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Harenberg J, Gosselin RC, Cuker A, Becattini C, Pabinger I, Poli S, Weitz J, Ageno W, Bauersachs R, Celap I, Choi P, Douketis J, Douxfils J, Elalamy I, Falanga A, Fareed J, Favaloro EJ, Gerotziafas G, Herkner H, Hetjens S, Heubner L, Klamroth R, Langer F, Lip GYH, Grory BM, Margetić S, Merrelaar A, Pikta M, Renne T, Schulman S, Schwameis M, Strbian D, Tafur A, Vassart J, Violi F, Walenga J, Weiss C. Algorithm for Rapid Exclusion of Clinically Relevant Plasma Levels of Direct Oral Anticoagulants in Patients Using the DOAC Dipstick: An Expert Consensus Paper. Thromb Haemost 2024. [PMID: 38316416 DOI: 10.1055/a-2261-1811] [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] [Indexed: 02/07/2024]
Abstract
BACKGROUND With the widespread use of direct oral anticoagulants (DOACs), there is an urgent need for a rapid assay to exclude clinically relevant plasma levels. Accurate and rapid determination of DOAC levels would guide medical decision-making to (1) determine the potential contribution of the DOAC to spontaneous or trauma-induced hemorrhage; (2) identify appropriate candidates for reversal, or (3) optimize the timing of urgent surgery or intervention. METHODS AND RESULTS The DOAC Dipstick test uses a disposable strip to identify factor Xa- or thrombin inhibitors in a urine sample. Based on the results of a systematic literature search followed by an analysis of a simple pooling of five retrieved clinical studies, the test strip has a high sensitivity and an acceptably high negative predictive value when compared with levels measured with liquid chromatography tandem mass spectrometry or calibrated chromogenic assays to reliably exclude plasma DOAC concentrations ≥30 ng/mL. CONCLUSION Based on these data, a simple algorithm is proposed to enhance medical decision-making in acute care indications useful primarily in hospitals not having readily available quantitative tests and 24/7. This algorithm not only determines DOAC exposure but also differentiates between factor Xa and thrombin inhibitors to better guide clinical management.
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Affiliation(s)
- Job Harenberg
- Ruprecht Karls University of Heidelberg, Heidelberg, Germany
- DOASENSE GmbH, Heidelberg, Germany
| | - Robert C Gosselin
- Davis Health System, Thrombosis and Hemostasis Center, University of California, Sacramento, California, United States
| | - Adam Cuker
- Department of Medicine and Department of Pathology & Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Cecilia Becattini
- Internal and Emergency Medicine -Stroke Unit, University of Perugia, Perugia PG, Italy
| | - Ingrid Pabinger
- Clinical Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Sven Poli
- Department of Neurology & Stroke, Eberhard-Karls University, University Hospital, Tubingen, Germany
- Hertie Institute for Clinical Brain Research, Eberhard-Karls University, Tubingen, Germany
| | - Jeffrey Weitz
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Walter Ageno
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Rupert Bauersachs
- GefasCentrum, CCB - Cardioangiologisches Centrum Bethanien, Frankfurt am Main, Germany
| | - Ivana Celap
- Department of Clinical Chemistry, University Hospital Center Sestre, Zagreb, Croatia
- Faculty of Pharmacy and Biochemistry, University of Zagreb, Croatia
| | - Philip Choi
- Neurosciences, Box Hill Hospital, Eastern Health, Melbourne, Victoria, Australia
- Eastern Health Clinical School, Monash University, Australia
| | - James Douketis
- Department Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Jonathan Douxfils
- Department of Pharmacy, Namur Research for Life Sciences, Namur, Belgium
- Qualiblood s.a., Department of Research and Development, Namur, Belgium
| | - Ismail Elalamy
- Service d'Hematologie Biologique Hopital Tenon, Hopitaux Universitaires Est Parisien, Assistance Publique Hopitaux de Paris, Paris, France
- Department of Obstetrics and Gynecology, The First I.M. Sechenov Moscow State Medical University, Moscow, Russia
| | - Anna Falanga
- Department of Transfusion Medicine and Hematology, Hospital Papa Giovanni XXIII, Bergamo, Italy
- University of Milan Bicocca, Monza, Italy
| | - Jawed Fareed
- Department of Molecular Pharmacology & Neuroscience, Loyola University Medical Center, Maywood, Illinois, United States
| | - Emmanuel J Favaloro
- Department of Haematology, Sydney Centres for Thrombosis and Haemostasis, Institute of Clinical Pathology and Medical Research (ICPMR), Westmead Hospital, Westmead, NSW, Australia
- Faculty of Science and Health, Charles Sturt University, Wagga Wagga, NSW, Australia
| | - Grigorios Gerotziafas
- INSERM, UMR_S 938, Research Group Cancer, Biology and Therapeutics, Centre de recherche Saint-Antoine (CRSA), Institut Universitaire de Cancerologie, Sorbonne Universite, Paris, France
- Thrombosis Center, Tenon-Saint Antoine, Hopitaux Universitaires de l'Est Parisien, Assistance Publique Hopitaux de Paris (APHP), France
| | - Harald Herkner
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Svetlana Hetjens
- Department of Statistics, Medical Faculty Mannheim, Ruprecht Karls University of Heidelberg, Mannheim, Germany
| | - Lars Heubner
- Department of Anesthesiology and Intensive Care Medicine, University Hospital "Carl Gustav Carus," Technische Universitat Dresden, Germany
| | - Robert Klamroth
- Vascular Medicine and Haemostaseology, Vivantes Klinikum im Friedrichschain, Berlin, Germany
| | - Forian Langer
- II. Medizinische Klinik und Poliklinik, Universitatsklinikum Eppendorf, Hamburg, Germany
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Brian Mac Grory
- Department of Neurology, Duke University, Durham, North Carolina, United States
| | - Sandra Margetić
- GefasCentrum, CCB - Cardioangiologisches Centrum Bethanien, Frankfurt am Main, Germany
- School of Medicine, Catholic University of Croatia, Zagreb, Croatia
| | - Anne Merrelaar
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Marika Pikta
- Department of Laboratory Medicine, North Estonia Medical Centre, Tallinn, Estonia
- Department of Health Technologies, Tallinn University of Technology, Tallinn, Estonia
| | - Thomas Renne
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Irish Centre for Vascular Biology, School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Sam Schulman
- Department of Obstetrics and Gynecology, The First I.M. Sechenov Moscow State Medical University, Moscow, Russia
- Thrombosis and Atherosclerosis Research Institute, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Michael Schwameis
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Daniel Strbian
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Alfonso Tafur
- Department of Medicine, Vascular Medicine, NorthShore University Health System, Evanston, Illinois, United States
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, United States
| | - Julie Vassart
- Department of Pharmacy, Namur Research for Life Sciences, Namur, Belgium
| | - Francesco Violi
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Jeanine Walenga
- Cardiovascular Research Institute, Loyola University Chicago, Maywood, Illinois, United States
| | - Christel Weiss
- Department of Statistics, Medical Faculty Mannheim, Ruprecht Karls University of Heidelberg, Mannheim, Germany
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Kim G, Sayer G, Ransom J, Keebler M, Katz J, Kilic A, Lindenfeld J, Egnaczyk G, Shah P, Brieke A, Walenga J, Crandall D, Farrar DJ, Sundareswaran K, Uriel N. Association of Angiopoetin-2 and TNF-α With Bleeding During Left Ventricular Assist Device Support: Analysis From the PREVENT Biorepository. ASAIO J 2023; 69:742-748. [PMID: 37134003 DOI: 10.1097/mat.0000000000001942] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
The purpose of this study was to describe the changes in plasma levels of angiogenic and inflammatory biomarkers, specifically Ang-2 and TNF-α, in patients receiving HeartMate II (HMII) left ventricular assist device (LVAD) and correlate them with nonsurgical bleeding. It has been shown that angiopoietin-2 (Ang-2) and tissue necrosis factor-α (TNF-α) may be linked to bleeding in LVAD patients. This study utilized biobanked samples prospectively collected from the PREVENT study, a prospective, multicenter, single-arm, nonrandomized study of patients implanted with HMII. Paired serum samples were obtained in 140 patients before implantation and at 90 days postimplantation. Baseline demographics were as follows: age 57 ± 13 years, 41% had ischemic etiology, 82% male, and 75% destination therapy indication. In the 17 patients with baseline elevation of both TNF-α and Ang-2, 10 (60%) experienced a significant bleeding event within 180 days postimplant compared with 37 of 98 (38%) patients with Ang-2 and TNF-α below the mean ( p = 0.02). The hazard ratio for a bleeding event was 2.3 (95% CI: 1.2-4.6) in patients with elevated levels of both TNF-α and Ang-2. In the PREVENT multicenter study, patients with elevations in serum Angiopoietin-2 and TNF-α at baseline before LVAD implantation demonstrated increased bleeding events after LVAD implantation.
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Affiliation(s)
- Gene Kim
- From the Department of Medicine, University of Chicago, Chicago, Illinois
| | - Gabriel Sayer
- Department of Medicine, Columbia University, New York, New York
| | - John Ransom
- Baptist Health Heart and Transplant Institute, Little Rock, Arkansas
| | - Mary Keebler
- Department Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jason Katz
- Department of Medicine, Duke University, Durham, North Carolina
| | - Ahmet Kilic
- Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - JoAnn Lindenfeld
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Palak Shah
- Inova Heart and Vascular Institute, Falls Church, Virginia
| | | | - Jeanine Walenga
- Health Sciences Division, Cardiovascular Research Institute, Loyola University Medical Center, Maywood, Illinois
| | | | | | | | - Nir Uriel
- Department of Medicine, Columbia University, New York, New York
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O'Hara A, Pozin J, Darki A, Siddiqui F, Hoppensteadt D, Walenga J, Fareed J, Kantarcioglu B. Glycemic Control and Plasma Levels of Pro-Inflammatory and Pro-Thrombotic Biomarkers in Diabetic Patients Presenting with Acute Pulmonary Embolism. Clin Appl Thromb Hemost 2023; 29:10760296231165058. [PMID: 36941804 PMCID: PMC10034284 DOI: 10.1177/10760296231165058] [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] [Indexed: 03/23/2023] Open
Abstract
Type I and type II diabetes are closely associated with a pro-inflammatory state and to a pro-thrombotic state. The role of glycemic control in pulmonary embolism (PE) is poorly understood and requires additional investigation. The aim of this study is to investigate the relationship between glycemic control and thrombo-inflammatory biomarkers in a PE patient cohort compared to normal samples. Demographic and clinical information for 86 diabetic patients and 106 non-diabetic patients presenting with acute PE was collected via retrospective chart review. Plasma levels of pro-inflammatory (C-reactive protein [CRP], tumor necrosis factor-alpha [TNF-α], interleukin-6 [IL-6]) and pro-thrombotic (d-dimer, plasminogen activator inhibitor-1 [PAI-1], tissue plasminogen activator [tPA], thrombin activatable fibrinolysis inhibitor [TAFI], von-Willebrand factor [vWF], endogenous glycosaminoglycans [GAGs]) biomarkers were drawn within 24 hours of diagnosis of acute PE. Data was also obtained for a population of healthy adult controls. All the pro-inflammatory and pro-thrombotic biomarkers were elevated in diabetic PE patients in comparison to healthy controls. None of the biomarkers were elevated in diabetic PE patients when compared to non-diabetic PE patients. There was no difference in the levels of the pro-inflammatory biomarkers according to glycemic control. The plasma level of TAFI was elevated in diabetic patients with poor glycemic control. Diabetic patients were more likely to have a more severe PE. These studies demonstrate that thrombo-inflammatory biomarkers are elevated in diabetic PE patients with associated comorbidities in comparison to normal individuals. However, there is no difference between the PE cohort alone in comparison to PE with diabetes. The role of TAFI within the continuum of diabetic vascular disease warrants additional investigation.
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Affiliation(s)
- Alexander O'Hara
- Stritch School of Medicine, 2456Loyola University Chicago, Maywood, IL, USA
| | - Jacob Pozin
- Stritch School of Medicine, 2456Loyola University Chicago, Maywood, IL, USA
| | - Amir Darki
- Department of Cardiology, 25815Loyola University Medical Center, Maywood, IL, USA
| | - Fakiha Siddiqui
- Department of Pathology and Laboratory Medicine, Cardiovascular Research Institute, 2456Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
- Program in Health Sciences, UCAM-Universidad Católica San Antonio de Murcia, Murcia, Spain
| | - Debra Hoppensteadt
- Department of Pathology and Laboratory Medicine, Cardiovascular Research Institute, 2456Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Jeanine Walenga
- Department of Pathology and Laboratory Medicine, Cardiovascular Research Institute, 2456Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Jawed Fareed
- Department of Pathology and Laboratory Medicine, Cardiovascular Research Institute, 2456Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Bulent Kantarcioglu
- Department of Pathology and Laboratory Medicine, Cardiovascular Research Institute, 2456Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
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Cavallo K, Kanwar M, Diao G, Sinha S, Singh R, Tang D, Isseh I, Brocious J, Bagchi P, Crandall D, Farrar D, Murali S, Walenga J, Lindenfeld J, deFilippi C, Shah P. Protein Biomarkers Predict Risk of Gastrointestinal Bleeding in Left Ventricular Assist Device Patients. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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5
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Thacker BE, Thorne KJ, Cartwright C, Park J, Glass K, Chea A, Kellman BP, Lewis NE, Wang Z, Di Nardo A, Sharfstein ST, Jeske W, Walenga J, Hogwood J, Gray E, Mulloy B, Esko JD, Glass CA. Multiplex genome editing of mammalian cells for producing recombinant heparin. Metab Eng 2022; 70:155-165. [PMID: 35038554 DOI: 10.1016/j.ymben.2022.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/05/2022] [Accepted: 01/09/2022] [Indexed: 10/19/2022]
Abstract
Heparin is an essential anticoagulant used for treating and preventing thrombosis. However, the complexity of heparin has hindered the development of a recombinant source, making its supply dependent on a vulnerable animal population. In nature, heparin is produced exclusively in mast cells, which are not suitable for commercial production, but mastocytoma cells are readily grown in culture and make heparan sulfate, a closely related glycosaminoglycan that lacks anticoagulant activity. Using gene expression profiling of mast cells as a guide, a multiplex genome engineering strategy was devised to produce heparan sulfate with high anticoagulant potency and to eliminate contaminating chondroitin sulfate from mastocytoma cells. The heparan sulfate purified from engineered cells grown in chemically defined medium has anticoagulant potency that exceeds porcine-derived heparin and confers anticoagulant activity to the blood of healthy mice. This work demonstrates the feasibility of producing recombinant heparin from mammalian cell culture as an alternative to animal sources.
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Affiliation(s)
- Bryan E Thacker
- TEGA Therapeutics Inc, 3550 General Atomics Court, G02-102, San Diego, CA, 92121, USA
| | - Kristen J Thorne
- TEGA Therapeutics Inc, 3550 General Atomics Court, G02-102, San Diego, CA, 92121, USA
| | - Colin Cartwright
- TEGA Therapeutics Inc, 3550 General Atomics Court, G02-102, San Diego, CA, 92121, USA
| | - Jeeyoung Park
- TEGA Therapeutics Inc, 3550 General Atomics Court, G02-102, San Diego, CA, 92121, USA
| | - Kimberly Glass
- TEGA Therapeutics Inc, 3550 General Atomics Court, G02-102, San Diego, CA, 92121, USA
| | - Annie Chea
- TEGA Therapeutics Inc, 3550 General Atomics Court, G02-102, San Diego, CA, 92121, USA
| | - Benjamin P Kellman
- Departments of Pediatrics and Bioengineering, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Nathan E Lewis
- Departments of Pediatrics and Bioengineering, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Zhenping Wang
- Department of Dermatology, University of California, San Diego, School of Medicine, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Anna Di Nardo
- Department of Dermatology, University of California, San Diego, School of Medicine, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Susan T Sharfstein
- College of Nanoscale Science and Engineering, SUNY Polytechnic Institute, 257 Fuller Road, Albany, NY, 12203, USA
| | - Walter Jeske
- Cardiovascular Research Institute, Loyola University Chicago, Health Sciences Division, 2160 S 1st Avenue, Maywood, IL, 60153, USA
| | - Jeanine Walenga
- Cardiovascular Research Institute, Loyola University Chicago, Health Sciences Division, 2160 S 1st Avenue, Maywood, IL, 60153, USA
| | - John Hogwood
- National Institute for Biological Standards and Control, Blanche Lane, South Mimms, Herts, EN6 3QG, UK
| | - Elaine Gray
- National Institute for Biological Standards and Control, Blanche Lane, South Mimms, Herts, EN6 3QG, UK
| | - Barbara Mulloy
- National Institute for Biological Standards and Control, Blanche Lane, South Mimms, Herts, EN6 3QG, UK
| | - Jeffrey D Esko
- Glycobiology Research and Training Center, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA; Department of Cellular and Molecular Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Charles A Glass
- TEGA Therapeutics Inc, 3550 General Atomics Court, G02-102, San Diego, CA, 92121, USA.
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Kantarcioglu B, Darki A, Siddiqui F, Krupa E, Vural M, Kacmaz M, Hoppensteadt D, Iqbal O, Jeske W, Walenga J, Adiguzel C, Fareed J. Predictive Role of Blood Cellular Indices and Their Relationship with Endogenous Glycosaminoglycans as Determinants of Inflammatory Biomarkers in Pulmonary Embolism. Clin Appl Thromb Hemost 2022; 28:10760296221104801. [PMID: 35733366 PMCID: PMC9234831 DOI: 10.1177/10760296221104801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION In this study, we profiled the levels of blood cellular indices, endogenous glycosaminoglycans (GAGs) and inflammatory biomarkers in a cohort comprised of pulmonary embolism (PE) patients, to determine their inter-relationships. Identification of this relationship may provide insight to the complex pathophysiology of PE and the predictive role of blood cellular indices in acute PE patients. MATERIALS AND METHODS Plasma samples from PE patients and healthy controls were analyzed for thrombo-inflammatory biomarkers (IL-2, IL-4, IL-6, IL-8, IL-10, VEGF, IFN-ɣ, TNF-α, IL-1α, IL-1β, MCP-1, EGF, D-dimer, CRP and MMP-9) using biochip array and ELISA methods. The endogenous GAG levels were quantified using a fluorescence quenching method. The data regarding the blood cellular indices were collected through the review of patient medical records and analyzed to demonstrate their relationship. RESULTS The levels of inflammatory biomarkers and endogenous GAGs were elevated in acute PE patients compared to controls (P < .05). Most of the blood cellular indices have shown significant differences in acute PE patients compared to controls (P < .05). The levels of inflammatory biomarkers, endogenous GAGs and the blood cellular indices have shown significant associations in correlation and multivariable analysis. While NLR, PLR and SII were significantly predicting the 30-day mortality, PNR, ELR and EMR were not sufficient to predict 30-day mortality in acute PE. CONCLUSION Our results show that the increased thrombo-inflammatory response is associated with the release of GAGs and the changes in blood cellular indices. The predictive role of the blood cellular indices for mortality is dependent on their relationship with the inflammatory response.
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Affiliation(s)
- Bulent Kantarcioglu
- Department of Pathology and Laboratory Medicine, Health Sciences Division, Cardiovascular Research Institute, 2456Loyola University Chicago, Maywood, IL, USA
| | - Amir Darki
- Division of Cardiovascular Disease, Loyola Stritch School of Medicine, 25815Loyola University Medical Center, Maywood, Illinois, USA
| | - Fakiha Siddiqui
- Department of Pathology and Laboratory Medicine, Health Sciences Division, Cardiovascular Research Institute, 2456Loyola University Chicago, Maywood, IL, USA.,Program in Health Sciences. UCAM - Universidad Católica San Antonio de Murcia, Spain
| | - Emily Krupa
- Department of Pathology and Laboratory Medicine, Health Sciences Division, Cardiovascular Research Institute, 2456Loyola University Chicago, Maywood, IL, USA
| | - Mehmet Vural
- Department of Internal Medicine, Loyola Stritch School of Medicine, 25815Loyola University Medical Center, Maywood, Illinois, USA.,Department of Internal Medicine, 24558Weiss Memorial Hospital, Chicago, USA
| | - Murat Kacmaz
- Department of Internal Medicine, Division of Hematology, 52987Hatay Mustafa Kemal University, Hatay, Turkey
| | - Debra Hoppensteadt
- Department of Pathology and Laboratory Medicine, Health Sciences Division, Cardiovascular Research Institute, 2456Loyola University Chicago, Maywood, IL, USA
| | - Omer Iqbal
- Department of Pathology and Laboratory Medicine, Health Sciences Division, Cardiovascular Research Institute, 2456Loyola University Chicago, Maywood, IL, USA
| | - Walter Jeske
- Department of Pathology and Laboratory Medicine, Health Sciences Division, Cardiovascular Research Institute, 2456Loyola University Chicago, Maywood, IL, USA
| | - Jeanine Walenga
- Department of Pathology and Laboratory Medicine, Health Sciences Division, Cardiovascular Research Institute, 2456Loyola University Chicago, Maywood, IL, USA
| | - Cafer Adiguzel
- Department of Internal Medicine, Division of Hematology, Bahcesehir University, Istanbul, Turkey
| | - Jawed Fareed
- Department of Pathology and Laboratory Medicine, Health Sciences Division, Cardiovascular Research Institute, 2456Loyola University Chicago, Maywood, IL, USA
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Newman J, Brailovsky Y, Allen S, Masic D, Bontekoe E, Walenga J, Fareed J, Darki A. ANGIOPOIETIN-2 IS A POWERFUL PREDICTOR OF SEVERITY OF ILLNESS, RIGHT VENTRICULAR DYSFUNCTION AND IN HOSPITAL MORTALITY IN ACUTE PULMONARY EMBOLISM. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)03138-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Newman J, Brailovsky Y, Allen S, Bontekoe E, Masic D, Walenga J, Fareed J, Darki A. Angiopoietin-2 correlates with pulmonary embolism severity, right ventricular dysfunction, and intensive care unit admission. Vasc Med 2021; 26:556-560. [PMID: 33840325 DOI: 10.1177/1358863x211002276] [Citation(s) in RCA: 3] [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] [Indexed: 11/16/2022]
Abstract
Risk stratification of acute pulmonary embolism (PE) is important to identify patients at risk for hemodynamic collapse who would benefit from more aggressive therapies. Angiopoietin-2 (Ang-2) is a signaling molecule involved in angiogenesis and is upregulated in response to tissue hypoxia. We aimed to assess the association of Ang-2 with (1) PE severity, (2) echocardiographic and invasive hemodynamic markers of right ventricular (RV) dysfunction, and (3) need for intensive treatment. Patients presenting to our institution with acute PE were included in a prospective database and blood samples were collected and stored for later analysis. A total of 65 patients were included in the study. Ang-2 correlated with PE risk stratification and echocardiographic and invasive hemodynamic markers of RV dysfunction and pulmonary hypertension. An Ang-2 level of > 4101 pg/mL had an odds ratio of 7.4 (95% CI: 1.53-12.5, p < 0.01) for intensive care unit (ICU) admission. In conclusion, Ang-2 correlates with PE severity, RV dysfunction, and need for ICU admission. Ang-2 holds promise as a novel marker that can aid in risk stratification for this patient population.
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Affiliation(s)
- Joshua Newman
- Department of Medicine, Division of Cardiovascular Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Yevgeniy Brailovsky
- Advanced Heart Failure, Mechanical Circulatory Support, Heart Transplantation, Jefferson Heart Institute, Sidney Kimmel School of Medicine, Philadelphia, PA, USA
| | - Sorcha Allen
- Department of Medicine, Division of Cardiovascular Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Emily Bontekoe
- Cardiovascular Research Institute, Loyola University Chicago Health Sciences Campus, Maywood, IL, USA
| | - Dalila Masic
- Department of Medicine, Division of Cardiovascular Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Jeanine Walenga
- Cardiovascular Research Institute, Loyola University Chicago Health Sciences Campus, Maywood, IL, USA
| | - Jawed Fareed
- Cardiovascular Research Institute, Loyola University Chicago Health Sciences Campus, Maywood, IL, USA
| | - Amir Darki
- Department of Medicine, Division of Cardiovascular Medicine, Loyola University Medical Center, Maywood, IL, USA
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Jaradeh M, Curran B, Poulikidis K, Rodrigues A, Jeske W, Abdelsattar ZM, Lubawski J, Walenga J, Vigneswaran WT. Inflammatory cytokines in robot-assisted thoracic surgery versus video-assisted thoracic surgery. J Thorac Dis 2021; 14:2000-2010. [PMID: 35813755 PMCID: PMC9264093 DOI: 10.21037/jtd-21-1820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/23/2022] [Indexed: 12/02/2022]
Abstract
Background Cytokines play a crucial role in the inflammatory response and are essential modulators of injury repair mechanisms. While minimally invasive operations have been shown to induce lower levels of cytokines compared to open thoracotomy, the inflammatory cytokine profile difference between video-assisted (VATS) and robotic-assisted thoracic surgery (RATS) techniques has yet to be elucidated. Methods In this prospective observational study of 45 patients undergoing RATS (n=30) or VATS (n=15) lung resection for malignancy, plasma levels of interleukin (IL)-1α, IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, vascular endothelial growth factor (VEGF), interferon (IFN)-γ, tumor necrosis factor (TNF)-α, monocyte chemo-attractant protein (MCP)-1, and endothelial growth factor (EGF) were measured before and after surgery via immunoassay. Results Levels of IL-6 and MCP-1 were significantly higher in patients undergoing VATS than in patients undergoing RATS (P<0.001 and P=0.005, respectively) 2 hours following surgery. MCP-1 levels were also found to be significantly higher in the VATS group (P<0.001) 24 hours following surgery. IL-1α, IL-1β, IL-2, IL-4, IL-8, IL-10, IFN-γ, TNF-α, and EGF levels were not significantly different at any time-point comparing VATS to RATS. Conclusions The VATS approach is associated with a more robust pro-inflammatory cytokine response through the upregulation of MCP-1 and IL-6 when compared to the RATS approach in patients undergoing anatomic lung resection. Further studies are necessary to validate the clinical significance of this finding.
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Farooqui A, Hoppensteadt D, Iqbal O, Bacher C, Lewis M, Walenga J, Kouta A, Jeske W, Fareed J. Studies on the Interaction of Unfractionated Heparin and Sulodexide with Functional Antiheparin Platelet Factor 4 Antibodies as Studied in Platelet Aggregation Assays. FASEB J 2020. [DOI: 10.1096/fasebj.2020.34.s1.05681] [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: 11/11/2022]
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11
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Krishnappan S, Siddiqui F, Farooqui A, Iqbal O, Kouta A, Hoppensteadt D, Jeske W, Walenga J, Fareed J. A Comparison of Mass and Potency Equated Bovine and Porcine Heparins. FASEB J 2020. [DOI: 10.1096/fasebj.2020.34.s1.03677] [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: 11/11/2022]
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12
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Newman J, Hussain Z, Hussain F, Poonawalla M, Bontekoe E, Basha HI, Fareed J, Heroux A, Liebo M, Walenga J, Raichlin E. Dysregulation of the Angiopoietin-2/Tie-2 Axis is Associated with Reduced Pulsatility and Increased Arteriovenous Malformation Related Gastrointestinal Bleeding Following Left Ventricular Assist Device Implantation. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1167] [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: 10/24/2022] Open
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13
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Curran B, Poulikidis K, Rodrigues A, Jeske W, Lubawski J, Walenga J, Vigneswaran W. ROBOTIC LUNG RESECTION CAUSES LESS INFLAMMATORY RESPONSE COMPARED TO VIDEO-ASSISTED THORACOSCOPIC LUNG RESECTION. Chest 2019. [DOI: 10.1016/j.chest.2019.08.211] [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: 10/25/2022] Open
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14
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Ramacciotti E, Agati LB, Aguiar VCR, Wolosker N, Guerra JC, de Almeida RP, Alves JC, Lopes RD, Wakefield TW, Comerota AJ, Walenga J, Fareed J. Zika and Chikungunya Virus and Risk for Venous Thromboembolism. Clin Appl Thromb Hemost 2019; 25:1076029618821184. [PMID: 30808213 PMCID: PMC6714924 DOI: 10.1177/1076029618821184] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
A variety of viral infections are associated with hypercoagulable states and may be
linked to the development of deep venous thrombosis and pulmonary embolism. The Zika and
Chikungunya viral infections spread through the South and Central American continents,
moving to North America in 2016, with severe cases of polyarthralgia, fever, and
Guillain-Barré syndrome leading eventually to death. A decreased trend for both infections
was reported in the first quarter of 2017. In this article, we report the possible
association of venous thromboembolic events associated with Zika infection. After 2 cases
of deep venous thrombosis in patients with acute Zika infections, D-dimer levels were
measured in 172 consecutive patients who presented to the emergency department of a
university hospital in an endemic region of Brazil with either Zika or Chikungunya
infections confirmed by polymerase chain reaction tests. D-dimer levels were increased in
19.4% of 31 patients with Zika and in 63.8% of 141 patients with Chikungunya infections.
The mechanisms behind this association are yet to be elucidated as well as the potential
for venous thromboembolism prevention strategies for in-hospital patients affected by Zika
and Chikungunya infections.
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Affiliation(s)
- Eduardo Ramacciotti
- Hospital e Maternidade Dr. Christovão da Gama, Santo André, São Paulo,
Brazil
- Eduardo Ramacciotti, Hospital e Maternidade Dr
Christovão da Gama, Santo André, SP, Brazil.
| | - Leandro B. Agati
- Hospital e Maternidade Dr. Christovão da Gama, Santo André, São Paulo,
Brazil
| | | | | | - João C. Guerra
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | | | | | | | - Thomas W. Wakefield
- Michigan Medicine, Cardiovascular Center, University of Michigan, Ann arbor,
MI, USA
| | | | | | - Jawed Fareed
- Loyola University Medical Center, Maywood, IL, USA
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Gomes W, Braile D, Leal JC, Guizilini S, Regenga M, Kouta A, Walenga J, Jeske W, Hoppensteadt D, Ramacciotti E, Nader H, Lima M, Fareed J. Potency Adjusted Bovine Heparin is Comparable to Porcine Heparin in Patients Undergoing Open Heart Surgery. FASEB J 2019. [DOI: 10.1096/fasebj.2019.33.1_supplement.819.8] [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: 11/11/2022]
Affiliation(s)
- Walter Gomes
- Departmento de CirurgiaDisciplina de Cirurgia CardiovascularSao PauloBrazil
| | - Domingo Braile
- Faculdade de Medicina de São José do Rio Preto (FAMERP)Sao Jose do Rio PretoBrazil
| | - Joao Carlos Leal
- Departmento de CirurgiaDisciplina de Cirurgia CardiovascularSao PauloBrazil
| | - Solange Guizilini
- Departmento de CirurgiaDisciplina de Cirurgia CardiovascularSao PauloBrazil
| | - Marisa Regenga
- Departmento de CirurgiaDisciplina de Cirurgia CardiovascularSao PauloBrazil
| | - Ahmed Kouta
- PathologyLoyola University Medical CenterMaywoodIL
| | - Jeanine Walenga
- Thoracic and Cardiovascular SurgeryLoyola University Medical CenterMaywoodIL
| | - Walter Jeske
- Thoracic and Cardiovascular SurgeryLoyola University Medical CenterMaywoodIL
| | | | | | - Helena Nader
- Departamento de Bioquímica, Disciplina de Biologia Molecular, Departamento de BioquímicaEscola Paulista de MedicinaSao PauloBrazil
| | - Marcelo Lima
- Departamento de Bioquímica, Disciplina de Biologia Molecular, Departamento de BioquímicaEscola Paulista de MedicinaSao PauloBrazil
| | - Jawed Fareed
- PathologyLoyola University Medical CenterMaywoodIL
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Sadeghi N, Kouta A, Duff R, Iqbal O, Abro S, Hoppensteadt D, Jeske W, Mehrotra S, Walenga J, Iacobelli M, Fareed J. A Generic Recombinant Factor VIIa is Comparable to the Branded Novoseven in In‐Vitro and Pharmacokinetic Studies in Primates. FASEB J 2019. [DOI: 10.1096/fasebj.2019.33.1_supplement.515.4] [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: 11/11/2022]
Affiliation(s)
| | - Ahmed Kouta
- PathologyLoyola University Medical CenterMaywoodIL
| | - Rick Duff
- Comparative MedicineLoyola University Medical CenterMaywoodIL
| | - Omer Iqbal
- PathologyLoyola University Medical CenterMaywoodIL
| | | | | | - Walter Jeske
- Thoracic and Cardiovascular SurgeryLoyola University Medical CenterMaywoodIL
| | | | - Jeanine Walenga
- Thoracic and Cardiovascular SurgeryLoyola University Medical CenterMaywoodIL
| | | | - Jawed Fareed
- PathologyLoyola University Medical CenterMaywoodIL
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17
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Fareed J, Walenga J, Jeske W, Bontekoe E, Siddiqui F, Kouta A, Tafur A, Hoppensteadt D. Differential Neutralization of Unfractionated Heparin, Enoxaparin and Fondaparinux by Andexanet Alpha. FASEB J 2019. [DOI: 10.1096/fasebj.2019.33.1_supplement.819.12] [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: 11/11/2022]
Affiliation(s)
- Jawed Fareed
- PathologyLoyola University Medical CenterMaywoodIL
| | - Jeanine Walenga
- Thoracic and Cardiovascular SurgeryLoyola University Medical CenterMaywoodIL
| | - Walter Jeske
- Thoracic and Cardiovascular SurgeryLoyola University Medical CenterMaywoodIL
| | | | | | - Ahmed Kouta
- PathologyLoyola University Medical CenterMaywoodIL
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18
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Kalodiki E, Wexels F, Dahl O, Walenga J, Jeske W, Iqbal O, Hoppensteadt D, Fareed J. In Vivo and Ex Vivo Thrombin Generation in Noncomorbid Patients with Suspected Deep Venous Thrombosis. J Vasc Surg Venous Lymphat Disord 2019. [DOI: 10.1016/j.jvsv.2019.01.014] [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: 10/27/2022]
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19
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Jeske W, Kouta A, Farooqui A, Siddiqui F, Rangnekar V, Niverthi M, Laddu R, Hoppensteadt D, Iqbal O, Walenga J, Fareed J. Bovine Mucosal Heparins Are Comparable to Porcine Mucosal Heparin at USP Potency Adjusted Levels. Front Med (Lausanne) 2019; 5:360. [PMID: 30687709 PMCID: PMC6333674 DOI: 10.3389/fmed.2018.00360] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 09/21/2018] [Accepted: 12/13/2018] [Indexed: 01/09/2023] Open
Abstract
Introduction: Bovine mucosal heparins (BMH) are currently being developed for re-introduction for both medical and surgical indications. BMH active pharmaceutical ingredient (API) exhibits a somewhat weaker USP potency when compared to PMHs. We hypothesized that when dosages are normalized based on the USP reference heparin, BMH will exhibit comparable in vitro and in vivo effects to those produced by PMH. Therefore, studies were developed to compare the APIs of bovine and porcine heparin. Materials and Methods: API versions of PMH were obtained from Celsus Laboratories (Franklin, OH) and Medefil (Glen Ellen, IL). API versions of BMH were obtained from Kin Master (Passo Fundo, Brazil). Each of these heparins was assayed for their molecular weight profile, AT affinity, USP potency, and anticoagulant/antiprotease profiles using standard laboratory methods. In vitro protamine neutralization studies were carried out. Antithrombotic and hemorrhagic effects were measured in rats and pharmacodynamic profiles were assessed in primates. Results: Size exclusion chromatography demonstrated that the mean molecular weight of BMH was ~15% higher than that of PMH (BMH: 20.1 ± 0.8 kDa and PMH: 17.5 ± 0.7 kDa). BMH exhibited an anti-Xa potency of 130 U/mg while PMH had an anti-Xa potency of 185 U/mg. In the anticoagulant and antiprotease assays, the BMH exhibited lower functionality which was proportional to USP potency. When the BMH was compared with PMH at potency adjusted concentrations, it showed identical concentration-response curves in the aPTT and anti-protease assays. However, in the protamine neutralization studies, BMH required slightly higher amounts of protamine in contrast to PMH. BMH and PMH administered to rats at equivalent anti-Xa unit dosages resulted in comparable antithrombotic activity and prolongation of bleeding time. Similar pharmacodynamic profiles were observed in primates when BMH and PMH were dosed on an anti-Xa U/kg basis. Conclusion: BMH, when used at comparable anti-Xa unit levels, is comparable to PMH, however, it requires proportionally higher amount of protamine due to the increased mass for adjusting to higher potency. Additional studies on the structural characterization, interactions with PF4 and in vivo neutralization studies are ongoing.
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Affiliation(s)
- Walter Jeske
- Cardiovascular Research Institute, Loyola University Chicago Health Sciences Division, Maywood, IL, United States
| | - Ahmed Kouta
- Cardiovascular Research Institute, Loyola University Chicago Health Sciences Division, Maywood, IL, United States
| | - Ambar Farooqui
- Cardiovascular Research Institute, Loyola University Chicago Health Sciences Division, Maywood, IL, United States
| | - Fakiha Siddiqui
- Cardiovascular Research Institute, Loyola University Chicago Health Sciences Division, Maywood, IL, United States
| | | | | | - Rajan Laddu
- Georgia Thrombosis Forum, Suwanee, GA, United States
| | - Debra Hoppensteadt
- Cardiovascular Research Institute, Loyola University Chicago Health Sciences Division, Maywood, IL, United States
| | - Omer Iqbal
- Cardiovascular Research Institute, Loyola University Chicago Health Sciences Division, Maywood, IL, United States
| | - Jeanine Walenga
- Cardiovascular Research Institute, Loyola University Chicago Health Sciences Division, Maywood, IL, United States
| | - Jawed Fareed
- Cardiovascular Research Institute, Loyola University Chicago Health Sciences Division, Maywood, IL, United States
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20
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Lewis B, Jeske WP, Leya F, Wallis D, Bakhos M, Fareed J, Walenga J. Combined Thrombin and Platelet Inhibition Treatment for HIT Patients. Hamostaseologie 2018. [DOI: 10.1055/s-0038-1660400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
SummaryDespite the use of potent anticoagulants such as r-hirudin and argatroban, the morbidity and mortality in heparin-induced thrombocytopenia (HIT) patients remains unacceptable. Data from our in vitro investigations show that thrombin inhibitors do not block platelet activation induced by heparin antibodies and heparin but that GPIIb/IIIa receptor inhibitors do block this process. We have treated four HIT positive patients with a combined therapy of thrombin inhibitor and GPIIb/IIIa receptor inhibitor when treatment with thrombin inhibitor alone failed to alleviate acute thrombosis. Combination therapies included r-hirudin (Refludan®) with tirofiban (Aggrastat®) and argatroban (Novastan®) with abciximab (ReoPro®). A reduced dose of the thrombin inhibitor was used with the standard dose of the anti-platelet drug. In all cases, there was no overt bleeding which required intervention, and all patients exhibited clinical improvement or full recovery. These case studies suggest that treatment of active thrombosis in HIT patients with adjunct GPIIb/IIIa receptor inhibitor therapy may be more effective than thrombin inhibitor treatment alone.
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21
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Hoppensteadt D, Walenga J, Ahsan A, Iqbal O, Jeske W, Fareed J. A Perspective on Low Molecular Weight Heparins in the Management of Thrombosis. Hamostaseologie 2018. [DOI: 10.1055/s-0038-1655237] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
SummaryThe introduction of low molecular weight heparins has added a new dimension to the pharmacological management of thrombotic disorders. Because of different chemical and pharmacological characteristics, due to the manufacturing process, each LMWH should be considered as a distinct entitity and only be used for its given indication. A list of commercially available LMWHs is included. The mechanism of action of the LMWHs and their use in various disorders are discussed. Available laboratory tests for monitoring LMWHs are presented and their limitations pointed out.
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22
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Ramacciotti E, Castelli V, Walenga J, Fareed J. Medical management of stable peripheral artery disease: the COMPASS trial. Perspectives from a vascular standpoint. INT ANGIOL 2018; 37:255-260. [PMID: 29745618 DOI: 10.23736/s0392-9590.18.03998-6] [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] [Indexed: 11/08/2022]
Abstract
The late-breaking presentation of the COMPASS (Cardiovascular Outcomes for People Using Anticoagulation Strategies) trial at the European Society of Cardiology Congress in 2017 with a simultaneous publication in The New England Journal of Medicine described important information on the relative risk/benefit of combining anticoagulation with antiplatelet therapy in both coronary artery disease and/or peripheral artery disease (PAD) patients. In this special article, a review of the literature addressing the effects of antiplatelets and anticoagulants in symptomatic PAD patients focusing on the two most relevant clinical endpoints: major adverse cardiovascular events and major adverse limb events is addressed. In addition, a critical review of the COMPASS trial results, with emphasis on the PAD population is performed from a vascular surgery standpoint. It is concluded that this important study validated the combined anticoagulation/antiplatelet strategies in the management of vascular disorders including stable atherosclerotic patients. However, challenges in implementing this strategy in clinical practice are expected, with bleeding complications still remaining as major concern, particularly for vascular surgeons. Further studies with different combinations of different anticoagulants/antiplatelets, eventually on top of new strategies such as PCSK9 inhibition are warranted to address the significant unmet medical need in this population of symptomatic atherosclerotic patients.
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Affiliation(s)
- Eduardo Ramacciotti
- Department of Vascular Surgery, Santa Casa de Sao Paulo School of Medical Sciences, São Paulo, Brazil - .,Hemostasis and Thrombosis Research Laboratories, Loyola University Medical Center, Maywood, IL, USA -
| | - Valter Castelli
- Department of Vascular Surgery, Santa Casa de Sao Paulo School of Medical Sciences, São Paulo, Brazil
| | - Jeanine Walenga
- Hemostasis and Thrombosis Research Laboratories, Loyola University Medical Center, Maywood, IL, USA
| | - Jawed Fareed
- Hemostasis and Thrombosis Research Laboratories, Loyola University Medical Center, Maywood, IL, USA
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23
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Savi P, Jeske W, Walenga J, Herbert JM. Effect of SR121566A, a Potent GP IIb-IIIa Antagonist, on the HIT Serum/heparin-Induced Platelet Mediated Activation of Human Endothelial Cells. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1615196] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [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
SummaryHeparin-induced thrombocytopenia (HIT) is a common adverse effect of heparin therapy that carries a risk of serious thrombotic events. This condition is caused by platelet aggregation, which is mediated by anti-heparin/platelet factor 4 antibodies. Sera from patients with HIT in the presence of platelets, induced the expression of E-selectin, VCAM, ICAM-1 and tissue factor and the release of IL1β, IL6, TNFα and PAI-1 by human umbilical vein endothelial cells (HUVECs) in vitro and initiated platelet adhesion to activated HUVECs. These effects which occurred in a time-dependent manner were significant in the first 1-2 h of incubation and reached a maximum after 6 to 9 h. The GP IIb-IIIa receptor antagonist SR121566A which has been shown to block platelet aggregation induced by a wide variety of agonists including HIT serum/heparin, reduced in a dose-dependent manner the HIT serum/heparin-induced, platelet mediated expression and release of the above mentioned proteins. The IC50 for inhibition of HIT serum/ heparin-induced platelet dependent HUVEC activation by SR121566A was approximately 10-20 nM. ADP, but not serotonin release, also appeared to be involved as apyrase and ATPγS blocked platelet-dependent, HIT serum/heparin-induced cell surface protein expression and cytokine release by HUVECs. Increased platelet adherence to HIT serum/heparin-activated HUVECs was inhibited by SR121566A and, to a lesser extent, by apyrase and ATPγS, showing that platelet activation and release was at the origin of the HIT serum/heparin-induced expression of these proteins by HUVECs.Thus, sera from patients with HIT induced the expression of adhesive and coagulation proteins and the release of cytokines by HUVECs through the activation of platelets which occurred in a GP IIb-IIIa-dependent manner, a process that could be selectively blocked by SR121566A.
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Quinn K, Doukas D, Balasubramanian N, Torres T, Walenga J, Coglianese E. Clinical and Hemostatic Characteristics of Patients With Ventricular Assist Device Thrombosis. J Card Fail 2016. [DOI: 10.1016/j.cardfail.2016.06.346] [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: 10/21/2022]
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Abstract
The vascular endothelium is an important me diator of the hemostatic balance. In addition to shielding subendothelial tissue factor from flowing blood, endothe lial cells produce a number of substances which favor an antithrombotic state including TFPI and tPA. The ability of polyelectrolytes such as heparin and defibrotide to modulate endothelial function is examined using animal models and human studies. Like heparin, defibrotide is observed to increase plasma TFPI antigen levels. Addi tionally, defibrotide administration is observed to in crease plasma tPa antigen levels and to decrease PAI, TF and endothelin levels. Modulation of endothelial function by defibrotide may account for its beneficial effect in PAOD.
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Affiliation(s)
- Jawed Fareed
- Department of Pathology, Loyola University Medical Center, Maywood, IL 60153, U.S.A
| | - Walter Jeske
- Department of Pathology, Loyola University Medical Center, Maywood, IL 60153, U.S.A
| | - Demetra Callas
- Department of Pathology, Loyola University Medical Center, Maywood, IL 60153, U.S.A
| | - Debra Hoppensteadt
- Department of Pathology, Loyola University Medical Center, Maywood, IL 60153, U.S.A
| | - Jeanine Walenga
- Department of Pathology, Loyola University Medical Center, Maywood, IL 60153, U.S.A
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Indran T, Alsarraj MK, Fareed J, Walenga J, Jeske W, Hoppensteadt D, Iqbal O, Bakhos M. Comparative studies on the anticoagulant and antiprotease activity of bovine, ovine and porcine heparins. Pathology 2016. [DOI: 10.1016/j.pathol.2015.12.281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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27
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Hoppensteadt D, Kalodiki E, Maia P, Silva de Castro A, Kumar E, Guler N, Jeske W, Kahn D, Walenga J, Coyne E, Fareed J. Resourcing of Heparin and Low-Molecular-Weight Heparins from Bovine, Ovine, and Porcine Origin: Studies to Demonstrate the Biosimilarities. J Vasc Surg Venous Lymphat Disord 2016. [DOI: 10.1016/j.jvsv.2015.10.042] [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: 10/22/2022]
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28
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Harenberg J, Du S, Wehling M, Zolfaghari S, Weiss C, Krämer R, Walenga J. Measurement of dabigatran, rivaroxaban and apixaban in samples of plasma, serum and urine, under real life conditions. An international study. ACTA ACUST UNITED AC 2016; 54:275-83. [DOI: 10.1515/cclm-2015-0389] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 06/10/2015] [Indexed: 01/21/2023]
Abstract
AbstractThe utility of measuring non-vitamin K antagonist oral anticoagulants (NOACs) in plasma, serum and urine samples and with the point-of-care test (POCT) on urine samples should be analysed in an international laboratory study.The study was performed to determine the inter-laboratory variance of data from two chromogenic assays each for the NOACs rivaroxaban, apixaban and dabigatran, and to analyse the sensitivity and specificity of the POCT assays for factor Xa- and thrombin inhibitors. Plasma, serum and urine samples were taken from six patients in each group on treatment with a NOAC.The inter-laboratory variances, which can be identified best by the coefficient of variation, ranged from 46% to 59% for apixaban, 63% to 73% for rivaroxaban and 39% to 104% for dabigatran using plasma, serum or urine samples and two chromogenic assays for each NOAC. The concentrations were about 20% higher in serum compared to plasma samples for apixaban and rivaroxaban, and 60% lower for dabigatran. The concentration in urine samples was five-fold (apixaban), 15-fold (rivaroxaban) and 50-fold (dabigatran) higher. Sensitivity and specificity of POCT for apixaban, rivaroxaban, and dabigatran were all >94%.The inter-laboratory study showed the feasibility of measurement of apixaban, rivaroxaban, and dabigatran in plasma, serum and urine samples of patients on treatment. Dabigatran was determined at far lower levels in serum compared to plasma samples. Concentrations of NOACs in urine were much higher compared to plasma. The POCT was highly sensitive and specific for all three NOACs.
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29
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Walenga J, Jeske W, Schwartz J, Escalante V, Menapace B, Coglianese E, Kumar E, Heroux A, Bakhos M. Cellular Microparticles as Predictive Markers for Adverse Events in Patients With Implanted Ventricular Assist Devices. J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.553] [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: 10/23/2022] Open
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30
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Fareed J, Nader H, Lima M, Hoppensteadt D, Walenga J, Jeske W, Kumar E, Raake W, Bakhos M. Bovine and Porcine Mucosal Heparins Exhibit Similar Biologic Profiles. FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.610.4] [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: 11/11/2022]
Affiliation(s)
- Jawed Fareed
- PathologyLoyola University Medical CenterUnited States
| | | | | | | | - Jeanine Walenga
- Cardiovascular Institute Loyola University Medical CenterUnited States
| | - Walter Jeske
- Cardiovascular Institute Loyola University Medical CenterUnited States
| | - Emmanuel Kumar
- Cardiovascular Institute Loyola University Medical CenterUnited States
| | | | - Mandouh Bakhos
- Cardiovascular Institute Loyola University Medical CenterUnited States
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Harenberg J, Du S, Weiss C, Krämer R, Hoppensteadt D, Walenga J. Report of the Subcommittee on Control of Anticoagulation on the determination of the anticoagulant effects of apixaban: communication from the SSC of the ISTH. J Thromb Haemost 2014; 12:801-4. [PMID: 24597497 DOI: 10.1111/jth.12547] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Indexed: 01/05/2023]
Affiliation(s)
- J Harenberg
- Medical Faculty Mannheim, Department of Clinical Pharmacology, Ruprecht-Karls-University Heidelberg, Mannheim, Germany
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Fareed J, Hoppensteadt D, Walenga J, Jeske W, Lewis B. Biochemical and pharmacological rationale for the use of newer oral anticoagulants in the long term management of heparin induced thrombocytopenia (LB526). FASEB J 2014. [DOI: 10.1096/fasebj.28.1_supplement.lb526] [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: 11/11/2022]
Affiliation(s)
- Jawed Fareed
- Pathology Loyola University Medical CenterMaywoodILUnited States
| | | | - Jeanine Walenga
- Thoracic and Cardiovascular Surgery Loyola University Medical CenterMaywoodILUnited States
| | - Walter Jeske
- Thoracic and Cardiovascular Surgery Loyola University Medical CenterMaywoodILUnited States
| | - Bruce Lewis
- Medicine Loyola University Medical CenterMaywoodILUnited States
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Abro S, Hoppensteadt D, Eshraghi R, Only A, Walenga J, Fareed J. Differential restoration of prothrombin time / INR in plasma from warfarin‐treated patients by various prothrombin complex concentrates (833.6). FASEB J 2014. [DOI: 10.1096/fasebj.28.1_supplement.833.6] [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: 11/11/2022]
Affiliation(s)
- Schuharazad Abro
- Pathology Loyola University Medical CenterMaywoodILUnited States
| | | | - Reza Eshraghi
- Pathology Loyola University Medical CenterMaywoodILUnited States
| | - Arthur Only
- Pathology Loyola University Medical CenterMaywoodILUnited States
| | - Jeanine Walenga
- Pathology Loyola University Medical CenterMaywoodILUnited States
| | - Jawed Fareed
- Pathology Loyola University Medical CenterMaywoodILUnited States
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Tobu M, Demir M, Iqbal O, Lietz H, Hoppensteadt D, Walenga J, Fareed J. The irrelevance of International Normalized Ratio in the monitoring of anti-IIa and anti-Xa drugs. J Thromb Haemost 2014. [DOI: 10.1111/j.1538-7836.2003.tb05643.x] [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: 11/27/2022]
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Schöni R, Walenga J, Samama M, Harenberg J, Drenth A, le Courvoisier-Flaujac C, Giese C, Rudin K, Bühler B, Wilmer M. EVALUATION OF A NEW FUNCTIONAL CLOTTING ASSAY FOR THE MONITORING OF HEPARIN AND HEPARINOID ANTICOAGULANTS BASED ON THROMBIN AND/OR FACTOR XA INHIBITION WITH CLINICAL PATIENT PLASMAS AT THREE UNIVERSITY MEDICAL CENTERS. J Thromb Haemost 2014. [DOI: 10.1111/j.1538-7836.2007.tb02429.x] [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: 11/29/2022]
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Harenberg J, Walenga J, Torri G, Dahl OE, Drouet L, Fareed J. Update of the recommendations on biosimilar low-molecular-weight heparins from the Scientific Subcommittee on Control of Anticoagulation of the International Society on Thrombosis and Haemostasis. J Thromb Haemost 2013; 11:1421-5. [PMID: 23615078 DOI: 10.1111/jth.12269] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- J Harenberg
- Clinical Pharmacology, Medical Faculty Mannheim, University of Heidelberg, Maybachstrasse 14, Heidelberg, Germany.
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Fareed J, Walenga J. Harry L. Messmore, Jr., MD (1922–2011). Semin Thromb Hemost 2012. [DOI: 10.1055/s-0032-1328892] [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: 10/27/2022]
Affiliation(s)
- Jawed Fareed
- Department of Pathology, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois
| | - Jeanine Walenga
- Department of Thoracic and Cardiovascular Surgery, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois
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Affiliation(s)
- Indermohan Thethi
- Department of Medicine, Aurora Memorial Hospital of Burlington, Burlington, Wisconsin
| | - Bruce Lewis
- Division of Cardiology, Department of Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Jeanine Walenga
- Departments of Thoracic & Cardiovascular Surgery and Pathology, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois
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Asada R, Wanaka K, Walenga J, Prechel M, Miyashita K, Escalante V, Kaneko C, Hoshino N, Oosawa M, Matsuo M. Murine monoclonal antibody to platelet factor 4/heparin complexes as a potential reference standard for platelet activation assays in heparin-induced thrombocytopenia. Clin Appl Thromb Hemost 2012; 19:37-41. [PMID: 22826445 DOI: 10.1177/1076029612453763] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Quality control of the platelet activation assays to diagnose heparin-induced thrombocytopenia (HIT), (14)C-serotonin release assay (SRA) and platelet aggregation test (PAT) has yet to be established due to lack of reference standards and the difficulty of obtaining significant amounts of HIT antibodies from patients with HIT. We prepared a murine monoclonal antibody to human platelet factor 4 (hPF4)/heparin complexes (HIT-MoAb) and investigated the platelet activating action of HIT-MoAb by using SRA and PAT. The HIT-MoAb activated human platelets at low heparin concentration and the platelet activations were inhibited at high heparin concentration in both SRA and PAT. The HIT-MoAb produced a concentration-dependent effect. Moreover, the platelet activation at low heparin concentration was inhibited by anti-FcγRIIa antibody. These results indicated that HIT-MoAb has characteristics similar to human HIT antibodies regarding heparin-dependent platelet activation. Therefore, it is suggested that HIT-MoAb has the potential to be a positive control or reference standard in platelet activation assays.
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Affiliation(s)
- Reiko Asada
- Department of Clinical Laboratory, Hyogo Cancer Center, Hyogo, Japan.
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Govindan S, Kahn D, Sundrani R, Jeske WP, Walenga J, Leya F, Hoppensteadt D, Fareed J, Sadayappan S. CARDIAC MYOSIN BINDING PROTEIN-C: A NEW BIOMARKER IN PATIENTS WITH ACUTE CORONARY SYNDROME. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)60405-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hoppensteadt DA, Cunanan J, Iqbal O, Gray A, Lewis B, Walenga J, Fareed J. DIFFERENTIAL MODULATION OF COAGULATION AND FIBRINOLYSIS BY NEW ORAL ANTICOAGULANTS. PHARMACOLOGIC IMPLICATIONS. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)60562-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Hull R, Walenga J. Contaminants in Heparin. Clin Appl Thromb Hemost 2011; 17:125. [DOI: 10.1177/1076029610397942] [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: 11/16/2022] Open
Affiliation(s)
- Russell Hull
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jeanine Walenga
- Cardiovascular Institute, Loyola University Medical Center, Maywood, IL, USA,
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Kalodiki E, Fareed J, Tapson VF, Hoppensteadt DA, Sussman I, Carter CA, Parker S, Harenberg J, Hull R, Rao G, Lovinger DF, Ried LD, Kakkar A, Talarico L, Ofuso F, Bussey HI, Fanikos J, Groce JB, Skinner N, Ahluwalia M, Iqbal O, Jackson CM, Jeske WP, Georges M, Ramacciotti E, Tapson VF, Van Thiel D, Wahi R, Walenga J. A consensus conference on complex biologics and low molecular weight heparins. INT ANGIOL 2010; 29:193-196. [PMID: 20351676] [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: 05/29/2023]
Affiliation(s)
- E Kalodiki
- Under the auspices of the North American Thrombosis Forum (NATF), the International Union of Angiology (IUA) and the South Asian Society of Atherosclerosisand Thrombosis (SASAT).
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Fareed J, Walenga J, Messmore H, Baker W, Bick M. In Memoriam. Clin Appl Thromb Hemost 2009. [DOI: 10.1177/1076029608328865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Fareed J, Walenga J, Jeske W, Hoppensteadt D, Prechel M, Iqbal O, Adiguzel C, Clark M, Litinas E, Cunanan J, Linhardt R, Harenberg J. Biological Profile of the Hyper/Oversulfated Chondroitin Sulfate Contaminant Isolated from Recalled Heparin. Semin Thromb Hemost 2008. [DOI: 10.1055/s-0028-1086092] [Citation(s) in RCA: 4] [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: 10/21/2022]
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Fareed J, Walenga J, Hoppensteadt D, Bick R, Messmore H. Dr. Eberhard F. Mammen Remembered: A Great Clinician-Scientist, Mentor, and Friend. Semin Thromb Hemost 2008. [DOI: 10.1055/s-0028-1086093] [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: 10/21/2022]
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Fareed J, Walenga J. A Tribute to Professor Hans Klaus Breddin. Semin Thromb Hemost 2008. [DOI: 10.1055/s-0028-1086075] [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: 10/21/2022]
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Walenga J, Bounameaux H, Ikeda Y. Landmarks in Anti-Thrombin Drug Development: The Argatroban Story. Semin Thromb Hemost 2008. [DOI: 10.1055/s-0028-1086073] [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: 10/21/2022]
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Adiguzel C, Iqbal O, Cunanan J, Jeske W, Hoppensteadt D, Walenga J, Fareed J. Potency Adjusted Generic Versions of Argatroban Can Be Differentiated from Branded Argatroban in Thrombin Generation and Platelet Activation Assays. Semin Thromb Hemost 2008. [DOI: 10.1055/s-0028-1086091] [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: 10/21/2022]
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Clark M, Hoppensteadt D, Walenga J, Myers L, Cunanan J, Jeske W, Adiguzel C, Iqbal O, Fareed J. Molecular profiling of heparinase-I resistant glycosaminoglycans in contaminated heparins. Comparative studies with uncontaminated heparin and porcine oversulfated chondroitin sulfate. INT ANGIOL 2008; 27:370-376. [PMID: 18974698] [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: 05/27/2023]
Abstract
AIM Heparin is a widely used anticoagulant which is usually obtained from porcine mucosal tissue. The structure of heparin is comparable to other naturally occurring glycosaminoglycans such as chondroitin sulfate and dermatan sulfate. The commercially available heparin preparations may contain small amounts of dermatan sulfate as a carry-over impurity. More recently (November 2007 to April 2008), an increased incidence of adverse events and deaths associated with the use of heparin alerted regulatory agencies to investigate the composition of heparin. As a result, oversulfated chondroitin sulfate was found to be the main determinant of the observed adverse reactions. This glycosaminoglycan is not usually found in the mammalian tissues. METHODS This investigation reports on the comparison of contaminant free and contaminated heparins and their digestion by heparinase-I. It also describes the molecular profile of the contaminant isolated from the recalled heparin preparations in comparison to oversulfated chondroitin sulfate. The anticoagulant and anti-Xa activities are also reported. RESULTS The contaminant is found to be comparable to the synthesized OSCS as both were resistant to heparinase-I digestion. The contaminant and OSCS exhibited weaker anticoagulant activities than heparin and did not have any anti-Xa effects. CONCLUSION This data strongly suggests that such glycosaminoglycans as chondroitin sulfate can be structurally modified to exhibit anticoagulant activities and their molecular weight can be adjusted to mimic heparin.
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Affiliation(s)
- M Clark
- Department of Pathology and Pharmacology, Loyola University Medical Center, Maywood, IL, USA
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