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Sirinvaravong N, Rodriguez Ziccardi MC, Patnaik S, Shah M, Fernandez G, Aliling JN, Rubin A. Nonbacterial thrombotic endocarditis in a patient with primary antiphospholipid syndrome. Oxf Med Case Reports 2018; 2018:omy024. [PMID: 29977578 PMCID: PMC6016692 DOI: 10.1093/omcr/omy024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 03/09/2018] [Accepted: 04/16/2018] [Indexed: 11/24/2022] Open
Abstract
Nonbacterial thrombotic endocarditis (NBTE) is described in patients with mucin-producing cancers and connective tissue disorders (usually SLE). We report NBTE in the setting of primary antiphospholipid antibody syndrome (APS). A 65-year-old female with APS was incidentally found to have thickened mitral leaflets on transthoracic echocardiogram with no signs of infection. Transesophageal echocardiogram (TEE) showed a mobile mitral mass (1.4 × 0.7 cm) and moderate mitral regurgitation. Differential diagnoses included bacterial endocarditis, NBTE, thrombus or tumor. Given the history of primary APS, the absence of fever and negative blood cultures, NBTE was considered. Low-molecular-weight heparin, hydroxychloroquine and corticosteroid were initiated. Repeat TEE in a week revealed shrinkage of the mass (0.6 × 0.7 cm), indicating an inflammatory nature. Lifelong anticoagulation is indicated regardless of embolism occurrence. Hydroxychloroquine and corticosteroids may have roles in the treatment. Determining and treating the underlying etiology is important.
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Affiliation(s)
| | | | - Soumya Patnaik
- Division of Cardiology, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Mahek Shah
- Division of Cardiology, Lehigh Valley Healthcare Network, Allentown, PA, USA
| | - Gustavo Fernandez
- Division of Pulmonology, Temple University Hospital, Philadelphia, PA, USA
| | | | - Alexander Rubin
- Division of Cardiology, Pennsylvania Heart and Vascular Group, Jenkintown, Philadelphia PA, USA
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Ma R, Xie R, Yu C, Si Y, Wu X, Zhao L, Yao Z, Fang S, Chen H, Novakovic V, Gao C, Kou J, Bi Y, Thatte HS, Yu B, Yang S, Zhou J, Shi J. Phosphatidylserine-mediated platelet clearance by endothelium decreases platelet aggregates and procoagulant activity in sepsis. Sci Rep 2017; 7:4978. [PMID: 28694452 PMCID: PMC5504060 DOI: 10.1038/s41598-017-04773-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 05/22/2017] [Indexed: 12/14/2022] Open
Abstract
The mechanisms that eliminate activated platelets in inflammation-induced disseminated intravascular coagulation (DIC) in micro-capillary circulation are poorly understood. This study explored an alternate pathway for platelet disposal mediated by endothelial cells (ECs) through phosphatidylserine (PS) and examined the effect of platelet clearance on procoagulant activity (PCA) in sepsis. Platelets in septic patients demonstrated increased levels of surface activation markers and apoptotic vesicle formation, and also formed aggregates with leukocytes. Activated platelets adhered were and ultimately digested by ECs in vivo and in vitro. Blocking PS on platelets or αvβ3 integrin on ECs attenuated platelet clearance resulting in increased platelet count in a mouse model of sepsis. Furthermore, platelet removal by ECs resulted in a corresponding decrease in platelet-leukocyte complex formation and markedly reduced generation of factor Xa and thrombin on platelets. Pretreatment with lactadherin significantly increased phagocytosis of platelets by approximately 2-fold, diminished PCA by 70%, prolonged coagulation time, and attenuated fibrin formation by 50%. Our results suggest that PS-mediated clearance of activated platelets by the endothelium results in an anti-inflammatory, anticoagulant, and antithrombotic effect that contribute to maintaining platelet homeostasis during acute inflammation. These results suggest a new therapeutic target for impeding the development of DIC.
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Affiliation(s)
- Ruishuang Ma
- Department of Hematology of the First Hospital, Harbin Medical University, Harbin, China.,The Key Laboratory of Myocardial Ischemia, Ministry of Education, Heilongjiang Province, Harbin Medical University, Harbin, China
| | - Rui Xie
- Department of Hematology of the First Hospital, Harbin Medical University, Harbin, China.,Department of Medicine of the Third Hospital, Harbin Medical University, Harbin, China
| | - Chengyuan Yu
- Department of Hematology of the First Hospital, Harbin Medical University, Harbin, China
| | - Yu Si
- Department of Hematology of the First Hospital, Harbin Medical University, Harbin, China.,The Key Laboratory of Myocardial Ischemia, Ministry of Education, Heilongjiang Province, Harbin Medical University, Harbin, China
| | - Xiaoming Wu
- Department of Hematology of the First Hospital, Harbin Medical University, Harbin, China
| | - Lu Zhao
- Department of Hematology of the First Hospital, Harbin Medical University, Harbin, China
| | - Zhipeng Yao
- Department of Hematology of the First Hospital, Harbin Medical University, Harbin, China
| | - Shaohong Fang
- The Key Laboratory of Myocardial Ischemia, Ministry of Education, Heilongjiang Province, Harbin Medical University, Harbin, China
| | - He Chen
- Department of Pathology, Harbin Medical University, Harbin, China
| | - Valerie Novakovic
- Departments of Research VA Boston Healthcare System, Harvard Medical School, Boston, Massachusetts, USA
| | - Chunyan Gao
- Department of Hematology of the First Hospital, Harbin Medical University, Harbin, China
| | - Junjie Kou
- Department of Cardiology of the Second Hospital, Harbin Medical University, Harbin, China
| | - Yayan Bi
- Departments of Cardiology of the First Hospital, Harbin Medical University, Harbin, China
| | - Hemant S Thatte
- Departments of Surgery, Brigham and Women's Hospital, VA Boston Healthcare System, Harvard Medical School, Boston, Massachusetts, USA
| | - Bo Yu
- The Key Laboratory of Myocardial Ischemia, Ministry of Education, Heilongjiang Province, Harbin Medical University, Harbin, China
| | - Shufen Yang
- The Key Laboratory of Myocardial Ischemia, Ministry of Education, Heilongjiang Province, Harbin Medical University, Harbin, China.
| | - Jin Zhou
- Department of Hematology of the First Hospital, Harbin Medical University, Harbin, China.
| | - Jialan Shi
- Department of Hematology of the First Hospital, Harbin Medical University, Harbin, China. .,Departments of Surgery, Brigham and Women's Hospital, VA Boston Healthcare System, Harvard Medical School, Boston, Massachusetts, USA.
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