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Alberca I, Astier M, Watelain E, Pradon D, Chénier F, Faupin A. Approche comparée de l’apprentissage synchrone vs asynchrone de la propulsion en fauteuil roulant manuel. Sci Sports 2021. [DOI: 10.1016/j.scispo.2020.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
SummaryWe studied a Spanish family in which one of the female members presented recurrent thrombophlebitis in both legs after three different deliveries. Biological and antigenic activity of protein C was decreased (35% and 42% respectively). Reduced protein C levels were also observed in 6 other family members. Administration of danazol (600 mg/day) in two patients with protein C deficiency elevated this protein and discontinuation of the drug resulted in a reduction of protein C to pretreatment values. The proposita showed a normal fibrinolytic activity and infusion of DDAVP produced a similar response of FVIII/VWF and plasminogen activator to those observed in healthy subjects.
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Affiliation(s)
- R Gonzalez
- The Department of Haematology, University of Salamanca, Barcelona, Spain
| | - I Alberca
- The Department of Haematology, University of Salamanca, Barcelona, Spain
| | - N Sala
- The Hospital de la Santa Cruz y San Pablo, Barcelona, Spain
| | - V Vicente
- The Department of Haematology, University of Salamanca, Barcelona, Spain
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Vicente V, Alberca I, Mannucci PM. Reduced Effect of Exercise and DDAVP on Factor VIII-von Willebrand Factor and Plasminogen Activator after Sequential Application of Both the Stimuli. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1661038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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)
- V Vicente
- Dept. of Hematology, Univ. Salamanca, Spain
| | - I Alberca
- Dept. of Hematology, Univ. Salamanca, Spain
| | - P M Mannucci
- A. Bianchi Bonomi Hemophilia and Thrombosis Centre, University of Milano, Italy
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Abstract
SummaryA 15-month-old girl from Coimbra (Portugal) had a history of numerous hemorrhagic episodes with multiple bruises, hematomas but not hemarthroses. On serial testing she showed deficiency of factors II, VII, IX, X and protein C. Malabsorption- induced vitamin K deficiency, liver disease or ingestion of a coumarin compound were excluded. An absence of detectable abnormalities was found among her relatives. Consanguinity was not present. The immunologic assay, immunoelectrophoresis or antibody neutralization, revealed much higher levels of these factors than the clotting assay. The non-physiological activator (Echis carinatus venom) produced higher levels of prothrombin activation than those detected by physiological activation. Twodimensional immunoelectrophoresis of the patient’s plasma in calcium showed that prothrombin had the same mobility as acarboxyprothrombin. No significant response to large doses of intravenous vitamin K3 (6 mg) was observed. Transfusion of 120 ml of frozen fresh plasma led to an immediate increase in the procoagulant activities of vitamin K dependent protein, similar to that found after perfusion of plasma plus vitamin K3. The results obtained from this patient suggest a defect in the gammacarboxylation mechanism inside the hepatocyte.
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Affiliation(s)
- V Vicente
- The Department of Hematology, University of Salamanca, Spain
| | - R Maia
- The Hospital Pediatrico de Coimbra, Coimbra, Portugal
| | - I Alberca
- The Department of Hematology, University of Salamanca, Spain
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Abstract
SummaryA hundred and one samples of cerebrospinal fluid (CSF) were obtained from patients with bacterial meningitis (18), viral meningitis (9), lymphoproliferative disorders (33), 15 with meningeal infiltrations, multiple sclerosis (8), stroke (8) and 25 subjects with normal CSF. All samples were studied for VIIIR: Ag with specific and sensitive immunoradiometric assay (IRMA) and Laurell’s technique.Prothrombin and factor IX antigenic activities were investigated by Laurell’s technique. Simultaneously, plasma specimens from ten patients with bacterial meningitis were evaluated. Only a selective increase of VIIIR: Ag was demonstrated in CSF from bacterial meningitis whereas prothrombin and factor IX were not detected. VIIIR: Ag plasma and CSF levels were uncorrelated. Similarly, no relationship could be established between the degree of elevation of VIIIR: Ag in the CSF and their protein concentration.These findings suggest that VIIIR :Ag elevation in CSF has diagnostic value for bacterial meningitis and that disruption of the blood-brain barrier is not responsible for their elevated levels. Accordingly, the presence of VIIIR :Ag in CSF may be an indication of endothelial damage in the choroid plexi.
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Affiliation(s)
- V Vicente Garcia
- The Department of Hematology, Hospital Clinico Universitario, University of Salamanca, Salamanca, Spain
| | - I Alberca
- The Department of Hematology, Hospital Clinico Universitario, University of Salamanca, Salamanca, Spain
| | - A Lopez Borrasca
- The Department of Hematology, Hospital Clinico Universitario, University of Salamanca, Salamanca, Spain
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Mannucci PM, Vicente V, Alberca I, Sacchi E, Longo G, Harris AS, Lindquist A. Intravenous and Subcutaneous Administration of Desmopresssin (DDAVP) to Hemophiliacs: Pharmacokinetics and Factor VIII Responses. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1646051] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [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
SummaryWhen desmopressin (DDAVP) is given to mild and moderate hemophiliacs intravenously (i. v.) or subcutaneously (s.c.), there is a very large between-patient variability for peak levels of factor VIII coagulant activity (VIII :C). To evaluate whether or not between-patient variability is related to DDAVP levels achieved in plasma, we measured drug levels in 14 hemophilic volunteers (VIII: C 2 to 31 U/dL) who were randomly given 0.3 μg/Kg of i. v. or s. c. DDAVP and crossed-over to the other treatment after an interval of 15–30 days. Peak DDAVP levels (Cmax) were higher for i.v. DDAVP (p <0.02), times to peak levels (tmax) were shorter for i.v. DDAVP (p <0.001). There was no difference between the i.v. and s.c. routes for plasma DDAVP time curve (AUC) and half-life (ti/,), but there was much larger variability for pharmacokinetic parameters with i.v. than with s.c. DDAVP. Post-DDAVP VIII:C increased 3.4 ± 1.6 fold (i.v.) and 3.3 ±1.3 fold (s. c.) over baseline levels, with no significant correlation between peak VIII :C and DDAVP levels for either route of administration. These findings establish the s. c. route of DDAVP administration to be bioequivalent in effect to the i.v. route, albeit with less variability. At the DDAVP dosage used in this study and currently recommended for therapy, the VIII: C response is neither a function of the rate of absorption of the compound nor of the magnitude of its plasma concentration.
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Affiliation(s)
- P M Mannucci
- A. Bianchi Bonomi Hemophilia and Thrombosis Center and Institute of Internal Medicine, University of Milan, Italy
| | - V Vicente
- Department of Hematology, University of Salamanca, Spain
| | - I Alberca
- Department of Hematology, University of Salamanca, Spain
| | - E Sacchi
- A. Bianchi Bonomi Hemophilia and Thrombosis Center and Institute of Internal Medicine, University of Milan, Italy
| | - G Longo
- Hemophilia Center and Department of Hematology, Florence, Italy
| | - A S Harris
- Clinical Research Department, Ferring AB, Malmö, Sweden
| | - A Lindquist
- Clinical Research Department, Ferring AB, Malmö, Sweden
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7
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Gonzalez-Porras JR, Lopez-Cadenas F, Alberca I, Bastida JM. Top-level sport in athletes with severe haemophilia A. Haemophilia 2017; 23:e391-e393. [DOI: 10.1111/hae.13283] [Citation(s) in RCA: 2] [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] [Accepted: 04/28/2017] [Indexed: 11/26/2022]
Affiliation(s)
- J. R. Gonzalez-Porras
- Department of Haematology; Hospital Universitario de Salamanca-IBSAL-USAL; Salamanca Spain
| | - F. Lopez-Cadenas
- Department of Haematology; Hospital Universitario de Salamanca-IBSAL-USAL; Salamanca Spain
| | - I. Alberca
- Department of Haematology; Hospital Universitario de Salamanca-IBSAL-USAL; Salamanca Spain
| | - J. M. Bastida
- Department of Haematology; Hospital Universitario de Salamanca-IBSAL-USAL; Salamanca Spain
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Pérez-Andreu V, Roldán V, López-Fernández MF, Antón AI, Alberca I, Corral J, Montes R, García-Barberá N, Ferrando F, Vicente V, González-Conejero R. Pharmacogenetics of acenocoumarol in patients with extreme dose requirements. J Thromb Haemost 2010; 8:1012-7. [PMID: 20149073 DOI: 10.1111/j.1538-7836.2010.03800.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
SUMMARY BACKGROUND There is currently intense debate as to whether pharmacogenetic algorithms for estimating the initial dose of coumarins provide a more accurate dose than the fixed-dose approach. Recently, it has been suggested that the greatest benefit of pharmacogenetic algorithms is observed in patients with extreme dose requirements. OBJECTIVES To identify clinical and genetic factors that better characterize patients who need extreme acenocoumarol doses for steady anticoagulation state. PATIENTS/METHODS We reviewed 9538 patients with a steady acenocoumarol dose from three Spanish hospitals, selecting 83 who took or= 30.00 mg week(-1) (p95). We also selected patients matched by gender and age taking 13.50-14.00 mg week(-1) (p50). We genotyped VKORC1 (rs9923231), CALU (rs1043550), GGCX (rs699664), CYP2C9 (rs1799853; rs1057910), CYP4F2 (rs2108622) and F7 (rs5742910) single-nucleotide polymorphisms (SNPs). RESULTS Comparison between p5 and p95 revealed five parameters with significant differences: body surface area (BSA) (P = 0.006), age, VKORC1, CYP2C9 and CYP4F2 genotypes (all P < 0.001). First VKORC1, and second, CYP2C9 SNPs played a strong effect by determining extreme doses, particularly in p95. Only one out of 203 p95 had the VKORC1 A-1639A genotype, but this subject was CYP2C9*1/*1. In contrast, nine out of 83 p5 carried the VKORC1 G-1639G genotype, although six of them were CYP2C9*3 homozygotes and another two were heterozygotes. Surprisingly, CYP4F2 V433M SNP displayed prevalences that suggest that its influence might only be evident when patients are treated with high doses. CONCLUSION Two clinical data, age and BSA, and three SNPs in the VKORC1, CYP2C9 and CYP4F2 genes strongly predict outlier patients treated with acenocoumarol.
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Affiliation(s)
- V Pérez-Andreu
- University of Murcia, Centro de Hemodonación, Murcia, Spain
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Julia A, Kovaleva L, Loria S, Alberca I, Hernandez F, Sandoval V, Sierra J, Vidaller A, Ayguasanosa J, Carretero M. Clinical efficacy and safety of Flebogammadif®, a new high-purity human intravenous immunoglobulin, in adult patients with chronic idiopathic thrombocytopenic purpura. Transfus Med 2009; 19:260-8. [DOI: 10.1111/j.1365-3148.2009.00945.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Minano A, Ordonez A, Espana F, Gonzalez-Porras JR, Lecumberri R, Fontcuberta J, Llamas P, Marin F, Estelles A, Alberca I, Vicente V, Corral J. AB0 blood group and risk of venous or arterial thrombosis in carriers of factor V Leiden or prothrombin G20210A polymorphisms. Haematologica 2008; 93:729-34. [DOI: 10.3324/haematol.12271] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Gonzalez-Porras JR, Martin-Herrero F, Garcia-Sanz R, Lopez ML, Balanzategui A, Mateos MV, Pavon P, Gonzalez M, Alberca I, San Miguel JF. Hyperhomocysteinemia is a risk factor of recurrent coronary event in young patients irrespective to the MTHFR C677T polymorphism. Thromb Res 2007; 119:691-8. [PMID: 17005242 DOI: 10.1016/j.thromres.2006.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2005] [Revised: 05/29/2006] [Accepted: 06/06/2006] [Indexed: 10/24/2022]
Abstract
Despite the well-known pro-coagulant effect of hyperhomocysteinemia, data is limited regarding the result on recurrent coronary event (RCE) in young people. One hundred and forty patients <55 years old with a first acute coronary syndrome (ACS) were prospectively followed for a mean (+/-S.D.) follow-up of 49+/-14 months in order to investigate the relationship between homocysteine levels (tHcy) at admission and the incidence of RCE. The tHcy values were divided into quartiles to examine their relationship with end points. Furthermore, we determined the effect of C677T methylene tetrahydrofolate reductase (MTHFR) polymorphism, as well as other risk factors for developing a RCE. The median plasma homocysteine concentration was 9.6 mumol/L (interquartile range, 3.7). In the screening of MTHFR C677T polymorphism in patients with ACS, the T allele frequency was 0.4 and the genotype frequency distributions were in Hardy-Weinberg equilibrium. At time of final evaluation, 49 (35%) of the 140 valuable patients had developed a RCE. Increasing numbers of RCE were observed for increasing quartiles of tHcy according to Kaplan-Meier survival (Log-rank test=0.0092). The MTHFR C677T polymorphism was not associated with an increased incidence of RCE. In multivariate analysis, the variables independently associated with a higher risk of RCE were age older than 45 years [HR=2.7; (95% CI, 1.3-6.1); p=0.030], body mass index more than 25 [HR=2.6; (95% CI, 1.1-5.9); p=0.034] and tHcy levels into quartile 4 (tHcy>12.37 mumol/L) [HR=2.5; (95% CI, 1.1-4.7); p=0.04]. Elevated plasma homocysteine level at admission is an independent risk factor for RCE after the first episode of ACS in young patients irrespective of the status of MTHFR C677T.
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Affiliation(s)
- J R Gonzalez-Porras
- Department of Hematology, University Hospital of Salamanca, Paseo de San Vicente, 58-182, Salamanca, 37007, Spain.
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Corrales JJ, Burgo RM, Garca-Berrocal B, Almeida M, Alberca I, González-Buitrago JM, Orfao A, Miralles JM. Partial androgen deficiency in aging type 2 diabetic men and its relationship to glycemic control. Metabolism 2004; 53:666-72. [PMID: 15131775 DOI: 10.1016/j.metabol.2003.12.016] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Aging in the male is associated with both a higher incidence of type 2 diabetes and hypogonadism. However, little information is available about the complex of symptoms and hormonal changes related to partial androgen deficiency in aging (called andropause) in type 2 diabetic men. Here, for the first time, we used a combination of clinical and hormonal criteria to define andropause and to analyze the relationships between the androgen environment and glucose metabolism in 55 type 2 diabetic men (63.6 +/- 7.9 years, mean +/- SD). Low plasma levels of total testosterone (< or =3.4 ng/mL) and free testosterone (< or =11 pg/mL) were found in 20% and 54.5%, respectively, of the diabetic men. The fraction of diabetic men with subnormal levels of total testosterone increased with aging: 14.2% (50 to 59 years), 17.4% (60 to 69 years) and 36% (> 70 years). The corresponding figures for subnormal values of free testosterone were 38%, 69.6%, and 54.5%, respectively. In the whole group of type 2 diabetic men, no significant linear correlations between total or free testosterone with fasting plasma glucose, insulin, C-peptide, or fructosamine values could be established. Total testosterone was positively correlated with glycosylated haemoglobin (HbA(1c)) levels (r =.322, P =.01). Although fasting plasma glucose was marginally higher in aging type 2 diabetic patients with andropause than in those without andropause (162 +/- 6.9 v 139 +/- 8.9, mean +/- SEM, P =.05), there were no differences between both subgroups for plasma fasting insulin, C-peptide, fructosamine, or HbA(1c) levels. Replacement therapy (150 mg intramuscular [IM] of enanthate of testosterone every 14 days for 6 months) was applied in 10 type 2 diabetic men with clinical features of andropause associated with subnormal concentrations of serum testosterone. The treatment induced significant increases in total plasma testosterone (baseline: 3.9 +/- 0.3; at 6 months: 7.1 +/- 0.9 ng/mL, mean +/- SEM, P =.003) and free testosterone (baseline: 9.3 +/- 0.6; at 6 months 17.6 +/- 2.4 pg/mL, P =.003), but had a neutral effect on overall glycemic control. These data show a high prevalence of andropause in aging type 2 diabetic men and suggest that the endogenous androgen environment, as well as correction of the partial androgen deficiency, do not have a meaningful effect on glycemic control.
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Affiliation(s)
- J J Corrales
- departamento de Medicina, Universidad de Salamanca, Salamanca, Spain
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Deira J, Alberca I, Lerma JL, Martín B, Tabernero JM. Changes in coagulation and fibrinolysis in the postoperative period immediately after kidney transplantation in patients receiving OKT3 or cyclosporine A as induction therapy. Am J Kidney Dis 1998; 32:575-81. [PMID: 9774117 DOI: 10.1016/s0272-6386(98)70019-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Different immunosuppressive agents, in particular OKT3, have been implicated as causative factors in the risk for renal thrombosis in the period immediately after kidney transplantation. Also, in different types of vascular surgery, a state similar to hypercoagulation has been reported. To assess the extent to which OKT3, cyclosporine A (CsA), and surgery itself affect coagulation and fibrinolysis, a study was conducted of 20 patients divided into two groups: group A, 10 patients received OKT3 (first dose during the induction of anesthesia); and group B, 10 patients received CsA (first dose at least 2 hours before transplantation). Basal determinations and determinations at 2, 4, and 24 hours after the induction of anesthesia were made. No differences were found between the groups with respect to the clinical and usual coagulation parameters. The following were studied in both groups: (1) markers of coagulation activity (prekallikrein [PKK] levels and formation of thrombin-antithrombin complexes [TATc]), (2) inhibitors and suppressors of hemostasis (antithrombin III [AT-III] and protein C [PC] activity), (3) markers of fibrinolysis activation (levels of plasminogen [PLG] and of alpha2-antiplasmin [alpha2-APL]), and (4) markers of endothelial damage (tissue plasminogen activator [TPA] and thrombomodulin [TMD]). In both groups, an important formation of TATc was observed early, together with a decrease in PKK levels and consumption of both AT-III and PC, which reached their lowest levels at 24 hours. This points to an activation of coagulation through the intrinsic route and a secondary consumption of hemostasis inhibitors, both possibly caused by surgery. A consumption of PLG and alpha2-APL was also observed, reflecting stimulation of the fibrinolytic system and a physiological response to the activation of coagulation. A greater release of endothelial TPA was only observed in the patients receiving OKT3 (P < 0.0001), possibly signaling endothelial activation. It is concluded that surgical stress could be the major factor triggering the alterations seen in hemostasis and their possible consequences.
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Affiliation(s)
- J Deira
- Service of Nephrology, University Hospital, Salamanca, Spain
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Tomás JF, Alberca I, Tabernero MD, Cordero M, Del Pino-Montes J, Vicente V. Natural anticoagulant proteins and antiphospholipid antibodies in systemic lupus erythematosus. J Rheumatol Suppl 1998; 25:57-62. [PMID: 9458203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Thrombosis is a relatively common complication in patients with systemic lupus erythematosus (SLE) and is strongly associated with the presence of antiphospholipid antibodies (aPL). The mechanism involved in the pathogenesis of this prothrombotic state remains obscure. We studied 4 natural anticoagulant proteins: protein C, protein S, antithrombin III, and plasminogen in 50 patients diagnosed with SLE. METHODS Protein C, antithrombin III, and plasminogen were measured by chromogenic substrates and total and free protein S by electrophoresis. We also determined the prevalence of different aPL (lupus anticoagulant and antibodies against cardiolipin, phosphatidylserine, and phosphatidylinositol). RESULTS Ten patients (20%) had a history of thrombosis. Some type of aPL was present in 26 patients (52%). Nine of the 10 patients with history of thrombosis had aPL (p = 0.007). Functional assays for protein C, antithrombin III, and plasminogen were in the normal range in all patients. Low free protein S levels were documented in 19 patients and were associated with the presence of aPL (13/19 were aPL positive) (p < 0.05). Only 4 patients with acquired free protein S deficiency had a history of thrombosis. CONCLUSION This study shows an association between aPL and reduced free protein S levels in patients with SLE. Further studies are needed to determine the mechanism and role of this acquired deficiency in the pathogenesis of thrombotic episodes in patients with SLE.
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Affiliation(s)
- J F Tomás
- Department of Hematology, Hospital Universitario de La Princesa Madrid, Spain
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15
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García-Sanz R, Alberca I, Vázquez L, Hernández JM, Castellanos A, San Miguel JF. [Control of oral anticoagulant treatment using an automated method]. Sangre (Barc) 1994; 39:95-98. [PMID: 8059301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
PURPOSES To evaluate the reproducibility of an automated method (IL test Pro-IL-Complex) in the control of oral anticoagulant therapy. PATIENTS AND METHODS Samples from patients subjected to oral anticoagulants were analysed with two different methods in order to compare the International Normalized Ratio (INR). The results were studied with the regression analysis and the statistical SPSS programme. RESULTS Two INR values were attained in 422 samples studied with Thrombotest and Pro-IL Complex. The correlation coefficient (r) between both values was 0.94. When establishing anticoagulation limits of 2.0 and 4.8 for Thrombotest and 1.66 and 4.2 for Pro-IL Complex, the percentage of coincidence between the two methods was above 90%. These findings were more evident when analysing separately those patients with coronary or vascular disease subjected to chronic anticoagulant treatment. CONCLUSIONS These findings show that Pro-IL Complex test renders results similar to those attained with Thrombotest. Since the former is an automated method available for most of the coagulometers used in clinical laboratories, its easy management, rapidity and possibility for using computerized data are most valuable.
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Affiliation(s)
- R García-Sanz
- Servicio de Hematología, Hospital Clínico Universitario, Salamanca, España
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16
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Cacho J, Tomás JF, Arcaya J, León V, Alberca I, Vicente V. [Primary antiphospholipid syndrome in juvenile ischemic stroke]. Neurologia 1993; 8:243-7. [PMID: 8240835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Results obtained in three patients with juvenile ischemic stroke and criteria of primary antiphospholipid syndrome is reported. These patients are selected out from a series of 12 patients with 18-mounts follow-up. Lupic anticoagulant and anticardiolipin antibodies were found in two of three patients and one patient show anticardiolipin antibodies with negative lupic anticoagulant. All others coagulation proteins examined (antithrombin III, plasminogen, protein C and protein S) were normal. We conclude that antiphospholipid antibodies are associated with increase risk of thrombosis. Therefore should be systematically investigated in juvenile ischemic stroke of unknown aetiology.
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Affiliation(s)
- J Cacho
- Servicio de Neurología, Hospital Clínico Universitario, Salamanca
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18
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Tabernero MD, Tomas JF, Alberca I, Orfao A, Lopez Borrasca A, Vicente V. Incidence and clinical characteristics of hereditary disorders associated with venous thrombosis. Am J Hematol 1991; 36:249-54. [PMID: 1826407 DOI: 10.1002/ajh.2830360405] [Citation(s) in RCA: 86] [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] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
At present, different congenital defects in several proteins--antithrombin III (AT III), protein C (PC), protein S (PS), and plasminogen (PLG)--are known to be causes of hereditary predisposition to thrombosis (thrombophilia). The incidence of these hereditary disorders in our 204 patients (106 males and 98 females) with venous thromboembolism were 4% (three cases deficient in PC, three in PS, two in PLG, and one patient in AT III). Their families were studied. In all cases the disorders were inherited as an autosomal dominant trait. The first thrombotic episodes occurred at a age of below 40 years. There was no relationship between protein levels and the occurrence of thrombosis, although a significant relationship was observed between a positive history of thromboembolic disease and a diagnosis of protein deficiencies. We evaluated the differences between primary thrombosis and secondary thrombosis. The most common thrombotic sites were the deep veins. There were no differences between males and females. Evaluation of PC, PS, AT III, and PLG in patients with thromboembolic disease should be considered.
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Affiliation(s)
- M D Tabernero
- Departamento de Medicina, Hospital Clinico Universitario de Salamanca, Spain
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Gomez E, Alberca I, Gonzalez M, Zaballos R, Vicente V. Effect of hepatitis C virus infection on the lymphoid population in hemophiliacs. Blood 1991; 77:1399-400. [PMID: 1848118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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Gómez E, Alberca I, Vicente V, González M, Martín AM, Corral M, Cordero M, López Borrasca A. [Antibodies against hepatitis C virus in hemophiliacs: correlation with peripheral blood lymphocyte populations]. Med Clin (Barc) 1991; 96:81-4. [PMID: 1851910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The presence of antibodies (Abs) against hepatitis C virus (HCV) was analyzed in 26 haemophiliac patients; a prevalence of 38% was found in the total series and 56% in the treated patients. There were no cases with a positive serology among the three patients who had only received pasteurized factor. The frequency of detection of anti-HCV was higher in the patients who had a positive serology for HIV (67%) and hepatitis B virus (56%) than in the seronegative patients (24 and 29%, respectively). The patients with HCV Abs showed a decrease in the helper (CD4+) lymphocytic population, mainly due to the decrease in the helper inducer (CD4+/Leu8-) cells, such alterations being more evident in the patients who also were HIV+ who showed as well an increase in the T-cell activated lymphocytes (CD3+/la+) and a decrease in CD16+ natural killer cells. These results suggest that the lymphocytic alterations found in the patients with anti-HCV Abs are not specific and would rather be related to the presence or not of HIV infection.
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Affiliation(s)
- E Gómez
- Servicio de Hematología, Hospital Clínico, Salamanca
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Cattaneo M, Tenconi PM, Alberca I, Garcia VV, Mannucci PM. Subcutaneous desmopressin (DDAVP) shortens the prolonged bleeding time in patients with liver cirrhosis. Thromb Haemost 1990; 64:358-60. [PMID: 2096487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The intravenous infusion of 1-deamino-8-D-arginine vasopressin (DDAVP) shortens the prolonged bleeding time in patients with congenital or acquired bleeding disorders, including patients with uremia or liver cirrhosis. We carried out a double-blind, placebo-controlled crossover study in ten patients with liver cirrhosis to evaluate whether or not their prolonged bleeding times could be shortened by subcutaneous injections of DDAVP (0.3 microgram/kg), a more practical route of administration than intravenous infusions. One hour after DDAVP injection the bleeding time was significantly shortened (p less than 0.05). After 4 h, however, the bleeding time shortening was no longer statistically significant. There was no bleeding time change after placebo. Plasma levels of von Willebrand factor antigen (vWF:Ag) did not significantly increase after DDAVP or placebo. The study shows that subcutaneous DDAVP is an alternative method for short-term shortening of the bleeding time in liver cirrhosis.
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Affiliation(s)
- M Cattaneo
- A. Bianchi Bonomi Hemophilia and Thrombosis Center, Maggiore Hospital, Milano, Italy
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22
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Vicente V, Tomás JF, Alberca I. [The use of desmopressin in the treatment of hemorrhagic syndromes]. Med Clin (Barc) 1990; 95:466-9. [PMID: 2084417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- V Vicente
- Servicio de Hematología, Hospital Clínico Universitario, Salamanca
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23
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Tabernero MD, Galende J, Tomás JF, Alberca I, Estelles A, Vicente V. [Plasminogen deficiencies in 2 Spanish families. Response to the administration of DDAVP]. Sangre (Barc) 1990; 35:137-41. [PMID: 2363094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
We describe two families with heterozygous plasminogen deficiency. In the first the patient was a 27 year-old female who suffered an acute episode of ischemic cerebrovascular disease affecting the left temporal lobe documented by arteriographic, gammagraphic and CAT studies. She had no family history of thrombotic conditions. In the other family the propositus was a 31 year-old man with spontaneous deep venous thrombosis in the left leg. His father was also symptomatic, with a history of recurrent thrombotic complications after predisposing factors, that included multiple venous thrombosis and a pulmonary embolism. Laboratory data showed normal hemostasis test results. Antigenic and functional levels of protein C, protein S and antithrombin III were within normal limits. The only abnormality found was decreased plasminogen activity in plasma; antigenic and functional levels were reduced to about half-normal levels. In both cases crossed immunoelectrophoresis revealed a normal migration pattern of plasminogen. Thus, we conclude that our patients were carriers of congenital hypoplasminogenemia or familial type I plasminogen deficiency, due to decreased synthesis. We also reported on fibrinolytic response to infusion of DDAVP, a synthetic analogue of the antidiuretic hormone. Fibrinolytic activity was normal in basal conditions as well as in response to DDAVP infusion.
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Tabernero MD, Estellés A, Vicente V, Alberca I, Aznar J. Incidence of increased plasminogen activator inhibitor in patients with deep venous thrombosis and/or pulmonary embolism. Thromb Res 1989; 56:565-70. [PMID: 2609293 DOI: 10.1016/0049-3848(89)90242-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- M D Tabernero
- Hematology Unit, University Hospital, Salamanca, Spain
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25
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Mannucci PM, Vicente V, Alberca I, Sacchi E, Longo G, Harris AS, Lindquist A. Intravenous and subcutaneous administration of desmopressin (DDAVP) to hemophiliacs: pharmacokinetics and factor VIII responses. Thromb Haemost 1987; 58:1037-9. [PMID: 3127916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
When desmopressin (DDAVP) is given to mild and moderate hemophiliacs intravenously (i.v.) or subcutaneously (s.c.), there is a very large between-patient variability for peak levels of factor VIII coagulant activity (VIII:C). To evaluate whether or not between-patient variability is related to DDAVP levels achieved in plasma, we measured drug levels in 14 hemophilic volunteers (VIII:C 2 to 31 U/dL) who were randomly given 0.3 micrograms/Kg of i.v. or s.c. DDAVP and crossed-over to the other treatment after an interval of 15-30 days. Peak DDAVP levels (Cmax) were higher for i.v. DDAVP (p less than 0.02), times to peak levels (tmax) were shorter for i.v. DDAVP (p less than 0.001). There was no difference between the i.v. and s.c. routes for plasma DDAVP time curve (AUC) and half-life (t 1/2), but there was much larger variability for pharmacokinetic parameters with i.v. than with s.c. DDAVP. Post-DDAVP VIII:C increased 3.4 +/- 1.6 fold (i.v.) and 3.3 +/- 1.3 fold (s.c.) over baseline levels, with no significant correlation between peak VIII:C and DDAVP levels for either route of administration. These findings establish the s.c. route of DDAVP administration to be bioequivalent in effect to the i.v. route, albeit with less variability. At the DDAVP dosage used in this study and currently recommended for therapy, the VIII:C response is neither a function of the rate of absorption of the compound nor of the magnitude of its plasma concentration.
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Affiliation(s)
- P M Mannucci
- A. Bianchi Bonomi Hemophilia and Thrombosis Center, University of Milan, Italy
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26
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Vicente V, Alberca I, Tabernero MD, López Borrasca AL. Ulcer necrotic legs as first manifestation of protein S deficiency. Blut 1987; 54:253-4. [PMID: 2950942 DOI: 10.1007/bf00594204] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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27
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Vicente V, Alberca I, Castro M, Goyenechea A, López Borrasca A. [Familial thrombosis caused by protein S deficiency]. Med Clin (Barc) 1987; 88:459-62. [PMID: 2952845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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28
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Vicente V, Alegre A, Alberca I. [Use of desmopressin in the treatment of mild forms of hemophilia A and von Willebrand's disease]. Med Clin (Barc) 1987; 88:353-5. [PMID: 3494893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Vincente V, Corrales J, Miralles J, Alberca I. Normal response to DDAVP in patients with plathology of the hypothalamoneurohypophyseal axis. Thromb Res 1987; 45:695-7. [PMID: 3109066 DOI: 10.1016/0049-3848(87)90333-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Abstract
The immunological functions of antithrombin III and protein C were studied in 8 patients before, during and after hemodialysis. After dialysis a significant decrease in protein C and antithrombin III levels was seen. The changes observed in both proteins after hemodialysis should be considered as a component in the genesis of the hypercoagulation state in these patients.
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Affiliation(s)
- A Alegre
- Division of Haematology, Hospital Clinico, Salamanca, Spain
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Abstract
A patient who had developed a VIII:C IgG-Kappa antibody after her first delivery became pregnant for a second time. At that time the titer of the inhibitor had increased fourfold, remaining at high levels throughout the rest of the pregnancy. The neonate exhibited an inhibitor with characteristics identical to that of the mother which could not be detected 3 months after birth. No hemorrhagic complications in either of the subjects were observed.
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Vicente V, Alberca I, Castro M, Lopez Borrasca A. Mode of inheritance of type II protein S deficiency. Blood 1986; 68:1415. [PMID: 2946334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
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Mannucci PM, Vicente V, Vianello L, Cattaneo M, Alberca I, Coccato MP, Faioni E, Mari D. Controlled trial of desmopressin in liver cirrhosis and other conditions associated with a prolonged bleeding time. Blood 1986; 67:1148-53. [PMID: 3513867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The synthetic vasopressin derivative desmopressin (DDAVP) shortens a prolonged bleeding time (BT) in patients with uremia, congenital platelet dysfunction, and von Willebrand disease. To establish the limits of the clinical usefulness of DDAVP, a controlled randomized study was carried out in 53 patients and ten volunteers with different conditions that have in common a prolonged BT. DDAVP significantly shortened the BT in 21 cirrhotics (P less than .01), in eight patients with unclassified prolonged BT (P less than .05) and in ten volunteers taking the antiplatelet drugs aspirin (P less than .05) and ticlopidine. The BT changes were not statistically significant in 15 patients with severe thrombocytopenia nor in nine with congenital platelet dysfunction, even though a few patients with storage pool deficiency responded with a marked BT shortening. Our findings indicate that DDAVP might be given when biopsies or other surgical procedures must be carried out in patients with prolonged BT. However, the compound is often ineffective in patients with thrombocytopenia or congenital platelet dysfunction.
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Manso M, de Dios I, Alberca I, Vicente V. Detection of anomalies in cell-surface carbohydrates on thrombasthenic platelets using 125I-labeled lectins. Blut 1986; 52:91-7. [PMID: 3633202 DOI: 10.1007/bf00321071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The composition of carbohydrates on the surface of platelets from a patient with Glanzmann's thrombasthenia and from seven normal donors were determined and compared. To this end, binding studies were performed using nine different purified 125I-labeled lectins; Concanavalin A, P-Phytohaemagglutinin, Wheat Germ Agglutinin, Dolichos biflorus, Pisum sativum, Ricinus communis II Agglutinin, Tetragonolobus purpureus, Lens culinaris and Soybean Agglutinin. These studies show that thrombasthenic platelets bear significantly decreased numbers of receptors for Concanavalin A and Lens culinaris, both with a specificity for D-mannose, and Ricinus communis II, with specificity for D-galactose. There were no detectable differences in the numbers of other lectin receptors. These results provide further evidence of molecular defects in thrombasthenic platelets. Moreover, the use of 125I-labeled lectins, as shown here, provides a fast and reliable technique for identifying abnormalities in the carbohydrate composition on the surface of platelets in various thrombopathies.
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Alegre A, Vicente V, Gonzalez R, Gomez J, Alberca I. Effect of haemodialysis on the prekallikrein system. Thromb Res 1986. [DOI: 10.1016/0049-3848(86)91423-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Fernández J, Vicente V, Sedano C, Páramo J, Alberca I, Richard C, Rocha E. Two new cases of congenital dysfibrinogenemia with impaired aggregation of monomers: Fibrinogens Salamanca II and Santander I. Thromb Res 1986. [DOI: 10.1016/0049-3848(86)91357-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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39
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Vicente V, Alberca I, Alegre A, Gonzalez R, Herrero I, Ruiz R. Demostration of hipercoagulability in patients with mediterranean spotted fever. Thromb Res 1986. [DOI: 10.1016/0049-3848(86)91655-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Vicente V, Alberca I, Ruiz R, Herrero I, Gonzalez R, Portugal J. Coagulation abnormalities in patients with Mediterranean spotted fever. J Infect Dis 1986; 153:128-31. [PMID: 3941278 DOI: 10.1093/infdis/153.1.128] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Vicente García V, D'Angelo A, Seveso P, Alberca I. Normal response to the tissue-type plasminogen activator after venous occlusion in a Fitzgerald trait patient. Thromb Haemost 1985; 54:548. [PMID: 3936219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Gonzalez R, Alberca I, Sala N, Vicente V. Protein C deficiency--response to danazol and DDAVP. Thromb Haemost 1985; 53:320-2. [PMID: 3840287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
We studied a Spanish family in which one of the female members presented recurrent thrombophlebitis in both legs after three different deliveries. Biological and antigenic activity of protein C was decreased (35% and 42% respectively). Reduced protein C levels were also observed in 6 other family members. Administration of danazol (600 mg/day) in two patients with protein C deficiency elevated this protein and discontinuation of the drug resulted in a reduction of protein C to pretreatment values. The proposita showed a normal fibrinolytic activity and infusion of DDAVP produced a similar response of FVIII/VWF and plasminogen activator to those observed in healthy subjects.
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Vicente V, Alberca I, González R, López Borrasca A. [Lymphocyte subpopulations and the presence of abnormal proteins in plasma concentrates]. Med Clin (Barc) 1985; 84:675-6. [PMID: 4033246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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48
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Vicente V, Alberca I, Mannucci PM. High levels of circulating von Willebrand factor inhibit the release of this protein but not of plasminogen activator after DDAVP. Thromb Res 1985; 38:101-5. [PMID: 3873723 DOI: 10.1016/0049-3848(85)90011-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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49
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García VV, D’Angelo A, Seveso P, Alberca I. Normal Response to the Tissue-Type Plasminogen Activator After Venous Occlusion in a Fitzgerald Trait Patient. Thromb Haemost 1985. [DOI: 10.1055/s-0038-1657895] [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: 10/28/2022]
Affiliation(s)
| | - A D’Angelo
- Centro Angelo Bianchi Bonomi, University of Milan, Italy
| | - P Seveso
- Centro Angelo Bianchi Bonomi, University of Milan, Italy
| | - I Alberca
- Department of Haematology, University of Salamanca, Spain
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Vicente V, Maia R, Alberca I, Tamagnini GP, Lopez Borrasca A. Congenital deficiency of vitamin K-dependent coagulation factors and protein C. Thromb Haemost 1984; 51:343-6. [PMID: 6548583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
A 15-month-old girl from Coimbra (Portugal) had a history of numerous hemorrhagic episodes with multiple bruises, hematomas but not hemarthroses. On serial testing she showed deficiency of factors II, VII, IX, X and protein C. Malabsorption-induced vitamin K deficiency, liver disease or ingestion of a coumarin compound were excluded. An absence of detectable abnormalities was found among her relatives. Consanguinity was not present. The immunologic assay, immunoelectrophoresis or antibody neutralization, revealed much higher levels of these factors than the clotting assay. The non-physiological activator (Echis carinatus venom) produced higher levels of prothrombin activation than those detected by physiological activation. Two-dimensional immunoelectrophoresis of the patient's plasma in calcium showed that prothrombin had the same mobility as acarboxyprothrombin. No significant response to large doses of intravenous vitamin K3 (6 mg) was observed. Transfusion of 120 ml of frozen fresh plasma led to an immediate increase in the procoagulant activities of vitamin K dependent protein, similar to that found after perfusion of plasma plus vitamin K3. The results obtained from this patient suggest a defect in the gammacarboxylation mechanism inside the hepatocyte.
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