果:基于 Luminex 的检测证明了抗emicizumab 抗体的存在,并通过竞争性分析得到了证实。我们在第 16 周至第 29 周期间在患者血浆中检测到了抗emicizumab IgG 抗体。确定了 IgG1 和 IgG2 亚类。纵向分析表明,埃米珠单抗和 FVIII 都有 IgG 同型抗体。经改良的贝塞斯达试验证实,抗埃米珠单抗抗体具有非抑制性活性。此外,在患者的血浆样本中没有观察到埃米珠单抗的加速清除:本研究首次记录了AHA中抗埃米珠单抗抗体的病例。我们的研究深入揭示了抗伊米珠单抗的 ADA 发展情况,强调了监测工具的必要性。所开发的方法可对ADA进行全面评估,有助于制定个性化治疗策略。这些发现有助于了解埃米珠单抗在 AHA 中的免疫原性概况,从而促进其临床应用的优化。
{"title":"Comprehensive Evaluation of Anti-Emicizumab Antibodies in Acquired Hemophilia A: A Detailed Case Study and Methodological Evaluation.","authors":"Behnaz Pezeshkpoor, Nadja Sereda, Janine Becker-Gotot, Ann-Cristin Berkemeier, Isabell Matuschek, Jens Müller, Samhitha Urs Ramaraje Urs, Sneha Singh, Claudia Klein, Natascha Marquardt, Johannes Oldenburg","doi":"10.1016/j.jtha.2024.10.003","DOIUrl":"https://doi.org/10.1016/j.jtha.2024.10.003","url":null,"abstract":"<p><strong>Background: </strong>Acquired hemophilia A (AHA) is a rare and severe bleeding disorder characterized by autoantibodies inhibiting coagulation factor VIII (FVIII). Current treatment of AHA involves bypassing agents, or FVIII replacement therapy, yet their efficacy is limited in cases of high inhibitor titers. Emicizumab, a humanized bispecific monoclonal antibody, has shown promising hemostatic effectiveness in congenital hemophilia A (HA) patients and AHA, but a minority of patients developed anti-drug antibodies (ADAs), compromising its efficacy.</p><p><strong>Materials and methods: </strong>We present a comprehensive characterization of anti-emicizumab antibodies in a patient with AHA experiencing diminished emicizumab efficacy from week 10 of treatment. We developed a method for analysis of anti-emicizumab antibodies, distinguishing immunoglobulin subclasses and IgG subtype profiling. ADAs' neutralizing activity was evaluated using a modified clotting assay.</p><p><strong>Results: </strong>The Luminex-based assay demonstrated the presence of anti-emicizumab antibodies, confirmed through competitive analysis. We detected anti-emicizumab IgG antibodies in the patient's plasma between week 16 and 29. IgG<sub>1</sub> and IgG<sub>2</sub> subclasses were identified. Longitudinal analysis showed IgG isotype antibodies against both emicizumab and FVIII. Anti-emicizumab antibodies exhibited non-inhibitory activity, confirmed by a modified Bethesda assay. Moreover, no accelerated clearance of emicizumab was observed in plasma samples from the patient.</p><p><strong>Conclusions: </strong>This study presents the first documented case of anti-emicizumab antibodies in AHA. Our study provides insights into ADA development against emicizumab, emphasizing the need for monitoring tools. The developed method enables comprehensive evaluation of ADAs, aiding in personalized treatment strategies. These findings contribute to understanding emicizumab's immunogenicity profile in AHA, facilitating its optimized clinical use.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":null,"pages":null},"PeriodicalIF":5.5,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Journal of Thrombosis and Haemostasis
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