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Di Minno G, Miesbach W, Castaman G, Peyvandi F. Next-generation strategies to improve safety and efficacy of adeno-associated virus-based gene therapy for hemophilia: lessons from clinical trials in other gene therapies. Haematologica 2024. [PMID: 38450517 DOI: 10.3324/haematol.2023.284622] [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] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Indexed: 03/08/2024] Open
Abstract
Three major directions for the global progress of adeno-associated virus (AAV) vectors for gene therapies (GT) are analyzed: a) engineering vectors to increase transgene expression; b) aligning interests of the health system with costs and challenges for pharmaceutical industry; c) refining patient eligibility criteria, and endpoints definition. Currently employed AAV vectors may cause toxicity and adverse events. Furthermore, studies in animals do not fully predict risks and clinical benefits of AAV-based GT, and animal models reflecting the heterogeneity of certain clinical settings (e.g., congestive heart failure) are poorly available for improving AAV-based GT. Finally, antisense and gene editing approaches will soon complement gene augmentation strategies for the stable solution of unsolved issues of AAV-based GT. While minimizing toxicity, next-generation AAV vectors should decrease the viral load needed to achieve therapeutic efficacy; be functional in a restricted cellular subset; avoid transgene expression in unwanted cells (e.g., hepatocytes), and escape immune oversight in AAV-based GT. The role of stress-induced apoptosis in the loss of transgene expression in GT should be also explored. Aligning interests and obligations of pharmaceutical industry with those of the health system is critical for AAV-based GT success. Costs and challenges for pharmaceutical industry include a) removing impurities from AAV; b) validating tests to measure treatment efficacy, c) promoting training programs to standardize vector genomes delivery, d) collecting long-term follow-up data, and e) maintaining sustainability and cost-effectiveness of AAV-based GT. In rare disorders with small patient numbers (e.g., hemophilia), clearcut outcomes are mandatory as endpoints of unequivocal efficacy data.
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Affiliation(s)
- Giovanni Di Minno
- Dipartimento di Medicina Clinica e Chirurgia, Federico II University, School of Medicine, Napoli.
| | - Wolfgang Miesbach
- The Haemophilia Center of the Medical Clinic, University Hospital Frankfurt/Main
| | - Giancarlo Castaman
- Center for Bleeding Disorders and Coagulation, Department of Oncology, Careggi University Hospital, Florence
| | - Flora Peyvandi
- Angelo Bianchi Bonomi Haemophilia and Thrombosis Center, Fondazione Luigi Villa, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan
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Villa S, De Cristofaro R, Di Minno G, Laratro S, Peyvandi F, Pippo L, Villa S, De Belvis AG. Design organization and clinical processes around patient characteristics: Evidence from a multiple case study of Hemophilia. Health Serv Manage Res 2024:9514848241231585. [PMID: 38355431 DOI: 10.1177/09514848241231585] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
Background: There is growing evidence of the relevance of designing organization of care around patient characteristics; this is especially true in the case of complex chronic diseases.Purpose: The goal of the paper - that focuses on the analysis of the clinical condition hemophilia in three different centers - is to address two different research questions:1. How can we define, within the same clinical condition, different patient profiles homogeneous in terms of intensity of service required (e.g. number of visits or diagnostics)? 2. What are the conditions to re-organize care around these patient profiles in a multidisciplinary and coordinated manner?Research design: The authors have used a multiple case study approach combining both qualitative and quantitative methodologies; in particularly the semi-structured interviews and the direct observation were aimed to map the process in order to come up with an estimate of the cost of the full cycle of care.Study sample: The research methodology has been applied consistently in three different centers. The selection of the structures has been based on two main different criteria: (i) high standards regarding both organizational and clinical aspects and (ii) willingness from management, nurses and physicians to provide data.Results: The study clearly shows that different patient profiles - within the same clinical condition - trigger a different set of diagnostic and therapeutic activities. It is, thus, important considering patient characteristics in the development and implementation of clinical pathways and this will imply relevant differences in terms of organizational and economic impact.Conclusions: These process-based analyses are very much critical especially if we want to move to a bundled and integrated payment system but, as shown by this study itself, require a lot of time and efforts since our healthcare information systems are still fragmented and vertically designed.
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Affiliation(s)
- Stefano Villa
- Università Cattolica Del Sacro Cuore, Milano, Italy
- CERISMAS (Research Center in Healthcare Management), Milano, Italy
| | | | | | - Simone Laratro
- CERISMAS (Research Center in Healthcare Management), Milano, Italy
| | - Flora Peyvandi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinicov, Milan, Italy
| | | | | | - Antonio G De Belvis
- Università Cattolica Del Sacro Cuore, Milano, Italy
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
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Iaccarino C, Carretta A, Demetriades AK, Di Minno G, Giussani C, Marcucci R, Marklund N, Mastrojanni G, Pompucci A, Stefini R, Zona G, Cividini A, Petrella G, Coluccio V, Marietta M. Management of Antithrombotic Drugs in Patients with Isolated Traumatic Brain Injury: An Intersociety Consensus Document. Neurocrit Care 2024; 40:314-327. [PMID: 37029314 DOI: 10.1007/s12028-023-01715-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/07/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND All available recommendations about the management of antithrombotic therapies (ATs) in patients who experienced traumatic brain injury (TBI) are mainly based on expert opinion because of the lack of strength in the available evidence-based medicine. Currently, the withdrawal and the resumption of AT in these patients is empirical, widely variable, and based on the individual assessment of the attending physician. The main difficulty is to balance the thrombotic and hemorrhagic risks to improve patient outcome. METHODS Under the endorsement of the Neurotraumatology Section of Italian Society of Neurosurgery, the Italian Society for the Study about Haemostasis and Thrombosis, the Italian Society of Anaesthesia, Analgesia, Resuscitation, and Intensive Care, and the European Association of Neurosurgical Societies, a working group (WG) of clinicians completed two rounds of questionnaires, using the Delphi method, in a multidisciplinary setting. A table for thrombotic and bleeding risk, with a dichotomization in high risk and low risk, was established before questionnaire administration. In this table, the risk is calculated by matching different isolated TBI (iTBI) scenarios such as acute and chronic subdural hematomas, extradural hematoma, brain contusion (intracerebral hemorrhage), and traumatic subarachnoid hemorrhage with patients under active AT treatment. The registered indication could include AT primary prevention, cardiac valve prosthesis, vascular stents, venous thromboembolism, and atrial fibrillation. RESULTS The WG proposed a total of 28 statements encompassing the most common clinical scenarios about the withdrawal of antiplatelets, vitamin K antagonists, and direct oral anticoagulants in patients who experienced blunt iTBI. The WG voted on the grade of appropriateness of seven recommended interventions. Overall, the panel reached an agreement for 20 of 28 (71%) questions, deeming 11 of 28 (39%) as appropriate and 9 of 28 (32%) as inappropriate interventions. The appropriateness of intervention was rated as uncertain for 8 of 28 (28%) questions. CONCLUSIONS The initial establishment of a thrombotic and/or bleeding risk scoring system can provide a vital theoretical basis for the evaluation of effective management in individuals under AT who sustained an iTBI. The listed recommendations can be implemented into local protocols for a more homogeneous strategy. Validation using large cohorts of patients needs to be developed. This is the first part of a project to update the management of AT in patients with iTBI.
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Affiliation(s)
- Corrado Iaccarino
- Department of Biomedical, Metabolic and Neural Sciences, School of Neurosurgery, University of Modena and Reggio Emilia, Modena, Italy
- Neurosurgery Division, "Nocsae" Hospital of Baggiovara, University Hospital of Modena, Modena, Italy
- Emergency Neurosurgery Unit, AUSL RE IRCCS, "ASMN" Hospital of Reggio Emilia, Reggio Emilia, Italy
| | - Alessandro Carretta
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.
| | | | - Giovanni Di Minno
- Regional Reference Center for Coagulation Disorders, Federico II University Hospital, Naples, Italy
- Department of Clinical and Surgical Medicine, Federico II University of Naples, Naples, Italy
| | - Carlo Giussani
- Department of Neurosurgery, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Rossella Marcucci
- Center for Atherothrombotic Disease, Department of Experimental and Clinical Medicine, Careggi University Hospital, University of Florence, Florence, Italy
| | - Niklas Marklund
- Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala, Sweden
- Department of Clinical Sciences, Department of Neurosurgery, Skåne University Hospital, Lund University, Lund, Sweden
| | | | - Angelo Pompucci
- Neurosurgery Division, ASL Latina Ospedale Santa Maria Goretti, Latina, Italy
| | - Roberto Stefini
- Neurosurgery Division, Department of Neurosciences, Head, Neck and Neurosurgery, Ospedale Civile di Legnano, Legnano, Italy
| | - Gianluigi Zona
- Neurosurgery Division, Department of Neurosciences (DINOGMI), IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Andrea Cividini
- Neurosurgery Division, Department of Neurosciences, Head, Neck and Neurosurgery, Ospedale Civile di Legnano, Legnano, Italy
| | - Gianpaolo Petrella
- Neurosurgery Division, ASL Latina Ospedale Santa Maria Goretti, Latina, Italy
| | - Valeria Coluccio
- Department of Hematology and Oncology, Hemostasis and Thrombosis Unit, University Hospital of Modena, Modena, Italy
| | - Marco Marietta
- Department of Hematology and Oncology, Hemostasis and Thrombosis Unit, University Hospital of Modena, Modena, Italy
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Antonazzo IC, Cortesi PA, Zanon E, Pasca S, Morfini M, Santoro C, De Cristofaro R, Di Minno G, Cozzolino P, Mantovani LG. Personalized Prophylaxis with myPKFiT CE: A Real-World Cost-Effectiveness Analysis in Haemophilia A Patients. Medicina (Kaunas) 2023; 60:34. [PMID: 38256294 PMCID: PMC10820281 DOI: 10.3390/medicina60010034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/18/2023] [Accepted: 12/21/2023] [Indexed: 01/24/2024]
Abstract
Background and Objectives: This study aimed to assess the effectiveness and costs associated with pharmacokinetics-driven (PK) prophylaxis based on the myPKFiT® device in patients affected by hemophilia A (HA) in Italy. Materials and Methods: An observational retrospective study was conducted in three Italian hemophilia centers. All patients with moderate or severe HA, aged ≥ 18 years, capable of having PK estimated using the myPKFiT device, and who had had a clinical visit between 1 November 2019 and 31 March 2022 were included. Differences in clinical, treatment, health resources, and cost data were assessed comparing post-PK prophylaxis with pre-PK. The incremental cost-effectiveness ratio (ICER) was estimated as cost (EUR) per bleed avoided. Results: The study enrolled 13 patients with HA. The mean annual bleeding rate decreased by -1.45 (-63.80%, p = 0.0055) after the use of myPKFiT®. Overall, the consumption of FVIII IU increased by 1.73% during follow-up compared to the period prior the use of the myPKFiT. Prophylaxis based on the myPKFiT resulted in an ICER of EUR 5099.89 per bleed avoided. Conclusions: The results of our study support the idea that the use of PK data in clinical practice can be associated with an improvement in the management of patients, as well as clinical outcomes, with a reasonable increase in costs.
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Affiliation(s)
- Ippazio Cosimo Antonazzo
- Research Centre on Public Health (CESP), University of Milan-Bicocca, 20900 Monza, Italy; (P.A.C.); (L.G.M.)
- IRCCS Istituto Auxologico Italiano, 20145 Milano, Italy
| | - Paolo Angelo Cortesi
- Research Centre on Public Health (CESP), University of Milan-Bicocca, 20900 Monza, Italy; (P.A.C.); (L.G.M.)
- IRCCS Istituto Auxologico Italiano, 20145 Milano, Italy
| | - Ezio Zanon
- Hemophilia Center, University Hospital of Padua, 35128 Padua, Italy;
| | - Samantha Pasca
- Laboratory Medicine, Department of Biomedical Sciences, Padua University Hospital, 35128 Padua, Italy;
| | - Massimo Morfini
- Italian Association of Haemophilia Centres—AICE, 50100 Firenze, Italy;
| | | | - Raimondo De Cristofaro
- Center for Haemorrhagic and Thrombotic Diseases, Department of Medical Sciences, Catholic University School of Medicine, ‘A. Gemelli’ Hospital, 00168 Rome, Italy;
| | - Giovanni Di Minno
- Department of Clinical Medicine and Surgery, Regional Service Centre of Coagulation Disorders, ‘Federico II’ University, 80138 Naples, Italy;
| | - Paolo Cozzolino
- Research Centre on Public Health (CESP), University of Milan-Bicocca, 20900 Monza, Italy; (P.A.C.); (L.G.M.)
| | - Lorenzo Giovanni Mantovani
- Research Centre on Public Health (CESP), University of Milan-Bicocca, 20900 Monza, Italy; (P.A.C.); (L.G.M.)
- IRCCS Istituto Auxologico Italiano, 20145 Milano, Italy
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Di Minno G, Spadarella G, Maldonato NM, De Lucia N, Castaman G, De Cristofaro R, Santoro C, Peyvandi F, Borrelli A, Lupi A, Follino M, Guerrino G, Morisco F, Di Minno M. Awareness of individual goals, preferences, and priorities of persons with severe congenital haemophilia A for a tailored shared decision-making approach to liver-directed gene therapy. A practical guideline. Blood Rev 2023; 62:101118. [PMID: 37544828 DOI: 10.1016/j.blre.2023.101118] [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: 06/05/2023] [Revised: 07/26/2023] [Accepted: 07/30/2023] [Indexed: 08/08/2023]
Abstract
In clinical medicine, shared decision making (SDM) is a well-recognized strategy to enhance engagement of both patients and clinicians in medical decisions. The success of liver-directed gene therapy (GT) to transform severe congenital haemophilia A (HA) from an incurable to a curable disease has launched a shift beyond current standards of treatment. However, GT acceptance remains low in the community of HA persons. We argue for both persons with haemophilia (PWH) and specialists in HA care including clinicians, as needing SDM-oriented educational programs devoted to GT. Here, we provide an ad hoc outline to implement education to SDM and tailor clinician information on GT to individual PWHs. Based on routine key components of SDM: patient priorities; recommendations based on individual risk reduction; adverse effects; drug-drug interactions; alternatives to GT; and ongoing re-assessment of the objectives as risk factors (and individual priorities) change, this approach is finalized to exploit efficacious communication.
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Affiliation(s)
| | - Gaia Spadarella
- Dipartimento di Scienze Mediche Traslazionali, Naples, Italy.
| | - Nelson Mauro Maldonato
- Dipartimento di Neuroscienze e di Scienze Riproduttive e Odontostomatologiche, "Federico II" University, Naples, Italy
| | - Natascia De Lucia
- Dipartimento di Neuroscienze e di Scienze Riproduttive e Odontostomatologiche, "Federico II" University, Naples, Italy.
| | - Giancarlo Castaman
- Center for Bleeding Disorders and Coagulation, Careggi University Hospital, Florence, Italy.
| | - Raimondo De Cristofaro
- Section of Haemorrhagic and Thrombotic Diseases, Department of Medicine and Translational Surgery, Sacred Heart University, Rome, Italy..
| | - Cristina Santoro
- Ematologia, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Rome, Italy.
| | - Flora Peyvandi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, 20122 Milan, Italy; Università degli Studi di Milano, Department of Pathophysiology and Transplantation, Milan, Italy.
| | - Anna Borrelli
- Direzione Sanitaria, AOU "Federico II" Napoli, Italy
| | - Angelo Lupi
- Federazione delle Associazioni Emofilici (FedEmo), Milan, Italy.
| | | | | | | | - Matteo Di Minno
- Dipartimento di Medicina Clinica e Chirurgia, Naples, Italy.
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Poon MC, D'Oiron R, Baby S, Zotz RB, Di Minno G. The Glanzmann Thrombasthenia Registry: safety of platelet therapy in patients with Glanzmann thrombasthenia and changes in alloimmunization status. Haematologica 2023; 108:2855-2858. [PMID: 36924249 PMCID: PMC10542831 DOI: 10.3324/haematol.2022.281973] [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: 09/02/2022] [Accepted: 03/06/2023] [Indexed: 03/18/2023] Open
Affiliation(s)
- Man-Chiu Poon
- Departments of Medicine, Pediatrics and Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Southern Alberta Rare Blood and Bleeding Disorders Comprehensive Care Program, Foothills Medical Centre, Calgary, Alberta.
| | - Roseline D'Oiron
- Centre de Référence de l'Hémophilie et des Maladies Hémorragiques Constitutionnelles, Hôpital Bicêtre, AP-HP, and HITh, UMR_S1176, INSERM. Université Paris Saclay, Le Kremlin-Bicêtre
| | - Sibin Baby
- Biostatistics and Programming GD GBS, Novo Nordisk Service Centre India Private Ltd, Whitefield, Bangalore
| | - Rainer B Zotz
- Institute for Laboratory Medicine, Blood Coagulation and Transfusion Medicine (LBT), Düsseldorf, Germany; Department of Hemostasis, Hemotherapy and Transfusion Medicine, Heinrich Heine University Medical Centre, Düsseldorf
| | - Giovanni Di Minno
- Department of Clinical Medicine and Surgery, Regional Reference Center for Coagulation Disorders, Federico II University, Naples
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Castaman G, Carulli C, De Cristofaro R, Follino M, Lupi A, Mancuso ME, Mansueto MF, Molinari AC, Pasquetti P, Santoro C, Santoro RC, Siragusa S, Solimeno LP, Tripodi A, Zanon E, Minno GD. Laying the foundations for gene therapy in Italy for patients with haemophilia A: A Delphi consensus study. Haemophilia 2023; 29:435-444. [PMID: 36469855 DOI: 10.1111/hae.14709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 10/24/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Current treatment for haemophilia A involves factor VIII replacement or non-replacement (emicizumab) therapies, neither of which permanently normalise factor VIII levels. Gene therapy using adeno-associated viral (AAV) vectors is an emerging long-term treatment strategy for people with severe haemophilia A (PwSHA) that is likely to be available for clinical use in the near future. AIM This article proposes practical guidelines for the assessment, treatment, and follow-up of potential PwSHA candidates for AAV-based gene therapy. METHOD Using the Delphi method, a working group of Italian stakeholders with expertise in and knowledge of the care of adults with haemophilia A analysed literature for AAV-based gene therapy and drafted a list of statements that were circulated to a panel of Italian peers. During two rounds of voting, panel members voted on their agreement with each statement to reach a consensus. RESULTS The Delphi process yielded 40 statements regarding haemophilia A gene therapy, across five topics: (1) organisational model; (2) multidisciplinary team; (3) patient engagement; (4) laboratory surveillance; and (5) patient follow-up and gene therapy outcomes. The consensus was reached for all 40 statements, with the second round of voting needed for five statements. CONCLUSION Use of the hub-and-spoke organisational model and multidisciplinary teams are expected to optimise patient selection for gene therapy, as well as the management of dosing and patient follow-up, patient engagement, laboratory surveillance, and patient expectations regarding outcomes. This approach should allow the benefits of AAV-based gene therapy for haemophilia A to be maximised.
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Affiliation(s)
- Giancarlo Castaman
- Center for Bleeding Disorders and Coagulation, Department of Oncology, Careggi University Hospital, Florence, Italy
| | | | - Raimondo De Cristofaro
- Section of Haemorrhagic and Thrombotic Diseases, Department of Diagnostic Imaging, Oncological Radiotherapy and Haematology, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy.,Department of Medicine and Translational Surgery, Sacred Heart University, Rome, Italy
| | | | - Angelo Lupi
- Federation of Haemophilia Associations (FedEmo), Milan, Italy
| | - Maria Elisa Mancuso
- Center for Thrombosis and Hemorrhagic Diseases, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Maria Francesca Mansueto
- "P. Giaccone" University Hospital, University of Palermo Haemophilia Centre and Haematology Unit, Palermo, Italy
| | - Angelo Claudio Molinari
- Regional Reference Centre for Haemorrhagic Diseases, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Pietro Pasquetti
- Recovery and Rehabilitation Agency, University Hospital of Careggi, Florence, Italy
| | - Cristina Santoro
- Division of Haematology, Umberto I University Hospital, Rome, Italy
| | - Rita Carlotta Santoro
- Haemophilia, Haemostasis and Thrombosis Unit, Regional Reference Centre for Bleeding and Thrombosis Disorders, Pugliese-Ciaccio Hospital, Catanzaro, Italy
| | - Sergio Siragusa
- "P. Giaccone" University Hospital, University of Palermo Haemophilia Centre and Haematology Unit, Palermo, Italy
| | - Luigi Piero Solimeno
- Division of Orthopaedic Surgery and Traumatology, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Armando Tripodi
- Angelo Bianchi Bonomi Haemophilia and Thrombosis Center, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ezio Zanon
- Haemophilia Centre, Department of Medicine, University Hospital of Padua, Padua, Italy
| | - Giovanni Di Minno
- Department of Clinical Medicine and Surgery, "Federico II University; Hub" Centre for Congenital Thrombotic and Haemorrhagic Disorders, Naples, Italy
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Di Minno G, Castaman G, De Cristofaro R, Brunetti-Pierri N, Pastore L, Castaldo G, Trama U, Di Minno M. Progress, and prospects in the therapeutic armamentarium of persons with congenital hemophilia. Defining the place for liver-directed gene therapy. Blood Rev 2023; 58:101011. [PMID: 36031462 DOI: 10.1016/j.blre.2022.101011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/12/2022] [Accepted: 08/16/2022] [Indexed: 02/07/2023]
Abstract
In persons with congenital severe hemophilia A (HA) living in high-income countries, twice weekly intravenous infusions of extended half-life (EHL) factor VIII (FVIII) products, or weekly/biweekly/monthly subcutaneous injections of emicizumab are the gold standard home treatments to grant days without hurdles and limitations. Once weekly/twice monthly infusions of EHL Factor IX (FIX) products achieve the same target in severe hemophilia B (HB). Gene therapy, which is likely to be licensed for clinical use within 1-2 years, embodies a shift beyond these standards. At an individual patient level, a single functional gene transfer leads to a > 10-yr almost full correction of the hemostatic defect in HB and to a sustained (3-6-yrs) expression of FVIII sufficient to discontinue exogenous clotting factor administrations. At the doses employed, the limited liver toxicity of systemically infused recombinant adeno-associated virus (rAAV) vectors is documented by long-term (12-15 yrs) follow-ups, and pre-existing high-titer neutralizing antibodies to the AAV5 vector are no longer an exclusion criterion for effective transgene expression with this vector. A safe durable treatment that converts a challenging illness to a phenotypically curable disease, allows persons to feel virtually free from the fears and the obligations of hemophilia for years/decades. Along with patient organizations and health care professionals, communicating to government authorities and reimbursement agencies the liberating potential of this substantial innovation, and disseminating across the Centers updated information on benefits and risks of this strategy, will align expectations of different stakeholders and establish the notion of a potentially lifelong cure of hemophilia.
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Affiliation(s)
- Giovanni Di Minno
- Hub Center for Hemorrhagic and Thrombotic Disorders, Dep. of Clinical Medicine and Surgery, School of Medicine, Federico II University, Naples, Italy.
| | - Giancarlo Castaman
- Center for Bleeding Disorders and Coagulation, Careggi University Hospital, Florence, Italy.
| | - Raimondo De Cristofaro
- Center for Hemorrhagic and Thrombotic Diseases, Foundation University Hospital A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy.
| | - Nicola Brunetti-Pierri
- Telethon Institute of Genetics and Medicine, Pozzuoli, Italy; Dept of Translational Medicine, School of Medicine, Università degli Studi di Napoli "Federico II", Italy.
| | - Lucio Pastore
- CEINGE-Biotecnologie Avanzate, and Department of Molecular Medicine and Medical Biotechnology, School of Medicine, University of Naples Federico II, 80131 Naples, Italy.
| | - Giuseppe Castaldo
- CEINGE-Biotecnologie Avanzate, and Department of Molecular Medicine and Medical Biotechnology, School of Medicine, University of Naples Federico II, 80131 Naples, Italy.
| | - Ugo Trama
- Coordination of the Regional Health System, General Directorate for Health Protection, Naples, Italy.
| | - Matteo Di Minno
- Hub Center for Hemorrhagic and Thrombotic Disorders, Dep. of Clinical Medicine and Surgery, School of Medicine, Federico II University, Naples, Italy.
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Reding MT, Pabinger I, Holme PA, Maas Enriquez M, Mancuso ME, Lalezari S, Miesbach W, Di Minno G, Klamroth R, Hermans C. Efficacy and safety of damoctocog alfa pegol prophylaxis in patients ⩾40 years with severe haemophilia A and comorbidities: post hoc analysis from the PROTECT VIII study. Ther Adv Hematol 2023; 14:20406207231166779. [PMID: 37113811 PMCID: PMC10126693 DOI: 10.1177/20406207231166779] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/14/2023] [Indexed: 04/29/2023] Open
Abstract
Background Advances in treatment have enabled patients with haemophilia A to live longer and therefore may be subjected to comorbidities associated with ageing, in addition to disease-associated morbidities. There have been few reports to date on efficacy and safety of treatment specifically in patients with severe haemophilia A and comorbidities. Objective To explore the efficacy and safety of damoctocog alfa pegol prophylaxis in patients with severe haemophilia A aged ⩾40 years with comorbidities of interest. Design A post hoc analysis of data from the phase 2/3 PROTECT VIII study and its extension. Methods Bleeding and safety outcomes were analysed in a subgroup of patients aged ⩾40 years with ⩾1 comorbidity receiving damoctocog alfa pegol (BAY 94-9027; Jivi®) prophylaxis. Results Thirty-four patients with severe haemophilia A were included in this analysis, with a mean age of 49.4 years at time of enrolment. The most prevalent comorbidities were hepatitis C (n = 33; chronic, n = 23), hepatitis B (n = 8) and hypertension (n = 11). Four patients had human immunodeficiency virus. All received damoctocog alfa pegol prophylaxis for the entire study [median (range) time in study = 3.9 (1.0-6.9) years]. During the main study and extension, median total annualised bleeding rates (ABRs) (Q1; Q3) were 2.1 (0.0; 5.8) and 2.2 (0.6; 6.0), respectively; median joint ABRs were 1.9 (0.0; 4.4) and 1.6 (0.0; 4.0), respectively. Mean adherence with prophylaxis schedule was greater than 95% throughout the study. No deaths or thrombotic events were reported. Conclusion Efficacy, safety and adherence of damoctocog alfa pegol were confirmed in patients aged ⩾40 years with haemophilia A and one or more comorbidities, with data for up to 7 years supporting its use as a long-term treatment option in this group. Plain language summary Advances in treatment mean that people with haemophilia A are now living longer and, as a result, may have additional medical conditions that occur with ageing. We aimed to investigate the efficacy and safety of the long-acting replacement factor VIII damoctocog alfa pegol in people with severe haemophilia A who had additional medical conditions. To do this, we investigated the recorded information about patients aged 40 years of age or older who had been treated with damoctocog alfa pegol in a previously completed clinical trial. We found that the treatment was well-tolerated; no deaths or thrombotic events (undesirable clotting events) were reported. Treatment was efficacious in reducing bleeding in this group of patients. The findings support the use of damoctocog alfa pegol as a long-term treatment for older patients with haemophilia A and coexisting conditions.
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Affiliation(s)
| | - Ingrid Pabinger
- University Clinic for Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Pål Andrè Holme
- Department of Haematology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Maria Elisa Mancuso
- Center for Thrombosis and Hemorrhagic Diseases, IRCCS Humanitas Research Hospital, Milan, Italy; Humanitas University, Milan, Italy
| | - Shadan Lalezari
- National Haemophilia Centre, Chaim Sheba Medical Centre, Tel Aviv University, Tel Aviv, Israel
| | | | - Giovanni Di Minno
- Department of Clinical and Experimental Medicine, University of Naples Federico II, Naples, Italy
| | | | - Cedric Hermans
- Division of Haematology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Louvain, Belgium
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10
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Loffredo L, Vidili G, Sciacqua A, Cogliati C, Di Giulio R, Bernardini S, Ciacci P, Pietrangelo A, Orlando F, Paraninfi A, Boddi M, Di Minno G, Falsetti L, Lodigiani C, Santoliquido A, Ettorre E, Pignatelli P, Arezzo MF, Gutu E, Harenberg J, Violi F. Asymptomatic and symptomatic deep venous thrombosis in hospitalized acutely ill medical patients: risk factors and therapeutic implications. Thromb J 2022; 20:72. [PMID: 36451162 PMCID: PMC9709753 DOI: 10.1186/s12959-022-00433-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 11/13/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Acutely ill medical patients experience deep venous thrombosis (DVT) during the hospitalization, however the time course of DVT is still unclear. OBJECTIVES To evaluate risk factors in acutely ill hospitalized medical patients for proximal asymptomatic DVT (ADVT) and symptomatic DVT (SDVT) at admission and discharge. PATIENTS/METHODS In this prospective observational study, consecutive acutely ill medical patients (hospitalized mainly for acute medical disease as infections, neoplasm, anemia, heart failure) underwent compression ultrasonography (CUS) of proximal lower limb veins within 48 h from admission and at discharge to diagnose ADVT and SDVT. Covid-19 patients, anticoagulant therapy, surgical procedures, acute SDVT, and acute pulmonary embolism, were exclusion criteria. Biographical characteristics at hospitalization, D-Dimer (assessed by ELISA)) and DD-improve score. RESULTS Of 2,100 patients (1002 females, 998 males, age 71 ± 16 years) 58 (2.7%) had proximal ADVT at admission. Logistic regression analysis showed that age, and active cancer were independently associated with ADVT at admission. The median length of hospitalization was 10 days [interquartile range: 6-15]. During the hospital stay, 6 patients (0.3%) with a negative CUS at admission experienced DVT (2 SDVT and 4 ADVT). In the subgroup of patients (n = 1118), in whom D-dimer was measured at admission, D-Dimer and IMPROVE-DD score were associated with ADVT at admission (n = 37) and with all DVT (n = 42) at discharge. ROC curve defined an IMPROVE-DD score of 2.5 as the optimal cut-off for discriminating patients with and without thrombotic events. CONCLUSIONS We provide evidence of early development of ADVT in unselected acutely ill medical patients suggesting the need of investigating patients by CUS immediately after hospital admission (within 48 h). Advanced age, active cancer, known thrombophilia and increased IMPROVE-DD score may identify patients at risk. The benefit of anticoagulation needs to be investigated in patients with these specific risk factors and negative CUS at admission. TRIAL REGISTRATION NCT03157843.
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Affiliation(s)
- Lorenzo Loffredo
- grid.7841.aDepartment of Clinical, Internal Medicine, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Gianpaolo Vidili
- grid.11450.310000 0001 2097 9138Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Angela Sciacqua
- grid.411489.10000 0001 2168 2547Department of Medical and Surgical Sciences, University Magna-Græcia of Catanzaro, Catanzaro, Italy
| | - Chiara Cogliati
- grid.4708.b0000 0004 1757 2822 Department of Biomedical and Clinical Sciences, L.Sacco Hospital, ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy
| | - Rosella Di Giulio
- grid.416290.80000 0004 1759 7093Department of Internal Medicine, Internal Medicine Unit, Maggiore Hospital, Bologna, Italy
| | - Sciaila Bernardini
- grid.415207.50000 0004 1760 3756Department of Internal Medicine, AUSL Della Romagna, S. Maria Delle Croci Hospital, 48121 Ravenna, Italy
| | - Paolo Ciacci
- grid.7841.aDepartment of Clinical, Internal Medicine, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Antonello Pietrangelo
- grid.413363.00000 0004 1769 5275Department of Internal Medicine 2, University Hospital of Modena, Modena, Italy
| | - Federica Orlando
- grid.7841.aDepartment of Clinical, Internal Medicine, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Aurora Paraninfi
- grid.7841.aDepartment of Clinical, Internal Medicine, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Maria Boddi
- grid.8404.80000 0004 1757 2304Experimental and Clinical Department, University of Florence, Florence, Italy
| | - Giovanni Di Minno
- grid.4691.a0000 0001 0790 385XDepartment of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Lorenzo Falsetti
- grid.415845.9Internal and Sub-Intensive Medicine Department, A.O.U. “Ospedali Riuniti”, Ancona, Italy
| | - Corrado Lodigiani
- grid.417728.f0000 0004 1756 8807Cardiovascular Department, Thrombosis and Hemorrhagic Diseases Center, Humanitas Research Hospital, Rozzano, Milan Italy
| | - Angelo Santoliquido
- grid.8142.f0000 0001 0941 3192Catholic University of the Sacred Heart, Rome, Italy
| | - Evaristo Ettorre
- grid.7841.aDepartment of Clinical, Internal Medicine, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Pasquale Pignatelli
- grid.7841.aDepartment of Clinical, Internal Medicine, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Maria Felice Arezzo
- grid.7841.aDepartment of Methods and Models for Economics, Territory and Finance, Sapienza University of Rome, Via del Castro Laurenziano, 9, 00161 Rome, Italy
| | - Evghenii Gutu
- grid.28224.3e0000 0004 0401 27383Rd Department of General Surgery, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, Chisinau, Republic of Moldova
| | - Job Harenberg
- grid.7700.00000 0001 2190 4373Ruprecht-Kalrs University Heidelberg, Heidelberg, Germany
| | - Francesco Violi
- grid.7841.aDepartment of Clinical, Internal Medicine, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
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11
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Castaman G, Di Minno G, De Cristofaro R, Peyvandi F. The Arrival of Gene Therapy for Patients with Hemophilia A. Int J Mol Sci 2022; 23:10228. [PMID: 36142153 PMCID: PMC9499514 DOI: 10.3390/ijms231810228] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/01/2022] [Accepted: 09/03/2022] [Indexed: 11/16/2022] Open
Abstract
Historically, the standard of care for hemophilia A has been intravenous administration of exogenous factor VIII (FVIII), either as prophylaxis or episodically. The development of emicizumab, a humanized bispecific monoclonal antibody mimicking activated FVIII, was a subsequent advance in treatment. However, both exogenous FVIII and emicizumab require repeated and lifelong administration, negatively impacting patient quality of life. A recent breakthrough has been the development of gene therapy. This allows a single intravenous treatment that could result in long-term expression of FVIII, maintenance of steady-state plasma concentrations, and minimization (or possibly elimination) of bleeding episodes for the recipient's lifetime. Several gene therapies have been assessed in clinical trials, with positive outcomes. Valoctocogene roxaparvovec (an adeno-associated viral 5-based therapy encoding human B domain-deleted FVIII) is expected to be the first approved gene therapy in European countries, including Italy, in 2022. Some novel challenges exist including refining patient selection criteria, managing patient expectations, further elucidation of the durability and variability of transgene expression and long-term safety, and the development of standardized 'hub and spoke' centers to optimize and monitor this innovative treatment. Gene therapy represents a paradigm shift, and may become a new reference standard for treating patients with hemophilia A.
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Affiliation(s)
- Giancarlo Castaman
- Center for Bleeding Disorders, Department of Oncology, Careggi University Hospital, Largo Brambilla 3, 50134 Firenze, Italy
| | - Giovanni Di Minno
- Regional Reference Centre for Hemo-Coagulation Diseases, Federico II University, Via S. Pansini 5, 80131 Naples, Italy
| | - Raimondo De Cristofaro
- Servizio Malattie Emorragiche e Trombotiche, Dipartimento di Medicina e Chirurgia Traslazionale, Fondazione Policlinico Universitraio “A. Gemelli” IRCCS, Università Cattolica S. Cuore Roma, Largo Francesco Vito, 1, 00168 Rome, Italy
| | - Flora Peyvandi
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione Luigi Villa, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Via Pace 9, 20122 Milan, Italy
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12
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Tufano A, Polimeno M, Matani B, Cardillo G, Capasso F, Mormile R, Paladino F, Di Minno G. Validation of PLASMIC score in a cohort of patients with suspected thrombotic microangiopathy in an academic medical centre. Blood Transfus 2022:2022.0082-22. [PMID: 35969133 DOI: 10.2450/2022.0082-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/23/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The PLASMIC score is a rapid and inexpensive clinical assessment tool for predicting severe ADAMTS13 deficiency (<10% activity) in patients with suspected thrombotic thrombocytopenic purpura (TTP). The score includes 7 parameters: absence of active cancer, patient not having received stem cell transplant or organ transplant, platelet count <30×109/L, haemolysis, mean corpuscular volume <90 fl, International Normalized Ratio <1.5, and serum creatinine <2 mg/dL. MATERIALS AND METHODS In this retrospective study, we evaluated a cohort of 59 consecutive patients with suspected thrombotic microangiopathy who had been referred to the Hemostasis and Thrombosis Center of the "Federico II" University of Naples, Italy, for measurement of ADAMTS13 activity. Relevant clinical and laboratory information were collected for all patients. RESULTS The PLASMIC score was calculated in 52 of the 59 patients included in the study. In the high-risk group (PLASMIC score 6 or 7), 12 out of 20 patients (60%) had ADAMTS13 <10%. Interestingly, all 6 patients (100%) with PLASMIC score 7 had ADAMTS13 <5%. In the intermediate risk group (score 5), only one case out of 17 (5.9%) had ADAMTS 13 <10%. In the low-risk group (score 0-4), none of the patients had severe ADAMTS13 deficiency. The collected data enabled the sensitivity and specificity of PLASMIC score in TTP to be calculated, achieving 92% (95% CI: 0.80-0.98) and 79% (95% CI: 0.66-0.89), respectively. The PLASMIC score was seen to be a very efficient tool in distinguishing between patients with severe ADAMTS13 deficiency from those without, with an AUC of 0.92 (95% CI: 0.82-1.0; p<0.001). DISCUSSION In our cohort, a high-risk PLASMIC score successfully predicted patients with severe ADAMTS13 deficiency, allowing the clinician to quickly define the best therapeutic approach, especially useful for those clinicians not used to the diagnosis and treatment of thrombotic microangiopathies.
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Affiliation(s)
- Antonella Tufano
- Department of Clinical Medicine and Surgery, "Federico II" University, Naples, Italy
| | - Mariateresa Polimeno
- Department of Clinical Medicine and Surgery, "Federico II" University, Naples, Italy
| | - Beniamino Matani
- Department of Clinical Medicine and Surgery, "Federico II" University, Naples, Italy
| | | | - Filomena Capasso
- Department of Molecular Medicine and Medical Biotechnology, "Federico II" University, Naples, Italy
| | - Rosaria Mormile
- Department of Molecular Medicine and Medical Biotechnology, "Federico II" University, Naples, Italy
| | | | - Giovanni Di Minno
- Department of Clinical Medicine and Surgery, "Federico II" University, Naples, Italy
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13
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Di Candia F, Marchetti V, Cirillo F, Di Minno A, Rosano C, Pagano S, Siano MA, Falco M, Assunto A, Boccia G, Magliacane G, Pinna V, De Luca A, Tartaglia M, Di Minno G, Strisciuglio P, Melis D. RASopathies and hemostatic abnormalities: key role of platelet dysfunction. Orphanet J Rare Dis 2021; 16:499. [PMID: 34857025 PMCID: PMC8638204 DOI: 10.1186/s13023-021-02122-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 11/06/2021] [Indexed: 11/23/2022] Open
Abstract
Background Bleeding anomalies have been reported in patients affected by Noonan syndrome. No study has been performed in patients with molecularly confirmed RASopathy. We aimed to characterize the frequency and types of bleeding disorders in patients with RASopathies and evaluate any significant association with laboratory findings. Patients and methods Forty-nine individuals (PTPN11, n = 27; SOS1, n = 7; RIT1, n = 3; SPRED1, n = 1; LZTR1, N = 3; RAF1, n = 2; BRAF, n = 4; MEK1, n = 1; MEK2, n = 1), and 49 age- and sex-matched controls were enrolled. The “Paediatric Bleeding Questionnaire Scoring Key” was administered to patients and families. Laboratory screening tests including clotting factors dosing, platelet count, Prothrombin Time and Partial Thromboplastin Time, were employed both in patients and controls to characterize the bleeding diathesis. A subgroup of 29/49 patients and 29/49 controls was also tested for platelet function. Results Regardless of the gene involved, pathological paediatric bleeding scores were recorded in 14/49 (28.5%) patients. Indeed, 7 were mutated in PTPN11, 3 in SOS1, 2 in RIT1, 1 in BRAF, and 1 in MEK1. Compared to patients with normal bleeding scores, those with pathologic bleeding score showed higher prevalence of splenomegaly (p = 0.006), prolonged aPTT (p = 0.04), lower levels of coagulation factor V (FV, p = 0.001), FVII (p = 0.003), FX (p = 0.0008) and FXIII (p = 0.002), higher vWAg (p = 0.04), and lower platelet sensitivity to Ristocetin (p = 0.001), arachidonic acid (AA) (p = 0.009) and collagen (p = 0.01). The presence of hematomas inversely correlated with factor V (p = 0.002), factor VII (p = 0.003), factor X (p = 0.002) and factor XIII (p = 0.004) levels, and directly correlated with platelet response to collagen (p = 0.02) and AA (p = 0.01). The presence of splenomegaly directly correlated with the presence of hematoma (p = 0.006), platelet response to Ristocetin (p = 0.04) and AA (p = 0.04), and inversely correlated with factor V levels (p = 0.03). Conclusions Patients with RASopathies and a bleeding tendency exhibit multiple laboratory abnormalities, including platelet-related disorders. Splenomegaly is frequently detected and might be a suggestive sign for qualitative platelet dysfunction. A comprehensive clinical assessment should be carried out at diagnosis, during the follow-up and before any surgical procedures. Since there is currently no consensus on management of bleeding complications, it is important that physicians closely monitor these patients.
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Affiliation(s)
- Francesca Di Candia
- Dipartimento di Scienze Mediche Traslazionali, Università degli studi di Napoli Federico II, Naples, Italy
| | - Valeria Marchetti
- Dipartimento di Scienze Mediche Traslazionali, Università degli studi di Napoli Federico II, Naples, Italy
| | - Ferdinando Cirillo
- Regional Reference Centre for Coagulation Disorders, Department of Clinical and Experimental Medicine, Federico II University of Naples, Naples, Italy
| | - Alessandro Di Minno
- Regional Reference Centre for Coagulation Disorders, Department of Clinical and Experimental Medicine, Federico II University of Naples, Naples, Italy
| | - Carmen Rosano
- Dipartimento di Scienze Mediche Traslazionali, Università degli studi di Napoli Federico II, Naples, Italy
| | - Stefano Pagano
- Dipartimento di Scienze Mediche Traslazionali, Università degli studi di Napoli Federico II, Naples, Italy
| | - Maria Anna Siano
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno, Italy.,Pediatric Unit, San Giovanni di Dio e Ruggi d'Aragona University Hospital, Salerno, Italy
| | - Mariateresa Falco
- Pediatric Unit, San Giovanni di Dio e Ruggi d'Aragona University Hospital, Salerno, Italy
| | - Antonia Assunto
- Dipartimento di Scienze Mediche Traslazionali, Università degli studi di Napoli Federico II, Naples, Italy
| | - Giovanni Boccia
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno, Italy
| | - Gerardo Magliacane
- Clinic Pathology, San Giovanni di Dio e Ruggi d'Aragona University Hospital, Salerno, Italy
| | - Valentina Pinna
- Medical Genetics Division, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Alessandro De Luca
- Medical Genetics Division, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Marco Tartaglia
- Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - Giovanni Di Minno
- Regional Reference Centre for Coagulation Disorders, Department of Clinical and Experimental Medicine, Federico II University of Naples, Naples, Italy
| | - Pietro Strisciuglio
- Dipartimento di Scienze Mediche Traslazionali, Università degli studi di Napoli Federico II, Naples, Italy
| | - Daniela Melis
- Dipartimento di Scienze Mediche Traslazionali, Università degli studi di Napoli Federico II, Naples, Italy. .,Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno, Italy. .,Pediatric Unit, San Giovanni di Dio e Ruggi d'Aragona University Hospital, Salerno, Italy.
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14
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Di Minno G, Coppola A, Margaglione M, Rocino A, Mancuso ME, Tagliaferri A, Linari S, Zanon E, Santoro C, Biasoli C, Castaman G, Santagostino E, Mannucci PM. Predictors of inhibitor eradication by primary immune tolerance induction in severe haemophilia A with high responding inhibitors. Haemophilia 2021; 28:55-64. [PMID: 34727394 DOI: 10.1111/hae.14431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 09/24/2021] [Accepted: 09/26/2021] [Indexed: 01/23/2023]
Abstract
BACKGROUND Immune tolerance induction (ITI) is the only proven strategy to eradicate factor VIII inhibitors in patients with haemophilia A (HA). AIM To identify patients and treatment options with the highest chance of inhibitor eradication by primary ITI. PATIENTS AND METHODS In the frame of the Italian ITI Registry, carried out from 1995 to 2015 (last follow-up 2018), 137 primary ITI courses in severe HA patients (90/137 with poor prognosis) were analysed for predictors of outcome (complete/partial response or failure). Sixty-six of them (48%) were prospectively evaluated. RESULTS ITI was successful in 91/137 patients (66.4%) and 70 (51.1%) achieved complete response within 11 months (median). Historical peak titres ≤200 BU/ml (P = .033), inhibitor titres ≤5 BU/ml at ITI start (P = .001), peak titres ≤100 BU/ml during ITI (P < .001) and missense mutations and small insertions/deletions of FVIII gene (P = .027) predicted complete inhibitor eradication. A score that considers the cumulative number of these variables predicted complete response with positive predictive values up to .81 at ITI start and .91 during ITI, respectively. Patients who had no bleeding (OR, 3.45, 95% CI: 1.4-8.6) nor other adverse events (OR 2.6, 95%CI: 1.3-5.3) during ITI had higher chances of complete response. During the 120-month follow-up (median), 2/70 patients who had achieved complete response relapsed (2.9%). CONCLUSIONS This Registry, with a centralized review of outcomes, homogeneous data collection (half of which prospective) and long-term follow-up, provides insights for optimizing ITI, with a rationale for further studies in the currently evolving scenario of inhibitor management in HA patients.
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Affiliation(s)
- Giovanni Di Minno
- Hub Centre for Haemorrhagic and Thrombotic Disorders, Dep. of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Antonio Coppola
- Hub Centre for Haemorrhagic and Thrombotic Disorders, Dep. of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | | | - Angiola Rocino
- Hemophilia and Thrombosis Centre, Ospedale del Mare, Naples, Italy
| | - Maria Elisa Mancuso
- IRCCS Ca' Granda Ospedale Maggiore Policlinico Foundation, Angelo Bianchi Bonomi Haemophilia and Thrombosis Centre, Milan, Italy
| | - Annarita Tagliaferri
- Regional Reference Centre for Inherited Bleeding Disorders, University Hospital of Parma, Italy
| | - Silvia Linari
- Center for Bleeding Disorders and Coagulation, Careggi University Hospital, Florence, Italy
| | - Ezio Zanon
- Hemophilia Centre, Internal Medicine, University of Padua, University Hospital of Parma, Italy
| | | | - Chiara Biasoli
- Hemophilia and Transfusion Centre, Bufalini Hospital, Cesena, Italy
| | - Giancarlo Castaman
- Hematology, Centre for Bleeding and Thrombosis Disorders, S. Bortolo Hospital, Vicenza, Italy
| | - Elena Santagostino
- IRCCS Ca' Granda Ospedale Maggiore Policlinico Foundation, Angelo Bianchi Bonomi Haemophilia and Thrombosis Centre, Milan, Italy
| | - Pier Mannuccio Mannucci
- IRCCS Ca' Granda Ospedale Maggiore Policlinico Foundation, Angelo Bianchi Bonomi Haemophilia and Thrombosis Centre, Milan, Italy
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15
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Tufano A, Rendina D, Abate V, Casoria A, Marra A, Buonanno P, Galletti F, Di Minno G, Servillo G, Vargas M. Venous Thromboembolism in COVID-19 Compared to Non-COVID-19 Cohorts: A Systematic Review with Meta-Analysis. J Clin Med 2021; 10:jcm10214925. [PMID: 34768445 PMCID: PMC8584903 DOI: 10.3390/jcm10214925] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 08/25/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 12/24/2022] Open
Abstract
Background: A high incidence of venous thromboembolism (VTE) is reported in hospitalized COVID-19 patients, in particular in patients admitted to the intensive care unit (ICU). In patients with respiratory tract infections, including influenza A (H1N1), many studies have demonstrated an increased incidence of thromboses, but evidence is lacking regarding the risk difference (RD) of the occurrence of VTE between COVID-19 and non-COVID-19 patients. Methods: In this systematic review with meta-analysis, we evaluated the RD of the occurrence of VTE, pulmonary embolism (PE), and deep venous thrombosis (DVT) between COVID-19 and other pulmonary infection cohorts, in particular H1N1, and in an ICU setting. We searched for all studies comparing COVID-19 vs. non-COVID-19 regarding VTE, PE, and DVT. Results: The systematic review included 12 studies and 1,013,495 patients. The RD for VTE in COVID-19 compared to non-COVID-19 patients was 0.06 (95% CI 0.11–0.25, p = 0.011, I2 = 97%), and 0.16 in ICU (95% CI 0.045–0.27, p = 0.006, I2 = 80%). The RD for PE between COVID-19 and non-COVID-19 patients was 0.03 (95% CI, 0.006–0.045, p = 0.01, I2 = 89%). The RD for PE between COVID-19 and non-COVID-19 patients was 0.021 in retrospective studies (95% CI 0.00–0.04, p = 0.048, I2 = 92%) and 0.11 in ICU studies (95% CI 0.06–0.16, p < 0.001, I2 = 0%). Conclusions: The growing awareness and understanding of a massive inflammatory response combined with a hypercoagulable state that predisposes patients to thrombosis in COVID-19, in particular in the ICU, may contribute to a more appropriate strategy of prevention and earlier detection of the thrombotic events.
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Affiliation(s)
- Antonella Tufano
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (A.T.); (D.R.); (V.A.); (A.C.); (F.G.); (G.D.M.)
| | - Domenico Rendina
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (A.T.); (D.R.); (V.A.); (A.C.); (F.G.); (G.D.M.)
| | - Veronica Abate
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (A.T.); (D.R.); (V.A.); (A.C.); (F.G.); (G.D.M.)
| | - Aniello Casoria
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (A.T.); (D.R.); (V.A.); (A.C.); (F.G.); (G.D.M.)
| | - Annachiara Marra
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (A.M.); (P.B.); (G.S.)
| | - Pasquale Buonanno
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (A.M.); (P.B.); (G.S.)
| | - Ferruccio Galletti
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (A.T.); (D.R.); (V.A.); (A.C.); (F.G.); (G.D.M.)
| | - Giovanni Di Minno
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (A.T.); (D.R.); (V.A.); (A.C.); (F.G.); (G.D.M.)
| | - Giuseppe Servillo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (A.M.); (P.B.); (G.S.)
| | - Maria Vargas
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (A.M.); (P.B.); (G.S.)
- Correspondence:
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Chiurazzi F, Tufano A, Esposito M, D'Agostino F, Casoria A, Capasso F, Minno GD. Acquired Factor V Inhibitor after Coronavirus Disease 2019 (COVID-19). Semin Thromb Hemost 2021; 48:124-126. [PMID: 34560795 DOI: 10.1055/s-0041-1735452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Federico Chiurazzi
- Department of Hematology and Bone Marrow Transplantation, University of Naples "Federico II," Naples, Italy
| | - Antonella Tufano
- Department of Clinical Medicine and Surgery, University of Naples "Federico II," Naples, Italy
| | - Maria Esposito
- Department of Hematology and Bone Marrow Transplantation, University of Naples "Federico II," Naples, Italy
| | - Francesco D'Agostino
- Department of Hematology and Bone Marrow Transplantation, University of Naples "Federico II," Naples, Italy
| | - Aniello Casoria
- Department of Clinical Medicine and Surgery, University of Naples "Federico II," Naples, Italy
| | - Filomena Capasso
- Department of Molecular Medicine and Medical Biotechnology, University of Naples "Federico II," Naples, Italy
| | - Giovanni Di Minno
- Department of Clinical Medicine and Surgery, University of Naples "Federico II," Naples, Italy
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Abate V, Casoria A, Rendina D, Muscariello R, Nuzzo V, Vargas M, Servillo G, Venetucci P, Conca P, Tufano A, Galletti F, Di Minno G. Spontaneous Muscle Hematoma in Patients with COVID-19: A Systematic Literature Review with Description of an Additional Case Series. Semin Thromb Hemost 2021; 48:100-108. [PMID: 34388842 DOI: 10.1055/s-0041-1732370] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Coagulation abnormalities, thrombosis, and endothelial dysfunction have been described in COVID-19 patients. Spontaneous muscle hematoma (SMH) is a rare complication in COVID-19. The aims of this study are to: (1) perform a systematic review of the literature to better define the clinical SMH characteristics, (2) describe the prevalence and the clinical characteristics of SMH in COVID-19 patients referring to a Department of Internal Medicine (IM) (Federico II University of Naples), a Department of Sub-Intensive Care Medicine (SIM) (Ospedale Del Mare), and a Department of Intensive Care Unit (ICU) (Federico II University). The systematic review was performed according to PRISMA criteria. The local prevalence of SMH in COVID-19 was evaluated retrospectively. The medical records of all COVID-19 patients referring to IM and ICU from March 11th, 2020, to February 28th, 2021 were examined for SMH occurrence. In our retrospective analysis, we describe 10 cases of COVID-19 patients with SMH not previously reported in literature, with a prevalence of 2.1%. The literature review, inclusive of our case series, describes a total of 50 SMHs in COVID-19 patients (57.4% males; mean age 68.8 ± 10.0 years). The SMH sites were ileo-psoas, vastus intermedius, gluteus, sternocleidomastoid, and pectoralis major muscles. Males developed SMH earlier than females (9.5 ± 7.8 vs. 17.1 ± 9.7 days). Ileo-psoas hematoma was more frequent in males (69.2 vs. 30.8%), while pectoralis major hematoma occurred only in females. The in-hospital mortality rate of SMH in COVID-19 patients was 32.4%. SMH is a rare but severe complication in COVID-19 hospitalized patients, associated with high mortality. A gender difference seems to be present in the clinical presentation of the disorder.
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Affiliation(s)
- Veronica Abate
- Department of Clinical Medicine and Surgery, "Federico II" University Hospital, Naples, Italy
| | - Aniello Casoria
- Department of Clinical Medicine and Surgery, "Federico II" University Hospital, Naples, Italy
| | - Domenico Rendina
- Department of Clinical Medicine and Surgery, "Federico II" University Hospital, Naples, Italy
| | | | - Vincenzo Nuzzo
- Endocrinology and Nutrition Department, Ospedale del Mare, Naples, Italy
| | - Maria Vargas
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II," Naples, Italy
| | - Giuseppe Servillo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II," Naples, Italy
| | - Pietro Venetucci
- Department of Morphological and Functional Diagnostics, Radiotherapy, Forensic Medicine, University of Naples "Federico II," Naples, Italy
| | - Paolo Conca
- Department of Clinical Medicine and Surgery, "Federico II" University Hospital, Naples, Italy
| | - Antonella Tufano
- Department of Clinical Medicine and Surgery, "Federico II" University Hospital, Naples, Italy
| | - Ferruccio Galletti
- Department of Clinical Medicine and Surgery, "Federico II" University Hospital, Naples, Italy
| | - Giovanni Di Minno
- Department of Clinical Medicine and Surgery, "Federico II" University Hospital, Naples, Italy
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Di Minno A, Spadarella G, Esposito S, Mathew P, Di Minno G, Mannucci PM. Perspective - The case for zero bleeds and drug bioequivalence in the treatment of congenital hemophilia A in 2021. Blood Rev 2021; 50:100849. [PMID: 34024681 DOI: 10.1016/j.blre.2021.100849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/13/2021] [Accepted: 05/04/2021] [Indexed: 01/19/2023]
Abstract
Not all patients with severe hemophilia A (HA) respond optimally to a given dose of a given product. Within-individual variance in cross-over studies makes each patient unique in the response to each standard half-life (SHL) factor VIII (FVIII) product in pharmacokinetic (PK) terms. This hampers the prediction of efficacy when a SHL FVIII product is employed. PK data showing that half-lives of SHL rFVIII are unsatisfactory to achieve zero bleeding in individual HA patients provide the rationale for switching from SHL to extended half-life (EHL) products. However, not all subjects receiving prophylaxis with EHL products achieve zero bleeding, the most cogent objective of personalized prophylaxis. Known determinants of FVIII half-life (age, von Willebrand factor [VWF] levels, blood group) cumulatively account for one third of the total inter-individual variation in FVIII clearance in subjects with severe HA. Investigations into precision, and accuracy of laboratory measurement to be employed; newer pathways for the clearance of both free-FVIII and VWF-bound FVIII, and adequately powered studies on omics and phenotypic heterogeneity, are likely to provide additional information on the remaining two thirds of inter-individual variation in FVIII clearance in HA. Variability in the clinical response has also been documented in patients when FVIII activity is mimicked by fixed subcutaneous doses of the bispecific antibody emicizumab. National registries that collect PK data of available FVIII products and ad hoc information on the individual response to emicizumab should be encouraged, to establish newer standards of care and ease personalized clinical decisions to achieve zero bleeding.
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Affiliation(s)
- Alessandro Di Minno
- Dipartimento di Farmacia, Università degli Studi di Napoli "Federico II", Italy; CEINGE-Biotecnologie Avanzate, Università degli Studi di Napoli "Federico II", Italy.
| | - Gaia Spadarella
- Dipartimento di Scienze Mediche Traslazionali, Università degli Studi di Napoli "Federico II", Italy
| | - Salvatore Esposito
- Dipartimento di Medicina Clinica e Chirurgia and Centro Hub per le Malattie Emorragiche Congenite e le Trombofilie, Università degli Studi di Napoli "Federico II", Italy
| | | | - Giovanni Di Minno
- Dipartimento di Medicina Clinica e Chirurgia and Centro Hub per le Malattie Emorragiche Congenite e le Trombofilie, Università degli Studi di Napoli "Federico II", Italy.
| | - Pier Mannuccio Mannucci
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy..
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Mannucci PM, Cortesi PA, Di Minno MND, Sanò M, Mantovani LG, Di Minno G. Comparative analysis of the pivotal studies of extended half-life recombinant FVIII products for treatment of haemophilia A. Haemophilia 2021; 27:e422-e433. [PMID: 33955638 DOI: 10.1111/hae.14313] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 03/17/2021] [Accepted: 03/31/2021] [Indexed: 12/25/2022]
Abstract
The need to reduce the burden of injections, and improve adherence and clinical outcomes in haemophilia A led to the development of recombinant FVIII products endowed with an extended plasma half-life (EHL-rFVIII) in comparison with standard half-life products (SHL-rFVIII). Lack of head-to-head studies makes difficult to grasp the relative value of each treatment option. We conducted a combined evaluation of the individual pivotal trials in order to assess between-product differences regarding the reported efficacy results and FVIII consumption. We evaluated 4 EHL-rFVIII products available to treat patients with haemophilia A without inhibitors and also a SHL-rFVIII as a comparator. In the frame of these clinical studies, all the EHL-rFVIII products showed a decrease in the injection burden coupled with good clinical efficacy, even though there were between-product differences in terms of reduction in injection frequencies. Further, between-product differences in terms of weekly/yearly consumption of rFVIII expressed in IU/Kg were identified, suggesting a different economic impact for the different EHL-rFVIII products in the context of comparable clinical efficacy. The present findings based upon the review of pivotal studies done in the frame of a highly selected clinical scenario should be integrated with real-life data.
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Affiliation(s)
- Pier Mannuccio Mannucci
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
| | - Paolo Angelo Cortesi
- Research Centre on Public Health (CESP), University of Milano-Bicocca, Monza, Italy
| | | | - Mario Sanò
- ASL CN2 Alba-Bra, Farmacia Ospedaliera e Servizio Farmaceutico Territoriale, Alba, Italy
| | - Lorenzo Giovanni Mantovani
- Research Centre on Public Health (CESP), University of Milano-Bicocca, Monza, Italy.,IRCCS Multimedica Research Hospital, Sesto San Giovanni, Italy
| | - Giovanni Di Minno
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
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De Carlo M, Di Minno G, Sayre T, Fazeli MS, Siliman G, Cimminiello C. Efficacy and Safety of Antiplatelet Therapies in Symptomatic Peripheral Artery Disease: A Systematic Review and Network Meta-Analysis. Curr Vasc Pharmacol 2021; 19:542-555. [PMID: 32819249 PMCID: PMC8573731 DOI: 10.2174/1570161118666200820141131] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/27/2020] [Accepted: 08/05/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Clopidogrel monotherapy is guideline-recommended in symptomatic peripheral artery disease (PAD). The advent of new antithrombotic strategies prompts an updated analysis of available evidence on antiplatelet therapy for PAD. METHODS We searched MEDLINE, Embase and CENTRAL through January 2019 for randomised controlled trials and observational studies comparing antiplatelet therapies as monotherapy, dual therapy, or combination with anticoagulants. Efficacy (major adverse cardiovascular events, acute or chronic limb ischaemia, vascular amputation, peripheral revascularisation) and safety (all-cause mortality and overall bleeding) outcomes were evaluated via Bayesian network meta-analyses. RESULTS We analysed 26 randomised controlled trials. Clopidogrel (hazard ratio, HR, 0.78; 95% credible interval [CrI] 0.65-0.93) and ticagrelor (HR 0.80; 95% CrI 0.65-0.98) significantly reduced major adverse cardiovascular events risk compared with aspirin. No significant difference was observed for dual antiplatelet therapy with clopidogrel and aspirin. Vorapaxar significantly reduced limb ischaemia and revascularisation compared with placebo, while dual antiplatelet therapy with clopidogrel and aspirin showed a trend for reduced risk of amputation compared with aspirin (risk ratio 0.68; 95% CrI 0.43-1.04). For all-cause mortality, picotamide, vorapaxar, dipyridamole with aspirin, and ticlopidine showed a significantly lower risk of all-cause mortality vs aspirin. Clopidogrel and ticagrelor showed similar overall bleeding risk vs aspirin, while dual antiplatelet therapy with clopidogrel and aspirin significantly increased bleeding risk. CONCLUSION This updated network meta-analysis confirms that clopidogrel significantly decreases the risk of major adverse cardiovascular events compared with aspirin, without increasing bleeding risk. Clopidogrel should remain a mainstay of PAD treatment, at least in patients at higher bleeding risk.
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Affiliation(s)
- Marco De Carlo
- Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Giovanni Di Minno
- Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | | | - Mir Sohail Fazeli
- Doctor Evidence, Santa Monica, CA, USA
- Evidinno Outcomes Research Inc., Vancouver, BC, Canada
| | - Gaye Siliman
- Doctor Evidence, Santa Monica, CA, USA
- Evidinno Outcomes Research Inc., Vancouver, BC, Canada
| | - Claudio Cimminiello
- Research and Study Center of the Italian Society of Angiology and Vascular Pathology (Società Italiana di Angiologia e Patologia Vascolare, SIAPAV), Milan, Italy
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Di Minno G, Mannucci PM, Ironside JW, Perno CF, Gürtler L, Aledort L. Convalescent plasma for administration of passive antibodies against viral agents. Haematologica 2020; 105:2710-2715. [PMID: 33256373 PMCID: PMC7716269 DOI: 10.3324/haematol.2020.267427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Giovanni Di Minno
- Dipartimento di Medicina Clinica e Chirurgia, Centro Hub per le Emocoagulopatie, Napoli, Italy.
| | - Pier Mannuccio Mannucci
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
| | - James W Ironside
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Lutz Gürtler
- Max von Pettenkofer Institute, Ludwig Maximilians University of Munich, Munich, Germany
| | - Louis Aledort
- Mary Weinfeld Professor of Clinical Research in Hemophilia at the Icahn School of Medicine at Mount Sinai, New York City, NY, USA
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Castaldo L, Laguzzi F, Strawbridge RJ, Baldassarre D, Veglia F, Vigo L, Tremoli E, de Faire U, Eriksson P, Smit AJ, Aubrecht J, Leander K, Pirro M, Giral P, Ritieni A, Di Minno G, Mälarstig A, Gigante B. Genetic Variants Associated with Non-Alcoholic Fatty Liver Disease Do Not Associate with Measures of Sub-Clinical Atherosclerosis: Results from the IMPROVE Study. Genes (Basel) 2020; 11:genes11111243. [PMID: 33105679 PMCID: PMC7690395 DOI: 10.3390/genes11111243] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 10/16/2020] [Accepted: 10/21/2020] [Indexed: 01/07/2023] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) and atherosclerosis-related cardiovascular diseases (CVD) share common metabolic pathways. We explored the association between three NAFLD-associated single nucleotide polymorphisms (SNPs) rs738409, rs10401969, and rs1260326 with sub-clinical atherosclerosis estimated by the carotid intima-media thickness (c-IMT) and the inter-adventitia common carotid artery diameter (ICCAD) in patients free from clinically overt NAFLD and CVD. The study population is the IMPROVE, a multicenter European study (n = 3711). C-IMT measures and ICCAD were recorded using a standardized protocol. Linear regression with an additive genetic model was used to test for association of the three SNPs with c-IMT and ICCAD. In secondary analyses, the association of the three SNPs with c-IMT and ICCAD was tested after stratification by alanine aminotransferase levels (ALT). No associations were found between rs738409, rs1260326, rs10401969, and c-IMT or ICCAD. Rs738409-G and rs10401969-C were associated with ALT levels (p < 0.001). In patients with ALT levels above 28 U/L (highest quartile), we observed an association between rs10401969-C and c-IMT measures of c-IMTmax and c-IMTmean-max (p = 0.018 and 0.021, respectively). In conclusion, NAFLD-associated SNPs do not associate with sub-clinical atherosclerosis measures. However, our results suggest a possible mediating function of impaired liver function on atherosclerosis development.
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Affiliation(s)
- Luigi Castaldo
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80138 Naples, Italy;
- Department of Pharmacy, University of Naples “Federico II”, 80138 Naples, Italy;
- Correspondence: ; Tel.: +39-081-678116
| | - Federica Laguzzi
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE-171 77 Stockholm, Sweden; (F.L.); (U.d.F.); (K.L.)
| | - Rona J. Strawbridge
- Mental Health and Wellbeing, Institute of Health and Wellbeing, University of Glasgow, Glasgow G12-8QQ, UK;
- Health Data Research University of Glasgow, College of Medicine, Veterinarian and Life Sciences, Glasgow G12-8RZ, UK
- Cardiovascular Medicine, Department of Medicine, Karolinska Institutet, Box 210, 171 77 Stockholm, Sweden; (P.E.); (A.M.); (B.G.)
| | - Damiano Baldassarre
- Centro Cardiologico Monzino, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Via Parea 4, 20138 Milan, Italy; (D.B.); (F.V.); (L.V.); (E.T.)
- Department of Medical Biotechnology and Translational Medicine, University of Milan, 20122 Milano MI, Italy
| | - Fabrizio Veglia
- Centro Cardiologico Monzino, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Via Parea 4, 20138 Milan, Italy; (D.B.); (F.V.); (L.V.); (E.T.)
| | - Lorenzo Vigo
- Centro Cardiologico Monzino, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Via Parea 4, 20138 Milan, Italy; (D.B.); (F.V.); (L.V.); (E.T.)
| | - Elena Tremoli
- Centro Cardiologico Monzino, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Via Parea 4, 20138 Milan, Italy; (D.B.); (F.V.); (L.V.); (E.T.)
| | - Ulf de Faire
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE-171 77 Stockholm, Sweden; (F.L.); (U.d.F.); (K.L.)
| | - Per Eriksson
- Cardiovascular Medicine, Department of Medicine, Karolinska Institutet, Box 210, 171 77 Stockholm, Sweden; (P.E.); (A.M.); (B.G.)
| | - Andries J. Smit
- Department of Medicine, Division of vascular medicine University Medical Center Groningen, 9713 GZ Groningen, The Netherlands;
| | - Jiri Aubrecht
- Takeda Pharmaceuticals International Co., Cambridge, 02139 MA, USA;
| | - Karin Leander
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE-171 77 Stockholm, Sweden; (F.L.); (U.d.F.); (K.L.)
| | - Matteo Pirro
- Unit of Internal Medicine, Department of Medicine, University of Perugia, 06123 Perugia PG, Italy;
| | - Philippe Giral
- Assistance Publique—Hopitaux de Paris; Service Endocrinologie-Metabolisme, Groupe Hôpitalier Pitie-Salpetriere, Unités de Prévention Cardiovasculaire, 75013 Paris, France;
| | - Alberto Ritieni
- Department of Pharmacy, University of Naples “Federico II”, 80138 Naples, Italy;
| | - Giovanni Di Minno
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80138 Naples, Italy;
| | - Anders Mälarstig
- Cardiovascular Medicine, Department of Medicine, Karolinska Institutet, Box 210, 171 77 Stockholm, Sweden; (P.E.); (A.M.); (B.G.)
| | - Bruna Gigante
- Cardiovascular Medicine, Department of Medicine, Karolinska Institutet, Box 210, 171 77 Stockholm, Sweden; (P.E.); (A.M.); (B.G.)
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Coppola A, Rocino A, Di Minno G, Biasoli C, De Cristofaro R, Giampaolo A, Marino R. XVII Convegno Triennale sui Problemi Clinici e Sociali dell'Emofilia e delle Malattie Emorragiche Congenite, Milano, 8 - 11 ottobre 2020. Blood Transfus 2020; 18:2020.S3. [PMID: 33044163 DOI: 10.2450/2020.s3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
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Tiede A, Collins P, Knoebl P, Teitel J, Kessler C, Shima M, Di Minno G, d'Oiron R, Salaj P, Jiménez-Yuste V, Huth-Kühne A, Giangrande P. International recommendations on the diagnosis and treatment of acquired hemophilia A. Haematologica 2020; 105:1791-1801. [PMID: 32381574 PMCID: PMC7327664 DOI: 10.3324/haematol.2019.230771] [Citation(s) in RCA: 163] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 04/07/2020] [Indexed: 12/18/2022] Open
Abstract
Acquired hemophilia A (AHA), a rare bleeding disorder caused by neutralizing autoantibodies against coagulation factor VIII (FVIII), occurs in both men and women without a previous history of bleeding. Patients typically present with an isolated prolonged activated partial thromboplastin time due to FVIII deficiency. Neutralizing antibodies (inhibitors) are detected using the Nijmegen-modified Bethesda assay. Approximately 10% of patients do not present with bleeding and, therefore, a prolonged activated partial thromboplastin time should never be ignored prior to invasive procedures. Control of acute bleeding and prevention of injuries that may provoke bleeding are top priorities in patients with AHA. We recommend treatment with bypassing agents, including recombinant activated factor VII, activated prothrombin complex concentrate, or recombinant porcine FVIII in bleeding patients. Autoantibody eradication can be achieved with immunosuppressive therapy, including corticosteroids, cyclophosphamide and rituximab, or combinations thereof. The median time to remission is 5 weeks, with considerable interindividual variation. FVIII activity at presentation, inhibitor titer and autoantibody isotype are prognostic markers for remission and survival. Comparative clinical studies to support treatment recommendations for AHA do not exist; therefore, we provide practical consensus guidance based on recent registry findings and the authors' clinical experience in treating patients with AHA.
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Affiliation(s)
- Andreas Tiede
- Hannover Medical School, Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover, Germany
| | - Peter Collins
- Arthur Bloom Haemophilia Centre, University Hospital of Wales School of Medicine, Cardiff University, Cardiff, UK
| | - Paul Knoebl
- Department of Medicine 1, Division of Hematology and Hemostasis, Medical University of Vienna, Vienna, Austria
| | - Jerome Teitel
- Division of Hematology and Oncology, St. Michael's Hospital, Toronto, and Department of Medicine, University of Toronto, Toronto, Canada
| | - Craig Kessler
- Georgetown University Hospital, Lombardi Cancer Center, Division of Hematology/Oncology, Washington, DC, USA
| | - Midori Shima
- Department of Pediatrics, Nara Medical University, Nara, Japan
| | - Giovanni Di Minno
- Regional Reference Center for Coagulation Disorders, Federico II University Hospital, Naples, Italy
| | - Roseline d'Oiron
- Centre de Référence de l'Hémophilie et des Maladies Hémorragiques Constitutionnelles Rares, Hôpitaux Universitaires Paris Sud, Hôpital Bicêtre APHP, Le Kremlin-Bicêtre, France
| | - Peter Salaj
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Victor Jiménez-Yuste
- Hematology Department, La Paz University Hospital, Autonoma University, Madrid, Spain
| | - Angela Huth-Kühne
- SRH Kurpfalzkrankenhaus Heidelberg GmbH and Hemophilia Center, Heidelberg, Germany
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Spadarella G, Di Minno A, Donati MB, Mormile M, Ventre I, Di Minno G. From unfractionated heparin to pentasaccharide: Paradigm of rigorous science growing in the understanding of the in vivo thrombin generation. Blood Rev 2020; 39:100613. [DOI: 10.1016/j.blre.2019.100613] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 08/19/2019] [Accepted: 08/22/2019] [Indexed: 12/20/2022]
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Spadarella G, Di Minno A, Milan G, Franco N, Polimeno M, Castaldo F, Di Minno G. Paradigm shift for the treatment of hereditary haemophilia: Towards precision medicine. Blood Rev 2019; 39:100618. [PMID: 31676141 DOI: 10.1016/j.blre.2019.100618] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 10/07/2019] [Accepted: 10/08/2019] [Indexed: 12/17/2022]
Abstract
Patients with haemophilia A (HA) or B (HB) experience spontaneous limb- or life-threatening bleedings which are prevented by regular prophylactic intravenous infusions of the deficient coagulation factor (FVIII or FIX). Prophylaxis with subcutaneous long-acting non-factor products that improve in vivo thrombin generation is now under intensive investigation (concizumab, fitusiran) or successfully employed (emicizumab) in haemophilia patients. Both haemophilia patients with/without inhibitors take advantage of non-factor products employed alone. In those who also need bypassing agents (or FVIII concentrates) for breakthrough bleeds, thromboembolic events and/or thrombotic microangiopathy may occur. By enhancing thrombin generation, prothrombotic mutations co-segregating with FVIII/FIX gene mutations may trigger thrombotic episodes in HA patients carrying acquired thrombogenic factors (e.g. venous catheters). A thorough knowledge of individual needs increasingly contributed to improve comprehensive care and personalize treatments in haemophilia. Integrating genomics, lifestyle and environmental data is expected to be key to: 1) identify which haemophilia patients are less likely to benefit from a given intervention; 2) define optimal dosing and scheduling of bypassing agents (or FVIII) to employ in combination with non-factor products; 3) establish tests to monitor in vivo thrombin generation; 4) improve communication and deliver results to individuals. As individual outcomes will be improved and the risk of adverse events minimized, non-factor products will come into wider use within the haemophilia community, and patients will hopefully have no more risks of breakthrough bleeds. The risks of a normal life for a "former haemophilia patient" is likely to change the treatment landscape and the structure of haemophilia Centers.
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Affiliation(s)
- Gaia Spadarella
- Postgraduation School in Radiodiagnostics, Università degli studi di Milano, Italy
| | - Alessandro Di Minno
- Dipartimento di Farmacia, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Graziella Milan
- Centro Geriatrico "Frullone" ASL Napoli-1 Centro, Naples, Italy.
| | - Nicoletta Franco
- Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Mariateresa Polimeno
- Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Francesco Castaldo
- Dipartimento di Farmacia, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Giovanni Di Minno
- Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli "Federico II", Naples, Italy.
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Castaldo L, Narváez A, Izzo L, Graziani G, Gaspari A, Di Minno G, Ritieni A. Red Wine Consumption and Cardiovascular Health. Molecules 2019; 24:E3626. [PMID: 31597344 PMCID: PMC6804046 DOI: 10.3390/molecules24193626] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/01/2019] [Accepted: 10/07/2019] [Indexed: 02/07/2023] Open
Abstract
Wine is a popular alcoholic beverage that has been consumed for hundreds of years. Benefits from moderate alcohol consumption have been widely supported by the scientific literature and, in this line, red wine intake has been related to a lesser risk for coronary heart disease (CHD). Experimental studies and meta-analyses have mainly attributed this outcome to the presence in red wine of a great variety of polyphenolic compounds such as resveratrol, catechin, epicatechin, quercetin, and anthocyanin. Resveratrol is considered the most effective wine compound with respect to the prevention of CHD because of its antioxidant properties. The mechanisms responsible for its putative cardioprotective effects would include changes in lipid profiles, reduction of insulin resistance, and decrease in oxidative stress of low-density lipoprotein cholesterol (LDL-C). The aim of this review is to summarize the accumulated evidence correlating moderate red wine consumption with prevention of CHD by focusing on the different mechanisms underlying this relationship. Furthermore, the chemistry of wine as well as chemical factors that influence the composition of the bioactive components of red wine are also discussed.
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Affiliation(s)
- Luigi Castaldo
- Department of Pharmacy, Faculty of Pharmacy, University of Naples “Federico II”, Via Domenico Montesano 49, 80131 Naples, Italy; (L.C.); (A.N.); (L.I.); (G.G.); (A.G.)
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Via S. Pansini 5, 80131 Naples, Italy;
| | - Alfonso Narváez
- Department of Pharmacy, Faculty of Pharmacy, University of Naples “Federico II”, Via Domenico Montesano 49, 80131 Naples, Italy; (L.C.); (A.N.); (L.I.); (G.G.); (A.G.)
| | - Luana Izzo
- Department of Pharmacy, Faculty of Pharmacy, University of Naples “Federico II”, Via Domenico Montesano 49, 80131 Naples, Italy; (L.C.); (A.N.); (L.I.); (G.G.); (A.G.)
| | - Giulia Graziani
- Department of Pharmacy, Faculty of Pharmacy, University of Naples “Federico II”, Via Domenico Montesano 49, 80131 Naples, Italy; (L.C.); (A.N.); (L.I.); (G.G.); (A.G.)
| | - Anna Gaspari
- Department of Pharmacy, Faculty of Pharmacy, University of Naples “Federico II”, Via Domenico Montesano 49, 80131 Naples, Italy; (L.C.); (A.N.); (L.I.); (G.G.); (A.G.)
| | - Giovanni Di Minno
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Via S. Pansini 5, 80131 Naples, Italy;
| | - Alberto Ritieni
- Department of Pharmacy, Faculty of Pharmacy, University of Naples “Federico II”, Via Domenico Montesano 49, 80131 Naples, Italy; (L.C.); (A.N.); (L.I.); (G.G.); (A.G.)
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Zotz RB, Poon MC, Di Minno G, D'Oiron R. The International Prospective Glanzmann Thrombasthenia Registry: Pediatric Treatment and Outcomes. TH Open 2019; 3:e286-e294. [PMID: 31523745 PMCID: PMC6742499 DOI: 10.1055/s-0039-1696657] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 07/25/2019] [Indexed: 11/13/2022] Open
Abstract
Background
Standard treatment for Glanzmann thrombasthenia (GT), a severe inherited bleeding disorder, is platelet transfusion. Recombinant activated factor VII (rFVIIa) is reported to be effective in GT with platelet antibodies and/or refractoriness to platelet transfusions.
Methods
We evaluated rFVIIa effectiveness and safety for the treatment and prevention of surgical and nonsurgical bleeding in children <18 years old, with or without platelet antibodies and/or refractoriness, as reported in the GT Registry (GTR). Data were used from the GTR, an international, multicenter, observational, postmarketing study of rFVIIa that prospectively collected data on the treatment and outcomes of bleeds in patients with GT. Only patients with a diagnosis of congenital GT were included in the registry.
Results
Between 2007 and 2011, 27 children were treated for 44 surgical procedures (minor: 36; major: 8); nonsurgical bleeds occurred in 104 patients (599 episodes: severe, 145; moderate, 454; spontaneous, 423; posttraumatic, 176). The effectiveness of treatment for minor procedures, major procedures, nonsurgical bleeds was 6/6, 1/1, and 75/84 for rFVIIa, 6/6, 2/2, and 64/76 for rFVIIa + antifibrinolytics (AF), 11/12, 1/1, and 162/214 for platelets ± AF, and 5/6, 0/3, and 33/45 for rFVIIa + platelets ± AF. In all, 25 adverse events were reported in children; no thromboembolic events were reported.
Conclusion
For all patients, regardless of platelet antibody or refractoriness status, rFVIIa, administered with or without platelets (± AF), provided effective hemostasis with a low frequency of adverse events in surgical, as well as nonsurgical, bleeding in patients with GT.
clinicaltrials.gov identifier: NCT01476423.
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Affiliation(s)
- Rainer B Zotz
- Institute for Laboratory Medicine, Blood Coagulation and Transfusion Medicine (LBT), Düsseldorf, Germany.,Department of Hemostasis, Hemotherapy and Transfusion Medicine, Heinrich Heine University Medical Centre, Düsseldorf, Germany
| | - Man-Chiu Poon
- Departments of Medicine, Pediatrics and Oncology, University of Calgary, Calgary, Alberta, Canada.,Southern Alberta Rare Blood and Bleeding Disorders Comprehensive Care Program, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Giovanni Di Minno
- Department of Clinical Medicine and Surgery, Regional Reference Center for Coagulation Disorders, Federico II University, Naples, Italy
| | - Roseline D'Oiron
- Center for Hemophilia and Rare Congenital Bleeding Disorders, University Hospitals Paris-Sud, AP-HP, Bicêtre Hospital, Le Kremlin-Bicêtre, France
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Ageno W, Di Minno G, Agnelli G, Cimminiello C, Imberti D, Polo Friz H, Prandoni P, Scaglione F. A survey on the views and attitudes of Italian physicians regarding the prophylaxis and treatment of venous thromboembolism. Minerva Med 2019; 111:370-372. [PMID: 31295981 DOI: 10.23736/s0026-4806.19.06034-8] [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: 11/08/2022]
Affiliation(s)
- Walter Ageno
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Giovanni Di Minno
- Department of Clinical and Experimental Medicine, Federico II University Hospital, Naples, Italy
| | - Giancarlo Agnelli
- Internal and Cardiovascular Medicine-Stroke Unit, University of Perugia, Perugia, Italy
| | - Claudio Cimminiello
- Studies and Research Center, Italian Society of Angiology and Vascular Pathology (SIAPAV), Milan, Italy
| | - Davide Imberti
- Hemostasis and Thrombosis Center, Department of Internal Medicine, Piacenza Hospital, Piacenza, Italy
| | - Hernan Polo Friz
- Department of Medicine, Vimercate Hospital, Vimercate, Monza-Brianza, Italy -
| | | | - Francesco Scaglione
- Department of Oncology and Onco-Hematology, University of Milan, Milan, Italy
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Tufano A, Di Minno MND, Guida A, Lembo M, Di Minno G, Galderisi M. Cardiac Manifestations of Antiphospholipid Syndrome: Clinical Presentation, Role of Cardiac Imaging, and Treatment Strategies. Semin Thromb Hemost 2019; 45:468-477. [DOI: 10.1055/s-0039-1692702] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
AbstractAntiphospholipid syndrome (APS) is an autoimmune disorder characterized by the presence of antiphospholipid antibodies, vascular thrombosis (venous, arterial, or small vessels), and/or pregnancy morbidity. Diagnosis of APS is based on the presence of at least one clinical criterion (thrombotic events or pregnancy morbidity) and at least one of the laboratory criteria (persistently medium/high titer immunoglobulin G [IgG]/immunoglobulin M [IgM] anticardiolipin antibodies, and/or medium/high titer IgG/IgM anti-β2-glycoprotein I antibodies, and/or a positive lupus anticoagulant test), confirmed after repetition at least 12 weeks apart. The clinical spectrum of APS encompasses additional (extracriteria) clinical manifestations, including cardiac diseases. Heart involvement may become evident as a consequence of direct (autoimmune-mediated) or indirect (thrombosis) mechanisms, and include valve heart disease (vegetations and/or thickening associated with functional abnormalities) and intracardiac thrombosis, coronary, and vascular accelerated atherosclerosis, along with ischemic heart disease. APS can also cause pulmonary arterial hypertension, left ventricular dysfunction, and heart failure. This review describes the major cardiac manifestations of APS and illustrates the role of cardiac imaging for diagnosing subclinical and overt heart involvement and addressing management of these patients. The possible role of therapeutic strategies in cardiac manifestations of APS is also discussed.
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Affiliation(s)
- Antonella Tufano
- Regional Reference Centre for Coagulation Disorders, Department of Clinical Medicine and Surgery, “Federico II” University Hospital, Naples, Italy
| | | | - Anna Guida
- Emergency Medicine, AOU Ruggi d'Aragona, Salerno, Italy
| | - Maria Lembo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Giovanni Di Minno
- Regional Reference Centre for Coagulation Disorders, Department of Clinical Medicine and Surgery, “Federico II” University Hospital, Naples, Italy
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
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Santagostino E, Riva A, Cesaro S, Esposito S, Matino D, Mazzucchelli RI, Molinari AC, Mura R, Notarangelo LD, Tagliaferri A, Di Minno G, Clerici M. Consensus statements on vaccination in patients with haemophilia-Results from the Italian haemophilia and vaccinations (HEVA) project. Haemophilia 2019; 25:656-667. [PMID: 30990961 PMCID: PMC6850056 DOI: 10.1111/hae.13756] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 03/15/2019] [Accepted: 03/15/2019] [Indexed: 12/13/2022]
Abstract
Vaccination against communicable diseases is crucial for disease prevention, but this practice poses challenges to healthcare professionals in patients with haemophilia. Poor knowledge of the vaccination requirements for these patients and safety concerns often result in vaccination delay or avoidance. In order to address this issue, a panel of 11 Italian haemophilia and immunization experts conducted a Delphi consensus process to identify the main concerns regarding the safe use of vaccines in patients with haemophilia. The consensus was based on a literature search of the available evidence, which was used by the experts to design 27 consensus statements. A group of clinicians then rated these statements using the 5‐point Likert‐type scale (1 = strongly disagree; 5 = strongly agree). The main issues identified by the expert panel included vaccination schedule for haemophilic patients; protocol and optimal route of vaccine administration; vaccination of haemophilic patients with antibodies inhibiting coagulation factor VIII (inhibitors); and vaccination and risk of inhibitor development. This manuscript discusses these controversial areas in detail supported by the available literature evidence and provides evidence‐ and consensus‐based recommendations. Overall, participants agreed on most statements, except those addressing the potential role of vaccination in inhibitor formation. Participants agreed that patients with haemophilia should receive vaccinations according to the institutional schedule for individuals without bleeding disorders; however, vaccination of patients with haemophilia requires comprehensive planning, taking into account disease severity, type and route of vaccination, and bleeding risk. Data also suggest vaccination timing does not need to take into consideration when the patient received factor VIII replacement.
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Affiliation(s)
- Elena Santagostino
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Centro Emofilia e Trombosi Angelo Bianchi Bonomi, Milan, Italy
| | - Agostino Riva
- III Divisione di Malattie Infettive, Ospedale L. Sacco - Polo Universitario, Milan, Italy
| | - Simone Cesaro
- Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Susanna Esposito
- Department of Surgical and Biomedical Sciences, Pediatric Clinic, Università degli Studi di Perugia, Perugia, Italy
| | - Davide Matino
- Department of Experimental Medicine, Università degli Studi di Perugia, Perugia, Italy
| | | | | | - Rosamaria Mura
- Pediatric Hematology and Oncology Unit, Ospedale Pediatrico Microcitemico, Cagliari, Italy
| | - Lucia Dora Notarangelo
- Paediatric Onco-haematology Unit, Children's Hospital, ASST Spedali Civili, Brescia, Italy
| | - Annarita Tagliaferri
- Regional Reference Center for Inherited Bleeding Disorders, University Hospital of Parma, Parma, Italy
| | - Giovanni Di Minno
- Regional Reference Center for Coagulation Disorders, Federico II University Hospital, Naples, Italy
| | - Mario Clerici
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.,Don C Gnocchi Foundation IRCCS, Milan, Italy
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Tufano A, Rendina D, Conca P, Matani B, Di Minno G. Hypocalcemia and hypophosphatemia after treatment with zoledronic acid in a patient with AL amyloidosis. Intern Emerg Med 2019; 14:447-449. [PMID: 30771083 DOI: 10.1007/s11739-019-02048-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 02/09/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Antonella Tufano
- Regional Reference Centre for Coagulation Disorders, Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Via S. Pansini, 5, 80131, Naples, Italy.
| | - Domenico Rendina
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Via S. Pansini, 5, 80131 Naples, Italy
| | - Paolo Conca
- Regional Reference Centre for Coagulation Disorders, Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Via S. Pansini, 5, 80131, Naples, Italy
| | - Beniamino Matani
- Regional Reference Centre for Coagulation Disorders, Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Via S. Pansini, 5, 80131, Naples, Italy
| | - Giovanni Di Minno
- Regional Reference Centre for Coagulation Disorders, Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Via S. Pansini, 5, 80131, Naples, Italy
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Tufano A, Lembo M, Di Minno MN, Nardo A, Esposito R, Santoro C, Buonauro A, Cerbone AM, Di Minno G, Galderisi M. Left ventricular diastolic abnormalities other than valvular heart disease in antiphospholipid syndrome: An echocardiographic study. Int J Cardiol 2019; 271:366-370. [PMID: 30223375 DOI: 10.1016/j.ijcard.2018.05.040] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 04/11/2018] [Accepted: 05/14/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND Antiphospholipid syndrome (APS) can be primary or secondary to other autoimmune disorders. Besides valvular heart disease (VHD) and coronary artery disease (CAD), little is known about the impact of APS on left ventricular (LV) function. METHODS After excluding CAD, relevant VHD and heart failure, 69 patients (mean age = 43.9 years, 40 with primary and 29 with secondary APS) were assessed by echo-Doppler. Sixty-nine heathy controls, matched for age and sex, formed the control group. APS was diagnosed in presence of at least one clinical criteria and one confirmed laboratory criteria, including lupus anticoagulant (LA) titre. The adjusted global APS score (aGAPSS), derived from the combination of risk factors for thrombosis and autoimmune-antibody profile was calculated. RESULTS Patients had similar blood pressure and heart rate, but higher body mass index (BMI) than controls. LV mass index (p = 0.007) and left atrial volume index (p < 0.01) were greater, while early diastolic velocity (e') was lower (p = 0.003) and E/e' higher (p = 0.007) in APS. Primary APS patients had lower E/A and e' compared to both controls and secondary APS, while E/e' was higher in secondary APS than in controls. APS patients with diastolic dysfunction were older but did not differ for risk factors prevalence from those with normal/indeterminate diastolic function. In the pooled APS, LA positivity was independently associated with e' and E/e' after adjusting for age, BMI and aGAPSS in separate multivariate models. CONCLUSION In APS, LV diastolic abnormalities are detectable. They are more pronounced in primary APS and independently associated with LA positivity.
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Affiliation(s)
- Antonella Tufano
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Maria Lembo
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | | | - Assunta Nardo
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Roberta Esposito
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Ciro Santoro
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Agostino Buonauro
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Anna Maria Cerbone
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Giovanni Di Minno
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy.
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Sanchez Hermosilla A, Di Minno G, Memmolo W, Rodella LF. Commentary on: Borrini M, Garlaschelli L. A BPA Approach to the Shroud of Turin. J Forensic Sci https://doi.org/10.1111/1556-4029.13867. Epub 2018 July 10. J Forensic Sci 2019; 64:325-326. [PMID: 30605574 DOI: 10.1111/1556-4029.13939] [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: 12/01/2022]
Affiliation(s)
- Alfonso Sanchez Hermosilla
- Institute of Legal Medicine, Anthropology and Forensic Genetic, Catholic University San Antonio, Campus los Jeronimos, Guadalupe, 30107, Murcia, Spain
| | - Giovanni Di Minno
- Clinical Medicine, Department of Clinical Medicine and Surgery, Federico II University, Via Pansini 5, 80131, Napoli, Italy
| | - Walter Memmolo
- Division of Surgery, Capri Hospital, ASL Napoli 1, Via L. Giordano 51, 80044, Cercola, Napoli, Italy
| | - Luigi F Rodella
- Section of Anatomy and Physiopatology, Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, 25123, Brescia, Italy
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Di Minno G, Santagostino E, Morfini M, Ettorre C, Cultrera D, Baldacci E, Russo E, Gallucci C. Patient satisfaction and acceptability of an on-demand and on-prophylaxis device for factor VIII delivery in patients with hemophilia A. Patient Prefer Adherence 2019; 13:233-240. [PMID: 30774319 PMCID: PMC6362933 DOI: 10.2147/ppa.s175254] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND FuseNGO is a relatively new device consisting of a prefilled dual-chamber syringe (DCS) that was recently introduced for the reconstitution of recombinant factor VIII. Herein, the DCS device was assessed using five questionnaires with the primary aim of evaluating patient perceptions and preferences. METHODS An observational, non-interventional, longitudinal study on 86 patients with a confirmed diagnosis of hemophilia A was carried out at 21 sites in Italy. Each patient underwent a baseline visit and final study visit within 3-6 months. Patients were administered five questionnaires: HemoPREF; Treatment Satisfaction Questionnaire for Medication (TSQM); VeritasPRO; Hemophilia Well-being Index (HWBI); Work Productivity and Activity Impairment Questionnaire (WPAI) + Classroom Impairment Questions (CIQ): Hemophilia Specific (HS). RESULTS Compared to baseline, scores for HemoPREF were higher at follow-up; significant increases in the percentage of positive responses were seen for all questions regarding the ease of use (P<0.05). The mean time needed for the reconstruction of the device at baseline was 11 minutes (range 1-30 minutes), which decreased to 6 minutes (range 30 seconds to 25 minutes) at follow-up. All scores in the TSQM indicated good satisfaction with the device. Patients reported an adherence of >70% in the VeritasPRO questionnaire, and the majority of patients reported in the HWBI that hemophilia A did not affect their lives in a significant way. The perceived level of overall impairment was 30% as reported in the WPAI + CIQ: HS, indicating little impairment. There were no safety concerns. CONCLUSION Considering patient-reported outcomes, the DCS device was associated with easier preparation, storage, disposal of equipment, and overall use. Of particular note, preparation times were reduced by around 50%. The majority of patients were satisfied with the device and overall adherence scores were high. Considering these results, the device has the potential to increase adherence to therapy and, possibly, reduce healthcare costs.
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Affiliation(s)
- Giovanni Di Minno
- Department of Clinical Medicine and Surgery, Azienda Universitaria Policlinico Federico II, Naples, Italy,
| | - Elena Santagostino
- Hemophilia and Thrombosis Center, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Massimo Morfini
- Scientific Committee, Italian Association of Haemophilia Centres (AICE), Florence, Italy
| | - Cosimo Ettorre
- Haemophilia and Thrombosis Center, Policlinico Giovanni XXIII, Bari, Italy
| | - Dorina Cultrera
- Hematology Unit, Regional Center for Hemophilia, Italy Ospedaliera-Universitaria "Policlinico - Vittorio Emanuele", Catania, Italy
| | - Erminia Baldacci
- Hemophilia, Thrombosis, and Hematology Center, Dipartimento Biotecnologie cellulari ed Ematologia, Università la Sapienza, Rome, Italy
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Prisco D, Tufano A, Cenci C, Pignatelli P, Santilli F, Di Minno G, Perticone F. Position paper of the Italian Society of Internal Medicine (SIMI) on prophylaxis and treatment of venous thromboembolism in patients with cancer. Intern Emerg Med 2019; 14:21-38. [PMID: 30276659 DOI: 10.1007/s11739-018-1956-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 09/18/2018] [Indexed: 02/01/2023]
Abstract
Cancer patients are at high risk of developing thrombotic events, including venous thromboembolism (VTE) [deep venous thrombosis (DVT) and pulmonary embolism (PE)], and arterial thrombosis. DVT and PE represent the second leading cause of death in cancer patients; moreover, the development of thromboembolic events in cancer patients is linked to a greater need of hospitalization and frequency of side effects during treatment, in particular bleeding, and to an increased risk of recurrence during and following antithrombotic therapy. The thromboembolic risk may be different in different subgroups of cancer population, being highest in patients with metastatic disease, patients with pancreas, stomach, kidney or primary brain cancer, or during therapeutic interventions or surgery. This document focuses on several relevant topics including the epidemiology and pathogenesis of cancer-associated VTE, the current and future strategies of primary prevention and anticoagulant treatment, and the management of bleeding complications. The main literature data are discussed in detail, including, when available, evidence from randomized clinical trials and meta-analyses, international guidelines statements, the results of recently published trials comparing direct oral anticoagulants to low molecular weight heparin, and the design and aims of ongoing trials on prevention/treatment of cancer-associated VTE.
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Affiliation(s)
- Domenico Prisco
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Antonella Tufano
- Department of Clinical Medicine and Surgery, Regional Reference Centre for Coagulation Disorders, "Federico II" University Hospital, Via S. Pansini, 5, 80131, Naples, Italy.
| | - Caterina Cenci
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Pasquale Pignatelli
- Department of Internal Medicine and Medical Specialties, La Sapienza University of Rome, Rome, Italy
| | - Francesca Santilli
- Department of Medicine and Aging and Center of Aging Science and Translational Medicine (CESI-Met), "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Giovanni Di Minno
- Department of Clinical Medicine and Surgery, Regional Reference Centre for Coagulation Disorders, "Federico II" University Hospital, Via S. Pansini, 5, 80131, Naples, Italy
| | - Francesco Perticone
- Department of Medical and Surgical Sciences, "Magna-Græcia" University of Catanzaro, Catanzaro, Italy
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Loffredo L, Arienti V, Vidili G, Cogliati C, Battaglia S, Perri L, Di Giulio R, Bernardini S, Summa ML, Sciacqua A, Perticone F, Boddi M, Di Minno G, Lodigiani C, Pietrangelo A, Farcomeni A, Violi F. Low Rate of Intrahospital Deep Venous Thrombosis in Acutely Ill Medical Patients: Results From the AURELIO Study. Mayo Clin Proc 2019; 94:37-43. [PMID: 30611451 DOI: 10.1016/j.mayocp.2018.07.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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] [Received: 04/09/2018] [Revised: 05/30/2018] [Accepted: 07/03/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To evaluate the effect of hospitalization on deep venous thrombosis (DVT) rate by the cumulative incidence of DVT in the proximal venous tract of the lower limbs at admission and discharge. METHODS The AURELIO (rAte of venoUs thRombosis in acutEly iLl patIents hOspitalized in internal medicine wards) multicenter observational study was carried out in hospital-university internal medicine wards including consecutive acutely ill medical patients. Patients underwent compression ultrasonography (CUS) of proximal lower limb veins at admission and discharge. The occurrence of DVT was the primary end point of the study. RESULTS Among 1340 patients, 26 (1.9%; 95% CI, 1.3%-2.8%) had asymptomatic DVT at admission and were excluded. During the follow-up, 144 patients were excluded because of hospitalization less than 5 days. The remaining 1170 patients underwent a CUS at discharge. Two hundred fifty (21%) underwent prophylaxis with parenteral anticoagulants; the remaining 920 (79%) were not treated with anticoagulants. The mean length of hospitalization was 13±8 days. Compared with patients without prophylaxis, those treated with parenteral anticoagulants had a higher incidence of active cancer, heart and respiratory failure, pneumonia, renal failure, previous venous thromboembolism, reduced mobility, and elderly age. During the hospital stay, 3 patients with a negative CUS at admission experienced DVT in the proximal tract (0.025%, rate of 1 per 5017 patient-days); 2 of them were in prophylaxis with parenteral anticoagulants. CONCLUSION We provide evidence that in the real world acutely ill medical patients display more than 90% (1.9%) asymptomatic DVT at admission, whereas the intrahospital DVT occurrence is very low. This suggests a novel diagnostic workup and a careful reanalysis of anticoagulant prophylaxis.
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Affiliation(s)
- Lorenzo Loffredo
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
| | - Vincenzo Arienti
- Department of Internal Medicine, Internal Medicine Unit, Maggiore Hospital, Bologna, Italy
| | - Gianpaolo Vidili
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Chiara Cogliati
- Department of Internal Medicine, L. Sacco Hospital, ASST-fbf-sacco, Milan, Italy
| | - Simona Battaglia
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
| | - Ludovica Perri
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
| | - Rosella Di Giulio
- Department of Internal Medicine, Internal Medicine Unit, Maggiore Hospital, Bologna, Italy
| | - Sciaila Bernardini
- Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiologic and Geriatric Sciences, Division of Gerontology, Sapienza University of Rome, Rome, Italy
| | - Maria Luna Summa
- Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiologic and Geriatric Sciences, Division of Gerontology, Sapienza University of Rome, Rome, Italy
| | - Angela Sciacqua
- Department of Medical and Surgical Sciences, University Magna-Græcia of Catanzaro, Catanzaro, Italy
| | - Francesco Perticone
- Department of Medical and Surgical Sciences, University Magna-Græcia of Catanzaro, Catanzaro, Italy
| | - Maria Boddi
- Experimental and Clinical Department, University of Florence, Florence, Italy
| | - Giovanni Di Minno
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Corrado Lodigiani
- Humanitas Research Hospital, Cardiovascular Department, Thrombosis and Haemorragic Diseases Center, Rozzano, Milan, Italy
| | | | - Alessio Farcomeni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Francesco Violi
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy.
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Monti M, De Rosa V, Iommelli F, Carriero MV, Terlizzi C, Camerlingo R, Belli S, Fonti R, Di Minno G, Del Vecchio S. Neutrophil Extracellular Traps as an Adhesion Substrate for Different Tumor Cells Expressing RGD-Binding Integrins. Int J Mol Sci 2018; 19:ijms19082350. [PMID: 30096958 PMCID: PMC6121671 DOI: 10.3390/ijms19082350] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [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] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 08/06/2018] [Indexed: 11/16/2022] Open
Abstract
Neutrophil extracellular traps (NETs), in addition to their function as a host defense mechanism, play a relevant role in thrombus formation and metastatic dissemination of cancer cells. Here we screened different cancer cell lines endogenously expressing a variety of integrins for their ability to bind to NETs. To this end, we used NETs isolated from neutrophil-like cells as a substrate for adhesion assays of HT1080, U-87 MG, H1975, DU 145, PC-3 and A-431 cells. Levels of α5, αIIb, αv, β1, β3 and β5 chains were determined by western blot analysis in all cell lines and levels of whole integrins on the plasma membrane were assessed by fluorescence-activated cell sorting (FACS) analysis. We found that high levels of α5β1, αvβ3 and αvβ5 enhance cell adhesion to NETs, whereas low expression of α5β1 prevents cell attachment to NETs. Excess of cyclic RGD peptide inhibited cell adhesion to NETs by competing with fibronectin within NETs. The maximal reduction of such adhesion was similar to that obtained by DNase 1 treatment causing DNA degradation. Our findings indicate that NETs from neutrophil-like cells may be used as a substrate for large screening of the adhesion properties of cancer cells expressing a variety of RGD-binding integrins.
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Affiliation(s)
- Marcello Monti
- Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli "Federico II", Via S. Pansini 5, 80131 Naples, Italy.
| | - Viviana De Rosa
- Istituto di Biostrutture e Bioimmagini, Consiglio Nazionale delle Ricerche, 80145 Naples, Italy.
| | - Francesca Iommelli
- Istituto di Biostrutture e Bioimmagini, Consiglio Nazionale delle Ricerche, 80145 Naples, Italy.
| | - Maria Vincenza Carriero
- Dipartimento di Oncologia Sperimentale, IRCCS Istituto Nazionale Tumori "Fondazione G. Pascale", 80145 Naples, Italy.
| | - Cristina Terlizzi
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli "Federico II", Via S. Pansini 5, 80145 Naples, Italy.
| | - Rosa Camerlingo
- Dipartimento di Oncologia Sperimentale, IRCCS Istituto Nazionale Tumori "Fondazione G. Pascale", 80145 Naples, Italy.
| | - Stefania Belli
- Istituto di Genetica e Biofisica, Consiglio Nazionale delle Ricerche, 80131 Naples, Italy.
| | - Rosa Fonti
- Istituto di Biostrutture e Bioimmagini, Consiglio Nazionale delle Ricerche, 80145 Naples, Italy.
| | - Giovanni Di Minno
- Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli "Federico II", Via S. Pansini 5, 80131 Naples, Italy.
| | - Silvana Del Vecchio
- Istituto di Biostrutture e Bioimmagini, Consiglio Nazionale delle Ricerche, 80145 Naples, Italy.
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli "Federico II", Via S. Pansini 5, 80145 Naples, Italy.
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Affiliation(s)
- Giovanni Di Minno
- Chair of Geriatrics, University of Palermo; l.R.C.C.S. “Casa Sollievo della Sofferenza”, S. Giovanni Rotondo, and Dept. of Clinical and Experimental Medicine, “Federico ll” University, Naples, ltaly
| | - Elvira Grandone
- Chair of Geriatrics, University of Palermo; l.R.C.C.S. “Casa Sollievo della Sofferenza”, S. Giovanni Rotondo, and Dept. of Clinical and Experimental Medicine, “Federico ll” University, Naples, ltaly
| | - Maurizio Margaglione
- Chair of Geriatrics, University of Palermo; l.R.C.C.S. “Casa Sollievo della Sofferenza”, S. Giovanni Rotondo, and Dept. of Clinical and Experimental Medicine, “Federico ll” University, Naples, ltaly
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Grandone E, Margaglione M, Colaizzo D, Cappucci G, Paladini D, Martinelli P, Montanaro S, Pavone G, Minno GD. Factor V Leiden, C>T MTHFR Polymorphism and Genetic Susceptibility to Preeclampsia. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1656110] [Citation(s) in RCA: 121] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryWe performed a case-controlled study to investigate whether the FV Leiden mutation and the C>T677 polymorphism of the 5,10 methylene tetrahydrofolate reductase (MTHFR) are associated with the occurrence of preeclampsia in 96 otherwise healthy preeclamptic women and 129 parous women as controls. FV Leiden carriers were 10 (10.5%) in cases and 3 (2.3%) in controls (OR: 4.9, 95% Cl: 1.3-18.3). MTHFR TT homozygotes were 28 (29.8%) in cases and 24 (18.6%) in the control group (OR: 1.8,95% Cl 1.0-3.5). No difference in any of the polymorphisms was found between proteinuric (n = 45) and non-proteinur-ic (n = 51) patients. Moreover, MTHFR polymorphism does not affect the association between FV Leiden and preeclampsia. In conclusion, FV Leiden mutation and MTHFR TT genotype are associated with the occurrence of preeclampsia, suggesting that, during pregnancy, women carrying these gene variants are prone to develop such a complication.
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Affiliation(s)
- Elvira Grandone
- Arteriosclerosis and Thrombosis Unit and Division of Obstetrics and Gynecology, I.R.C.C.S. "Casa Sollievo della Sofferenza", S.Giovanni R. (FG), University of Palermo, Italy
| | - Maurizio Margaglione
- Arteriosclerosis and Thrombosis Unit and Division of Obstetrics and Gynecology, I.R.C.C.S. "Casa Sollievo della Sofferenza", S.Giovanni R. (FG), University of Palermo, Italy
| | - Donatella Colaizzo
- Arteriosclerosis and Thrombosis Unit and Division of Obstetrics and Gynecology, I.R.C.C.S. "Casa Sollievo della Sofferenza", S.Giovanni R. (FG), University of Palermo, Italy
| | - Giuseppe Cappucci
- Arteriosclerosis and Thrombosis Unit and Division of Obstetrics and Gynecology, I.R.C.C.S. "Casa Sollievo della Sofferenza", S.Giovanni R. (FG), University of Palermo, Italy
| | - Dario Paladini
- Department of Obstetrics and Gynecology, University "Federico II", Naples, University of Palermo, Italy
| | - Pasquale Martinelli
- Department of Obstetrics and Gynecology, University "Federico II", Naples, University of Palermo, Italy
| | - Sergio Montanaro
- Arteriosclerosis and Thrombosis Unit and Division of Obstetrics and Gynecology, I.R.C.C.S. "Casa Sollievo della Sofferenza", S.Giovanni R. (FG), University of Palermo, Italy
| | - G Pavone
- Arteriosclerosis and Thrombosis Unit and Division of Obstetrics and Gynecology, I.R.C.C.S. "Casa Sollievo della Sofferenza", S.Giovanni R. (FG), University of Palermo, Italy
| | - Giovanni Di Minno
- Institute of Internal Medicine and Geriatrics, University of Palermo, Italy
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Grandone E, Margaglione M, Colaizzo D, Montanaro S, Pavone G, Minno GD. Presence of FV Leiden and MTHFR Mutation in a Patient with Complicated Pregnancies. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1656101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Elvira Grandone
- Arteriosclerosis and Thrombosis Unit and Division of Obstetrics and Gynecology, I.R.C.C.S. “Casa Sollievo della Sofferenza”, S. Giovanni R. (FG), University of Palermo, Italy
| | - Maurizio Margaglione
- Arteriosclerosis and Thrombosis Unit and Division of Obstetrics and Gynecology, I.R.C.C.S. “Casa Sollievo della Sofferenza”, S. Giovanni R. (FG), University of Palermo, Italy
| | - Donatella Colaizzo
- Arteriosclerosis and Thrombosis Unit and Division of Obstetrics and Gynecology, I.R.C.C.S. “Casa Sollievo della Sofferenza”, S. Giovanni R. (FG), University of Palermo, Italy
| | - Sergio Montanaro
- Arteriosclerosis and Thrombosis Unit and Division of Obstetrics and Gynecology, I.R.C.C.S. “Casa Sollievo della Sofferenza”, S. Giovanni R. (FG), University of Palermo, Italy
| | - Giuseppe Pavone
- Arteriosclerosis and Thrombosis Unit and Division of Obstetrics and Gynecology, I.R.C.C.S. “Casa Sollievo della Sofferenza”, S. Giovanni R. (FG), University of Palermo, Italy
| | - Giovanni Di Minno
- Arteriosclerosis and Thrombosis Unit and Division of Obstetrics and Gynecology, I.R.C.C.S. “Casa Sollievo della Sofferenza”, S. Giovanni R. (FG), University of Palermo, Italy
- Institute of Internal Medicine and Geriatrics, University of Palermo, Italy
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Margaglione M, Di Minno G, Grondone E, Vecchione G, Celentano E, Cappucci G, Giordano M, Grilli M, Simone P, Fusilli S, Panico S, Mancini M. Raised Plasma Fibrinogen Concentrations in Subjects Attending a Metabolic Ward - Relation to Family History and Vascular Risk Factors. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1653824] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryWe have evaluated plasma fibrinogen levels in 171 subjects attending a metabolic ward. As in the general population, a significant difference in plasma fibrinogen concentrations (p <0.05) was found between subjects with diabetes mellitus or hypertension and those without. However, fibrinogen was also abnormally high (p <0.05) when evaluated according to the presence of a family history of ischemic complications of atherosclerosis (p <0.05). In this setting, fibrinogen correlated with diabetes mellitus or hypertension as well as with familial risk, and the latter interacted with hypertension (p <0.05) in accounting for plasma fibrinogen.The relationships between certain fibrinogen genotypes and familial risk have then been evaluated. Analysis of a locus (1.3 kb, HAE III digestion) of the promoter region of the BB fibrinogen gene, identified a polymorphic cutting site. The allele with the alternative restriction site (HI) was associated with mean fibrinogen levels which were 0.1-0.3 g/1 lower than those associated with the other allele (H2). This difference was not statistically significant. No obvious association was found between the familial risk and the presence of the H2 allele. We conclude that in a group of subjects from a metabolic ward, a positive family history for ischemic complications of atherosclerosis is consistently associated with high plasma fibrinogen levels. Interaction with hypertension significantly strengthens the association.
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Affiliation(s)
- Maurizio Margaglione
- The Clinica Medica, Istituto di Medicina Interna e Malattie Dismetaboliche, Universita’ di Napoli, and Unita’ di Trombosi e Aterosclerosi, I.R.C.C.S, “Casa Sollievo della Sofferenza”, S. Giovanni Rotondo, Italy
| | - Giovanni Di Minno
- The Clinica Medica, Istituto di Medicina Interna e Malattie Dismetaboliche, Universita’ di Napoli, and Unita’ di Trombosi e Aterosclerosi, I.R.C.C.S, “Casa Sollievo della Sofferenza”, S. Giovanni Rotondo, Italy
| | - Elvira Grondone
- The Clinica Medica, Istituto di Medicina Interna e Malattie Dismetaboliche, Universita’ di Napoli, and Unita’ di Trombosi e Aterosclerosi, I.R.C.C.S, “Casa Sollievo della Sofferenza”, S. Giovanni Rotondo, Italy
| | - Gennaro Vecchione
- The Clinica Medica, Istituto di Medicina Interna e Malattie Dismetaboliche, Universita’ di Napoli, and Unita’ di Trombosi e Aterosclerosi, I.R.C.C.S, “Casa Sollievo della Sofferenza”, S. Giovanni Rotondo, Italy
| | - Egidio Celentano
- The Clinica Medica, Istituto di Medicina Interna e Malattie Dismetaboliche, Universita’ di Napoli, and Unita’ di Trombosi e Aterosclerosi, I.R.C.C.S, “Casa Sollievo della Sofferenza”, S. Giovanni Rotondo, Italy
| | - Giuseppe Cappucci
- The Clinica Medica, Istituto di Medicina Interna e Malattie Dismetaboliche, Universita’ di Napoli, and Unita’ di Trombosi e Aterosclerosi, I.R.C.C.S, “Casa Sollievo della Sofferenza”, S. Giovanni Rotondo, Italy
| | - Mauro Giordano
- The Clinica Medica, Istituto di Medicina Interna e Malattie Dismetaboliche, Universita’ di Napoli, and Unita’ di Trombosi e Aterosclerosi, I.R.C.C.S, “Casa Sollievo della Sofferenza”, S. Giovanni Rotondo, Italy
| | - Massimo Grilli
- The Clinica Medica, Istituto di Medicina Interna e Malattie Dismetaboliche, Universita’ di Napoli, and Unita’ di Trombosi e Aterosclerosi, I.R.C.C.S, “Casa Sollievo della Sofferenza”, S. Giovanni Rotondo, Italy
| | - Pasquale Simone
- The Clinica Medica, Istituto di Medicina Interna e Malattie Dismetaboliche, Universita’ di Napoli, and Unita’ di Trombosi e Aterosclerosi, I.R.C.C.S, “Casa Sollievo della Sofferenza”, S. Giovanni Rotondo, Italy
| | - Saverio Fusilli
- The Clinica Medica, Istituto di Medicina Interna e Malattie Dismetaboliche, Universita’ di Napoli, and Unita’ di Trombosi e Aterosclerosi, I.R.C.C.S, “Casa Sollievo della Sofferenza”, S. Giovanni Rotondo, Italy
| | - Salvatore Panico
- The Clinica Medica, Istituto di Medicina Interna e Malattie Dismetaboliche, Universita’ di Napoli, and Unita’ di Trombosi e Aterosclerosi, I.R.C.C.S, “Casa Sollievo della Sofferenza”, S. Giovanni Rotondo, Italy
| | - Mario Mancini
- The Clinica Medica, Istituto di Medicina Interna e Malattie Dismetaboliche, Universita’ di Napoli, and Unita’ di Trombosi e Aterosclerosi, I.R.C.C.S, “Casa Sollievo della Sofferenza”, S. Giovanni Rotondo, Italy
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Tufano A, Di Minno G. Prophylaxis of venous thromboembolism in Internal Medicine Units: the RAMs issue. Intern Emerg Med 2018. [PMID: 29541919 DOI: 10.1007/s11739-018-1829-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Antonella Tufano
- Clinica Medica, Dipartimento di Medicina Clinica e Chirurgia, Centro di Coordinamento Regionale per le Coagulopatie, Università degli Studi di Napoli "Federico II", Via S. Pansini, 5, 80131, Naples, Italy.
| | - Giovanni Di Minno
- Clinica Medica, Dipartimento di Medicina Clinica e Chirurgia, Centro di Coordinamento Regionale per le Coagulopatie, Università degli Studi di Napoli "Federico II", Via S. Pansini, 5, 80131, Naples, Italy
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Coppola A, Franchini M, Castaman G, Santagostino E, Santoro C, Santoro RC, Morfini M, Di Minno G, Rocino A. Treatment Regimens with Bypassing Agents in Patients with Hemophilia A and Inhibitors: A Survey from the Italian Association of Hemophilia Centers (AICE). Semin Thromb Hemost 2018; 44:551-560. [PMID: 29723892 DOI: 10.1055/s-0038-1648230] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The development of neutralizing antibodies (inhibitors) against infused factor VIII currently represents the main complication of replacement therapy in patients with severe hemophilia A. Inhibitors, indeed, particularly high-titer inhibitors (>5 BU/mL), greatly complicate the management of bleeding, exposing patients to an increased morbidity and mortality risk, thus representing a significant burden for physicians of Hemophilia Treatment Centers (HTCs). Although bypassing agents (i.e., activated prothrombin complex concentrate [APCC] and recombinant activated factor VII [rFVIIa]) are available for the treatment and prevention of bleeding in inhibitor patients, their efficacy, safety, and cost-benefit outcomes are poorly known in the long term and should be further improved. In the frame of the update of recommendations for the management of inhibitor patients by the Italian Association of Hemophilia Centers (AICE), to collect more information on real-life therapeutic approaches with bypassing agents in this setting, a survey was conducted among the Directors of the Italian HTCs. From questionnaires returned by 55% of them, data on the use of rFVIIa and APCC in children, adolescent, and adult patients with hemophilia A and inhibitors were obtained and are summarized in this article, including information about the implementation of prophylaxis with both bypassing agents, the adopted regimens, and reasons for starting, adjusting, and interrupting such a therapeutic approach.
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Affiliation(s)
- Antonio Coppola
- Hemophilia and Congenital Bleeding Disorders Hub Center, University Hospital of Parma, Parma, Italy
| | - Massimo Franchini
- Department of Transfusion Medicine and Hematology, Carlo Poma Hospital, Mantova, Italy
| | - Giancarlo Castaman
- Center for Bleeding Disorders, Careggi University Hospital, Florence, Italy
| | - Elena Santagostino
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, IRCCS Ca' Granda Foundation, Maggiore Hospital Policlinico, Milan, Italy
| | - Cristina Santoro
- Hematology Unit, Department of Cellular Biotechnology and Hematology, Sapienza University of Rome, Rome, Italy
| | | | - Massimo Morfini
- Past President of the Italian Association of Hemophilia Centers (AICE), Italy
| | - Giovanni Di Minno
- Regional Reference Center for Coagulation Disorders, Federico II University Hospital, Naples, Italy
| | - Angiola Rocino
- Hemophilia and Thrombosis Center, Hematology Unit, Ascalesi Hospital, Naples, Italy
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Tufano A, Contaldi P, Coppola A, Nardo A, Franco N, Cerbone AM, Minno GD. Cytomegalovirus-Associated Splanchnic Vein Thrombosis in Immunocompetent Patients: Two Case Reports and Literature Review. Semin Thromb Hemost 2018; 44:298-303. [PMID: 29294492 DOI: 10.1055/s-0037-1615262] [Citation(s) in RCA: 1] [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] [Indexed: 10/18/2022]
Affiliation(s)
- Antonella Tufano
- Department of Clinical Medicine and Surgery, Regional Reference Centre for Coagulation Disorders, "Federico II" University Hospital, Naples, Italy
| | - Paola Contaldi
- Department of Clinical Medicine and Surgery, Regional Reference Centre for Coagulation Disorders, "Federico II" University Hospital, Naples, Italy
| | - Antonio Coppola
- Department of Clinical Medicine and Surgery, Regional Reference Centre for Coagulation Disorders, "Federico II" University Hospital, Naples, Italy
| | - Assunta Nardo
- Department of Clinical Medicine and Surgery, Regional Reference Centre for Coagulation Disorders, "Federico II" University Hospital, Naples, Italy
| | - Nicoletta Franco
- Department of Clinical Medicine and Surgery, Regional Reference Centre for Coagulation Disorders, "Federico II" University Hospital, Naples, Italy
| | - Anna Maria Cerbone
- Department of Clinical Medicine and Surgery, Regional Reference Centre for Coagulation Disorders, "Federico II" University Hospital, Naples, Italy
| | - Giovanni Di Minno
- Department of Clinical Medicine and Surgery, Regional Reference Centre for Coagulation Disorders, "Federico II" University Hospital, Naples, Italy
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Bossone A, Coalizzo D, D’Andrea G, Brancaccio V, Ciampa A, Grandone E, Di Minno G, Margaglione M. FV HR2 Haplotype as Additional Inherited Risk Factor for Deep Vein Thrombosis in Individuals with a High-Risk Profile. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1612939] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryA number of strongly linked polymorphisms within the Factor V gene (FV HR2 haplotype) has been identified as a cause of resistance to activated protein C, and has suggested a modest risk factor for vein thrombosis. We investigated the frequency of the HR2 haplotype in 433 consecutive patients with confirmed deep vein thrombosis and 326 controls. The HR2 haplotype was more frequent in patients (15.2%) than in controls (10.1%). The risk of thrombosis among carriers of this haplotype was significantly increased (odds ratio: 1.6 [95% CI: 1.0-2.5]). The estimated risk associated with the HR2 haplotype was 1.8 (95% CI: 1.1-2.9) in subjects with (n = 255), and 1.4 (95% CI: 0.8-2.4) in those without (n = 178) acquired risk factors for vein thrombosis. After adjustment for sex, FV Leiden and FII A20210 mutations, the estimated risk of vein thrombosis among carriers of the HR2 haplotype was 1.8 (95% CI: 1.1-2.8). Present data indicate that the HR2 haplotype is independently associated with vein thrombosis among individuals with a highrisk profile.
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Tufano A, Cimino E, Agangi A, Maruotti G, Martinelli P, Di Minno G, Coppola A. Recombinant factor VIIa in a patient with Glanzmann’s thrombasthenia undergoing gynecological surgery: open issues in light of successful treatment. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1614304] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Brancaccio V, Ciampa A, Minno GD, Margaglione M. Reply to Rebuttal: Gene Variants of the Cytochrome P450 CYP2C9 Affect Oral Anticoagulation with Warfarin. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1616159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Colaizzo D, D’Andrea G, Brancaccio V, Ciampa A, Grandone E, Di Minno G, Margaglione M. Genetic Modulation of Oral Anticoagulation with Warfarin. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1614114] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryCytochrome P450 CYP2C9 gene variants have been associated with hyperresponsiveness to small doses of warfarin and a higher bleeding complication rate. The aim of this study was to investigate whether CYP2C9 gene variants affect doses of drug prescribed to acquire the target anticoagulation intensity and the occurence of bleeding complications. In a cohort of 180 patients followed up at one specialized clinic from the start of the anticoagulation with warfarin, we have investigated whether CYP2C9 gene variants have affected doses of drug prescribed to acquire the target anticoagulation intensity and the incidence of bleeding complications.The adjusted dose required of warfarin was higher among patients with the CYP2C9*1 haplotype (5.6 mg) than those of patients carrying the CYP2C9*2 (4.7 mg; p = 0.007, Scheffé’s test) or the CYP2C9*3 haplotype (4.0 mg; p <0.001, Scheffé’s test). The occurrence of bleeding complications was more frequent among patients with the CYP2C9*2 and/or the CYP2C9*3 haplotype than in carriers of the CYP2C9*1 haplotype (OR: 2.57; 95% CI: 1.16–5.73). An interaction between the presence of local bleeding sources and the CYP2C9*2 and/or the CYP2C9*3 haplotype was observed (p <0.001). Patients with both local sites of potential bleeding and CYP2C9*2 and/or the CYP2C9*3 haplotype had the higher estimated risk of bleeding (OR: 12.81; 95% CI: 2.86–57.26).CYP2C9 gene variants modulate the anticoagulant effect of the dose of warfarin prescribed. The incidence of bleeding complications in CYP2C9*2 and CYP2C9*3 carriers was significantly higher than that in noncarriers and interacted with the presence of local bleeding sources.
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Bossone A, Brancaccio V, Ciampa A, Di Minno G, Margaglione M. Factor XIII Val34Leu Polymorphism and Risk of Deep Vein Thrombosis. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1614181] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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