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Camoin-Jau L, Mariotti A, Suchon P, Morange PE. [Heparin-induced thrombocytopenia: Update]. Rev Med Interne 2021; 43:18-25. [PMID: 34535328 DOI: 10.1016/j.revmed.2021.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 07/27/2021] [Accepted: 08/29/2021] [Indexed: 11/26/2022]
Abstract
Heparin-induced thrombocytopenia (HIT) is a serious complication of heparin therapy. It is due to the synthesis of antibodies most often directed against platelet factor 4 (FP4) modified by heparin (H). HIT is manifested by a platelet count fall, associated with a high risk of venous or arterial thrombosis. The diagnosis of HIT is based on the assessment of clinical probability (4Ts score or change in platelet count after cardiac surgery) and the demonstration of heparin-modified anti-FP4 antibodies (FP4/H). If the immunological tests are positive, functional tests should be performed. In case of suspicion of HIT, it is necessary to urgently stop heparin therapy, to perform a doppler ultrasound of the lower limbs, and to prescribe an alternative anticoagulation agent at a curative dose. Currently, danaparoid sodium and argatroban are authorized. The diagnosis and management of HIT remain complex and requires multidisciplinary collaboration.
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Affiliation(s)
- L Camoin-Jau
- Laboratoire d'hématologie, hôpital de la Timone, AP-HM, boulevard Jean-Moulin, 13005 Marseille, France; Aix-Marseille univsersité, IRD, AP-HM, MEPHI, IHU Méditerranée infection, Marseille, France.
| | - A Mariotti
- Laboratoire d'hématologie, hôpital de la Timone, AP-HM, boulevard Jean-Moulin, 13005 Marseille, France
| | - P Suchon
- Laboratoire d'hématologie, hôpital de la Timone, AP-HM, boulevard Jean-Moulin, 13005 Marseille, France; C2VN, Aix-Marseille université, Inserm, INRAE, Marseille, France
| | - P-E Morange
- Laboratoire d'hématologie, hôpital de la Timone, AP-HM, boulevard Jean-Moulin, 13005 Marseille, France; C2VN, Aix-Marseille université, Inserm, INRAE, Marseille, France
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2
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Sarlon-Bartoli G, Michel Q, Sarlon E, Carcopino-Tusoli M, Suchon P, Soler R, Bartoli MA, Brunet D, Morange P, Charbonnier A. Ultrasound arterial anomalies in patients exposed to nilotinib therapy for chronic myeloid leukemia. J Med Vasc 2021; 46:66-71. [PMID: 33752848 DOI: 10.1016/j.jdmv.2021.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 02/06/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Patients exposed to nilotinib for chronic myeloid leukemia (CML) appear to be at risk of arterial complication. The prevalence and aspect of ultrasound asymptomatic arterial lesions are unknown. OBJECTIVE To describe prevalence and characteristics of ultrasound arterial anomalies in patients treated with nilotinib for CML. METHODS Patients treated with nilotinib from 2006 to 2015 in the department of the Paoli-Calmettes Institute, Marseille, were included retrospectively. A vascular ultrasound screening was carried out from 2010. The arterial lesions at the first examination were described: plaque and its echogenicity, stenosis or occlusion. A vascular arterial anomaly (VAA) was defined by the presence of a clinical and/or ultrasound anomaly. Patients with or without VAA at initial vascular examination were compared using bivariate and multivariate analysis. RESULTS 74 patients were included (51.4% men, mean age 54.5 years); 25 patients had ultrasound arterial anomalies (33.8%). Carotid bulb was the most involved territory (44%). Arterial anomalies were: 88% plaques, 44%>50% stenosis and 12% occlusion. 72.7% plaques were echolucent or hypoechogenic. A VAA was present in 25 patients with initial vascular evaluation (33.8%). Patients with VAA at baseline were significantly older (64.9 vs 49.3, P<0.001), older at nilotinib initiation (60.8 vs 46.5, P<0.001), with more arterial hypertension (40% vs 12.2%, P=0.01), with more cardiovascular risk factors (P=0.03). In patient with no cardiovascular risk factor 12.5% had VAA (n=24). CONCLUSION Nilotinib seems to be associated to arterial lesions of unstable lipid-like appearance. The most involved arterial territory was the carotid bulb and the most common lesion was echolucent or hypoechogenic plaque. VAA can occur in patients without cardiovascular risk factors. This result encourages us to systematically screen and follow all patients exposed to nilotinib even those without cardiovascular risk factors.
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Affiliation(s)
- G Sarlon-Bartoli
- Unité d'Exploration et de médecine vasculaires, Faculté de Médecine de Marseille, Aix-Marseille Université, Assistance Publique Hôpitaux de Marseille - Hôpital de la Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France.
| | - Q Michel
- Unité d'Exploration et de médecine vasculaires, Faculté de Médecine de Marseille, Aix-Marseille Université, Assistance Publique Hôpitaux de Marseille - Hôpital de la Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
| | - E Sarlon
- Unité de Santé publique, Centre Hospitalier Intercommunal Gap, 1, place Auguste Muret, 05000 Gap, France
| | - M Carcopino-Tusoli
- Unité d'Exploration et de médecine vasculaires, Faculté de Médecine de Marseille, Aix-Marseille Université, Assistance Publique Hôpitaux de Marseille - Hôpital de la Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
| | - P Suchon
- Service d'hématologie, Faculté de Médecine de Marseille, Aix-Marseille Université, Assistance Publique Hôpitaux de Marseille - Hôpital de la Timone, Marseille, France
| | - R Soler
- Service de Chirurgie Vasculaire, Faculté de Médecine de Marseille, Aix-Marseille Université, Assistance Publique Hôpitaux de Marseille - Hôpital de la Timone, Marseille, France
| | - M A Bartoli
- Service de Chirurgie Vasculaire, Faculté de Médecine de Marseille, Aix-Marseille Université, Assistance Publique Hôpitaux de Marseille - Hôpital de la Timone, Marseille, France
| | - D Brunet
- Unité d'Exploration et de médecine vasculaires, Faculté de Médecine de Marseille, Aix-Marseille Université, Assistance Publique Hôpitaux de Marseille - Hôpital de la Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France; Service d'hématologie, Faculté de Médecine de Marseille, Aix-Marseille Université, Assistance Publique Hôpitaux de Marseille - Hôpital de la Timone, Marseille, France
| | - P Morange
- Service d'hématologie, Faculté de Médecine de Marseille, Aix-Marseille Université, Assistance Publique Hôpitaux de Marseille - Hôpital de la Timone, Marseille, France
| | - A Charbonnier
- Unité d'Exploration et de médecine vasculaires, Faculté de Médecine de Marseille, Aix-Marseille Université, Assistance Publique Hôpitaux de Marseille - Hôpital de la Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France; Institut Paoli-Calmettes, département d'Onco-hématologie, 232, boulevard Sainte-Marguerite, BP 156, 13273 Marseille cedex 9, France
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Arcani R, Grapperon AM, Venton G, Suchon P, Verschueren A, Bas J, Salort-Campana E, Attarian S, Delmont E. Should we prevent thrombosis related to intravenous immunoglobulin infusions with systematic anticoagulant prophylaxis? Rev Neurol (Paris) 2020; 177:100-106. [PMID: 32718469 DOI: 10.1016/j.neurol.2020.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 04/09/2020] [Accepted: 04/28/2020] [Indexed: 10/23/2022]
Abstract
Intravenous immunoglobulins (IVIg) are commonly used for treatment of dysimmune diseases, but they are known to promote thrombotic events. The medical records of patients who received IVIg infusions to treat neuromuscular disorders were retrospectively studied during two periods: the on-demand period (May 2013-January 2015), when patients received anticoagulant prophylaxis based on personal thrombotic risk factors, and the systematic period (May 2015-January 2017), when patients received systematic anticoagulant prophylaxis. Of the 334 total patients included, 19/153 received anticoagulant prophylaxis in the on-demand period, and 181 were treated in the systematic period. In the on-demand period, thrombosis occurred in three patients (1.96%) as one central retinal artery occlusion, one pulmonary embolism, and one brachiocephalic vein thrombosis. In the systematic period, thrombosis occurred in two patients (1.1%), both as pulmonary embolisms. There was no statistical difference in thrombosis incidence between the periods (P=0.66). The only factor associated with thrombosis was splenectomy (20% versus 0.3% in patients without thrombosis, P=0.03). There were no adverse events due to thromboprophylaxis by low-molecular-weight heparin in either period. Systematic thromboprophylaxis did not significantly reduce the incidence of thrombosis versus thromboprophylaxis based on personal thrombotic risk.
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Affiliation(s)
- R Arcani
- Department of neuromuscular diseases and Amyotrophic Lateral Sclerosis, La Timone, University Hospital of Marseille, 278 rue Saint-Pierre, 13005 Marseille, France.
| | - A-M Grapperon
- Department of neuromuscular diseases and Amyotrophic Lateral Sclerosis, La Timone, University Hospital of Marseille, 278 rue Saint-Pierre, 13005 Marseille, France
| | - G Venton
- Hematology and Cellular Therapy Department, La Conception, University Hospital of Marseille, 147, boulevard Baille, Marseille, France
| | - P Suchon
- Hematology laboratory, La Timone, University Hospital of Marseille, 278, rue Saint-Pierre, 13005 Marseille, France
| | - A Verschueren
- Department of neuromuscular diseases and Amyotrophic Lateral Sclerosis, La Timone, University Hospital of Marseille, 278 rue Saint-Pierre, 13005 Marseille, France
| | - J Bas
- Department of neuromuscular diseases and Amyotrophic Lateral Sclerosis, La Timone, University Hospital of Marseille, 278 rue Saint-Pierre, 13005 Marseille, France
| | - E Salort-Campana
- Department of neuromuscular diseases and Amyotrophic Lateral Sclerosis, La Timone, University Hospital of Marseille, 278 rue Saint-Pierre, 13005 Marseille, France
| | - S Attarian
- Department of neuromuscular diseases and Amyotrophic Lateral Sclerosis, La Timone, University Hospital of Marseille, 278 rue Saint-Pierre, 13005 Marseille, France
| | - E Delmont
- Department of neuromuscular diseases and Amyotrophic Lateral Sclerosis, La Timone, University Hospital of Marseille, 278 rue Saint-Pierre, 13005 Marseille, France
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Paoletti E, Rezkallah S, El Harake S, Castelli M, Benresdouane Y, Brunet D, Suchon P, Morange P, Sarlon-Bartoli G. Descriptive study of the general practitioners' perception of direct oral anticoagulants and the risk of genital bleeding in women of childbearing age. J Med Vasc 2020; 45:198-209. [PMID: 32571560 DOI: 10.1016/j.jdmv.2020.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 04/19/2020] [Indexed: 06/11/2023]
Abstract
AIM OF THE STUDY AND PATIENTS Direct oral anticoagulants (DOA) tend to replace antivitamins K (VKA). The incidence of major and minor hemorrhages is higher in women, a difference potentially linked to genital hemorrhages. The objective is to assess the practices and perception of general practitioners of the use of oral anticoagulant therapy in women of childbearing age. MATERIALS AND METHODS Descriptive, observational, transversal and monocentric study. An 11-items questionnaire was sent to 900 randomized general practitioners, assessing the type of patient, the type of anticoagulant prescribed, the management of genital bleeding, and the assessment of the quality of life of anticoagulated patients. RESULTS DOA were the most prescribed anticoagulants. Genital hemorrhage was the second leading cause of minor hemorrhage. Most doctors (60.6%) believed they were due to VKAs. 25% reported an alteration in the quality of life of patients following these genital hemorrhages and 47.5% addressed this subject in consultation. CONCLUSION Our study suggests that, according to the general practitioners interviewed, genital hemorrhage is more frequent on VKA than on DOA in women of reproductive age, which is contradictory with the data in the literature. The probably taboo subject is rarely mentioned in consultation and is responsible for a deterioration in the quality of life in these young patients. No recommendation exists on the management of this type of genital hemorrhage in these women. An algorithm is proposed for their management.
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Affiliation(s)
- E Paoletti
- Medicine Vascular Department, La Timone Hospital, CHU Timone, 264, rue Saint-Pierre, Marseille, France
| | - S Rezkallah
- Medicine Vascular Department, La Timone Hospital, CHU Timone, 264, rue Saint-Pierre, Marseille, France
| | - S El Harake
- Medicine Vascular Department, La Timone Hospital, CHU Timone, 264, rue Saint-Pierre, Marseille, France
| | - M Castelli
- Medicine Vascular Department, La Timone Hospital, CHU Timone, 264, rue Saint-Pierre, Marseille, France
| | - Y Benresdouane
- Laboratory of Haematology, La Timone Hospital, Marseille, France
| | - D Brunet
- Laboratory of Haematology, La Timone Hospital, Marseille, France
| | - P Suchon
- Laboratory of Haematology, La Timone Hospital, Marseille, France; C2VN, Aix Marseille University, Marseille, France
| | - P Morange
- Laboratory of Haematology, La Timone Hospital, Marseille, France; C2VN, Aix Marseille University, Marseille, France
| | - G Sarlon-Bartoli
- Medicine Vascular Department, La Timone Hospital, CHU Timone, 264, rue Saint-Pierre, Marseille, France; C2VN, Aix Marseille University, Marseille, France.
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Arcani R, Suchon P, Venton G, Soubrier C, Gaigne L, Doddoli S, Koubi M, Brandejsky L, Swiader L, Veit V, Jean E, Harlé JR, Durand JM. Efficacy of intravenous iron therapy in non-anaemic iron-deficient patients with fatigue. Neth J Med 2020; 78:34-36. [PMID: 32043476] [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: 06/10/2023]
Abstract
Iron deficiency, without anaemia, is common in the general population and induces various symptoms. Its management consists of oral and intravenous supplementation for cases of inefficacy of or intolerance to oral iron. We assessed the efficacy of intravenous iron therapy in non-anaemic iron-deficient patients with fatigue. We prospectively evaluated the level of fatigue, using the Fatigue Severity Scale (FSS), in patients suffering from iron deficiency without anaemia, treated by intravenous iron at the moment of the perfusion (W0), after 4 weeks (W4), and 12 weeks (W12). Of 25 patients, at W0, the mean FFS was 49.3+/-13.7. There was a significant improvement in FSS at W4 (44+/-15; p = 0.01) and a sustained response at W12 with an FFS of 35.8+/-17.1 (p < 0,0001). There was no correlation between FSS and serum ferritin level at W12 (p=0.54) or between serum ferritin at W12 and difference between FSS at W0 and W12 (p=0.58). There were six mild adverse events (24%): asthenia (8%), nausea (8%), headache (4%), local pain (4%); and no serious adverse events. Our results suggest the rapid efficacy of intravenous iron in improving fatigue in iron deficiency without anaemia with a good profile of tolerance.
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Affiliation(s)
- R Arcani
- Internal Medicine Department, La Timone, University Hospital of Marseille, France
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Venton G, Suchon P, Colle J, Baier C, Sanderson F, Poullin P, Ivanov V, Mercier C, Farnault L, Roche P, Arcani R, Fanciullino R, Brunet C, Philip PJM, Costello R. Hematopoietic reconstitution after autologous hematopoietic stem cell transplantation: do CD45 (+) CD34 (+) CD38 (-) progenitors really matter in real life? Transfus Apher Sci 2018; 57:406-408. [PMID: 29709543 DOI: 10.1016/j.transci.2018.04.021] [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] [Received: 03/15/2018] [Revised: 03/30/2018] [Accepted: 04/04/2018] [Indexed: 10/17/2022]
Affiliation(s)
- G Venton
- INSERM, UMR1090 TAGC,Marseille, F_13288,France; Aix-Marseille University, UMR1090 TAGC,Marseille, F_13288,France; Hematology and Cellular Therapy Department, La Conception, University Hospital of Marseille, France
| | - P Suchon
- Hematology laboratory, La Timone, University Hospital of Marseille, France; UMR 1062 NORT, INSERM, Marseille France
| | - J Colle
- INSERM, UMR1090 TAGC,Marseille, F_13288,France; Aix-Marseille University, UMR1090 TAGC,Marseille, F_13288,France; Hematology and Cellular Therapy Department, La Conception, University Hospital of Marseille, France
| | - C Baier
- INSERM, UMR1090 TAGC,Marseille, F_13288,France
| | - F Sanderson
- Hematology and Cellular Therapy Department, La Conception, University Hospital of Marseille, France; Apheresis and auto transfusion department, la Conception, University Hospital of Marseille, France
| | - P Poullin
- Hematology and Cellular Therapy Department, La Conception, University Hospital of Marseille, France; Apheresis and auto transfusion department, la Conception, University Hospital of Marseille, France
| | - V Ivanov
- Hematology and Cellular Therapy Department, La Conception, University Hospital of Marseille, France
| | - C Mercier
- Hematology and Cellular Therapy Department, La Conception, University Hospital of Marseille, France; UMR-911 INSERM, Toxicokinetics andpharmacokinetics laboratory, pharmacological faculty, Marseille, France
| | - L Farnault
- Hematology and Cellular Therapy Department, La Conception, University Hospital of Marseille, France
| | - P Roche
- Hematology and Cellular Therapy Department, La Conception, University Hospital of Marseille, France
| | - R Arcani
- Hematology and Cellular Therapy Department, La Conception, University Hospital of Marseille, France
| | - R Fanciullino
- SMARTc Unit, Pharmacokinetics Laboratory, UMR_911 CRO2 AMU Marseille, France; Pharmacy Unit, La Conception University Hospital of Marseille, APHM, Marseille, France
| | - C Brunet
- Hematology laboratory, La Conception, University Hospital of Marseille, France
| | - P J M Philip
- Cell therapy unit - The French Blood Establishment (EFS - Provence - Alpes Côte d'Azur - Corse)", Saint Laurent du Var, France
| | - R Costello
- INSERM, UMR1090 TAGC,Marseille, F_13288,France; Aix-Marseille University, UMR1090 TAGC,Marseille, F_13288,France; Hematology and Cellular Therapy Department, La Conception, University Hospital of Marseille, France.
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7
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Ragheb R, Venton G, Chelbi R, Bonnet N, Le Treut T, Ivanov V, Mercier C, Poulin P, Beaufils N, Gabert J, Suchon P, Rihet P, Loriod B, Kahn-Perlès B, Costello RT. Vorinostat and Mithramycin A in combination therapy as an interesting strategy for the treatment of Sézary T lymphoma: a transcriptomic approach. Arch Dermatol Res 2017; 309:611-623. [PMID: 28695331 DOI: 10.1007/s00403-017-1761-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 06/07/2017] [Accepted: 07/03/2017] [Indexed: 12/22/2022]
Abstract
SAHA (vorinostat) is a histone deacetylase inhibitor approved by the USA Food and Drug Administration (FDA) for treating advanced refractory cutaneous T cell lymphomas. As SAHA alters the expression of many genes under control of the Sp1 transcription factor, we examined the effect of its association with the FDA-approved anticancer antibiotic Mithramycin A (MTR, plicamycin), a competitive inhibitor of Sp1 binding to DNA. Sézary syndrome (SS) cells, expanded ex vivo from peripheral blood mononuclear cells of 4 patients, were tested for their sensitivity to the drugs regarding cytotoxicity and differential responsive gene expression. Multivariate statistical methods were used to identify genes whose expression is altered by SAHA, MTR, and the synergist effect of the two drugs. MTR, like SAHA, induced the apoptosis of SS cells, while the two drugs in combination showed clear synergy or potentiation. Expression data stressed a likely important role of additive or synergistic epigenetic modifications in the combined effect of the two drugs, while direct inhibition of Sp1-dependent transcription seemed to have only limited impact. Ontological analysis of modified gene expression suggested that the two drugs, either independently or synergistically, counteracted many intertwined pro-survival pathways deregulated in SS cells, resistance of these tumors to intrinsic and extrinsic apoptosis, abnormal adhesion migration, and invasive properties, as well as immunosuppressive behavior. Our findings provide preliminary clues on the individual and combined effects of SAHA and MTR in SS cells and highlight a potential therapeutic interest of this novel pair of drugs for treatment of SS patients.
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Affiliation(s)
- R Ragheb
- Aix Marseille Université, INSERM UMR_S 1090, Technological Advances for Genomics and Clinics, 13288, Marseille-Luminy, France
| | - G Venton
- Aix Marseille Université, INSERM UMR_S 1090, Technological Advances for Genomics and Clinics, 13288, Marseille-Luminy, France.,Assistance Publique des Hôpitaux de Marseille, Hôpital de la Conception, Service d'Hématologie et de Thérapie Cellulaire, 13005, Marseille, France
| | - R Chelbi
- Aix Marseille Université, INSERM UMR_S 1090, Technological Advances for Genomics and Clinics, 13288, Marseille-Luminy, France
| | - N Bonnet
- Assistance Publique Hôpitaux de Marseille, Hôpital Nord, Service de Dermatologie, 13915, Marseille, France
| | - T Le Treut
- Assistance Publique Hôpitaux de Marseille, Hôpital Nord, Laboratoire d'Hématologie, 13915, Marseille, France
| | - V Ivanov
- Assistance Publique des Hôpitaux de Marseille, Hôpital de la Conception, Service d'Hématologie et de Thérapie Cellulaire, 13005, Marseille, France
| | - C Mercier
- Assistance Publique des Hôpitaux de Marseille, Hôpital de la Conception, Service d'Hématologie et de Thérapie Cellulaire, 13005, Marseille, France
| | - P Poulin
- Assistance Publique Hôpitaux de Marseille, Hôpital La Conception, Service d'Hémaphérèse, 13005, Marseille, France
| | - N Beaufils
- Assistance Publique des Hôpitaux de Marseille, Hôpital Nord, Laboratoire de Biochimie Biologie Moléculaire, 13288, Marseille, France
| | - J Gabert
- Assistance Publique des Hôpitaux de Marseille, Hôpital Nord, Laboratoire de Biochimie Biologie Moléculaire, 13288, Marseille, France
| | - P Suchon
- Assistance Publique des Hôpitaux de Marseille, Hôpital de la Timone, Service d'Hématologie, 13005, Marseille, France
| | - P Rihet
- Aix Marseille Université, INSERM UMR_S 1090, Technological Advances for Genomics and Clinics, 13288, Marseille-Luminy, France
| | - B Loriod
- Aix Marseille Université, INSERM UMR_S 1090, Technological Advances for Genomics and Clinics, 13288, Marseille-Luminy, France
| | - B Kahn-Perlès
- Aix Marseille Université, INSERM UMR_S 1090, Technological Advances for Genomics and Clinics, 13288, Marseille-Luminy, France
| | - Régis T Costello
- Aix Marseille Université, INSERM UMR_S 1090, Technological Advances for Genomics and Clinics, 13288, Marseille-Luminy, France. .,Assistance Publique des Hôpitaux de Marseille, Hôpital de la Conception, Service d'Hématologie et de Thérapie Cellulaire, 13005, Marseille, France.
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8
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Tripodi A, Chantarangkul V, Cini M, Devreese K, Dlott JS, Giacomello R, Gray E, Legnani C, Martinuzzo ME, Pradella P, Siegemund A, Subramanian S, Suchon P, Testa S. Variability of cut-off values for the detection of lupus anticoagulants: results of an international multicenter multiplatform study. J Thromb Haemost 2017; 15:1180-1190. [PMID: 28316135 DOI: 10.1111/jth.13678] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Indexed: 11/29/2022]
Abstract
Essentials Between-lab variations of cut-off values in lupus anticoagulant detection are unknown. Cut-off values were calculated in 11 labs each testing plasma from 120 donors with 3 platforms. Major variation was observed even within the same platform. Cut-off values determined in different labs are not interchangeable. SUMMARY Background Cut-off values for interpretation of lupus anticoagulant (LA) detection are poorly investigated. Aims (i) To assess whether results from healthy donors were normally distributed and (ii) the between-laboratories differences in cut-off values for screening, mixing and LA confirmation when calculated as 99th or 95th centiles, and (iii) to assess their impact on the detection rate for LA. Methods Each of 11 laboratories using one of the three widely used commercial platforms for LA detection was asked to collect plasmas from 120 healthy donors and to perform screening, mixing and LA confirmation with two methods (activated partial thromboplastin time [APTT] and dilute Russell viper venom [dRVV]). A common set of LA-positive or LA-negative freeze-dried plasmas was used to assess the LA detection rate. Results were centralized (Milano) for statistical analysis. Results and conclusions (i) Clotting times or ratios for healthy subjects were not normally distributed in the majority of cases. The take-home message is that cut-off values should be determined preferably by the non-parametric method based on centiles. (ii) There were relatively large inter-laboratory cut-off variations even within the same platform and the variability was marginally attenuated when results were expressed as ratios (test-to-normal pooled plasma). The take-home message is that cut-off values should be determined locally. (iii) There were differences between cut-off values calculated as 99th or 95th centiles that translate into a different LA detection rate (the lower the centile the greater the detection rate). The take-home message is that cut-off values determined as the 95th centile allow a better LA detection rate.
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Affiliation(s)
- A Tripodi
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Department of Clinical Sciences and Community Health, Università degli Studi di Milano and IRCCS Maggiore Hospital Foundation, Milano, Italy
| | - V Chantarangkul
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Department of Clinical Sciences and Community Health, Università degli Studi di Milano and IRCCS Maggiore Hospital Foundation, Milano, Italy
| | - M Cini
- Department of Angiology and Blood Coagulation, University Hospital Sant'Orsola-Malpighi, Bologna, Italy
| | - K Devreese
- Coagulation Laboratory, Department of Laboratory Medicine, Ghent-University Hospital, Ghent, Belgium
| | - J S Dlott
- Quest Diagnostics, Chantilly, VA, USA
| | - R Giacomello
- Department of Medical and Biological Sciences, University of Udine, Udine, Italy
- Department of Laboratory Medicine, ASUI UD, University Hospital, Udine, Italy
| | - E Gray
- National Institute for Biological Standards and Controls, Potters Bar, UK
| | - C Legnani
- Department of Angiology and Blood Coagulation, University Hospital Sant'Orsola-Malpighi, Bologna, Italy
| | - M E Martinuzzo
- Laboratorio Central del Hospital Italiano de Buenos Aires, Instituto Universitario del Hospital Italiano, Buenos Aires, Argentina
| | - P Pradella
- Haemostasis Laboratory, Department of Transfusion Medicine, ASUI TS, University Hospital of Cattinara, Trieste, Italy
| | | | - S Subramanian
- Department of Clinical Pathology, St John's Medical College Hospital, Bangalore, India
| | - P Suchon
- Assistance Publique des Hopitaux de Marseille, Marseille, France
- Institut National pour la Santé et la Recherche Médicale (INSERM), Unité Mixte de Recherche en Santé (UMR_S) 1062, Nutrition Obesity and Risk of Thrombosis, Aix-Marseille University, Marseille, France
| | - S Testa
- Haemostasis and Thrombosis Center, General Hospital, Cremona, Italy
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9
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Suchon P, Germain M, Delluc A, Smadja D, Jouven X, Gyorgy B, Saut N, Ibrahim M, Deleuze JF, Alessi MC, Morange PE, Trégouët DA. Protein S Heerlen mutation heterozygosity is associated with venous thrombosis risk. Sci Rep 2017; 7:45507. [PMID: 28374852 PMCID: PMC5379621 DOI: 10.1038/srep45507] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 02/27/2017] [Indexed: 12/16/2022] Open
Abstract
Hereditary Protein S (PS) deficiency is a rare coagulation disorder associated with an increased risk of venous thrombosis (VT). The PS Heerlen (PSH) mutation is a rare S501P mutation that was initially considered to be a neutral polymorphism. However, it has been later shown that PSH has a reduced half-life in vivo which may explain the association of PSH heterozygosity with mildly reduced levels of plasma free PS (FPS). Whether the risk of VT is increased in PSH carriers remains unknown. We analyzed the association of PSH (rs121918472 A/G) with VT in 4,173 VT patients and 5,970 healthy individuals from four independent case-control studies. Quantitative determination of FPS levels was performed in a subsample of 1257 VT patients. In the investigated populations, the AG genotype was associated with an increased VT risk of 6.57 [4.06–10.64] (p = 1.73 10−14). In VT patients in whom PS deficiency was excluded, plasma FPS levels were significantly lower in individuals with PSH when compared to those without [72 + 13 vs 91 + 21 UI/dL; p = 1.86 10−6, mean + SD for PSH carriers (n = 21) or controls (n = 1236) respectively]. We provide strong evidence that the rare PSH variant is associated with VT in unselected individuals.
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Affiliation(s)
- P Suchon
- Laboratory of Haematology, La Timone Hospital, Marseille, France.,Institut National pour la Santé et la Recherche Médicale (INSERM), Unité Mixte de Recherche en Santé(UMR_S) 1062, Nutrition Obesity and Risk of Thrombosis, Aix-Marseille University, Marseille, France
| | - M Germain
- Sorbonne Universités, UPMC Univ. Paris 06, INSERM, UMR_S 1166, Team Genomics &Pathophysiology of Cardiovascular Diseases, Paris, France.,ICAN Institute for Cardiometabolism and Nutrition, Paris, France
| | - A Delluc
- Université de Brest, EA3878 and CIC1412, 29238 Brest, France
| | - D Smadja
- Service d'hématologie biologique, AP-HP, Hôpital Européen Georges Pompidou, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, France, Inserm UMR-S1140, Paris, France
| | - X Jouven
- INSERM, UMR-S970, Department of Epidemiology, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France.,APHP, Georges Pompidou European Hospital, Department of Cardiology, Paris, France
| | - B Gyorgy
- Sorbonne Universités, UPMC Univ. Paris 06, INSERM, UMR_S 1166, Team Genomics &Pathophysiology of Cardiovascular Diseases, Paris, France.,ICAN Institute for Cardiometabolism and Nutrition, Paris, France
| | - N Saut
- Laboratory of Haematology, La Timone Hospital, Marseille, France
| | - M Ibrahim
- Laboratory of Haematology, La Timone Hospital, Marseille, France.,Institut National pour la Santé et la Recherche Médicale (INSERM), Unité Mixte de Recherche en Santé(UMR_S) 1062, Nutrition Obesity and Risk of Thrombosis, Aix-Marseille University, Marseille, France
| | - J F Deleuze
- Centre National de Génotypage, Institut de Génomique, CEA, 91057 Evry, France.,CEPH, Fondation Jean Dausset, Paris, France
| | - M C Alessi
- Laboratory of Haematology, La Timone Hospital, Marseille, France.,Institut National pour la Santé et la Recherche Médicale (INSERM), Unité Mixte de Recherche en Santé(UMR_S) 1062, Nutrition Obesity and Risk of Thrombosis, Aix-Marseille University, Marseille, France
| | - P E Morange
- Laboratory of Haematology, La Timone Hospital, Marseille, France.,Institut National pour la Santé et la Recherche Médicale (INSERM), Unité Mixte de Recherche en Santé(UMR_S) 1062, Nutrition Obesity and Risk of Thrombosis, Aix-Marseille University, Marseille, France
| | - D A Trégouët
- Sorbonne Universités, UPMC Univ. Paris 06, INSERM, UMR_S 1166, Team Genomics &Pathophysiology of Cardiovascular Diseases, Paris, France.,ICAN Institute for Cardiometabolism and Nutrition, Paris, France
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10
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Henneuse A, Suchon P, Chambost H, Morange PE, Frere C, Alessi MC. α 1 -antitrypsin Pittsburgh and plasmin-mediated proteolysis. J Thromb Haemost 2016; 14:2023-2026. [PMID: 27468101 DOI: 10.1111/jth.13426] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 06/24/2016] [Indexed: 11/28/2022]
Abstract
Essentials Patients with α-1-antitrypsin (α1-AT) Pittsburgh exhibit a mild bleeding tendency. A new case of α1-AT Pittsburgh with suspected high antifibrinolytic potential was studied. We showed that α1-AT Pittsburgh inhibits tissue plasminogen activator and plasmin. The antifibrinolytic potential of the variant contributes to explaining the mild bleeding phenotype. SUMMARY α1 -Antitrypsin (α1 -AT) Pittsburgh has a Met358 to Arg substitution at the reactive Met-Ser site of α1 -AT, which enables the protein to act as a potent thrombin inhibitor. Four patients with α1 -AT Pittsburgh have been described to date. An additional young girl was recently diagnosed with α1 -AT Pittsburgh in our center after presenting with a large hematoma in the forearm. Interestingly, all of these patients showed a potent thrombin inhibitor in the plasma and a mild bleeding phenotype. This observation suggests that the in vivo consequences of the mutation may contribute to the maintenance of normal hemostatic balance. We assessed inhibition of the fibrinolytic system by the variant protein by evaluating the fibrinolysis inhibitory potential of the patient's plasma, purified wild-type α1 -AT and purified Pittsburgh α1 -AT with an electrophoretic zymography system, western blotting, and clot fibrinolysis. Our results indicate that the patient's plasma and purified α1 -AT Pittsburgh have strong potential to inhibit tissue-type plasminogen activator and plasmin.
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Affiliation(s)
- A Henneuse
- Laboratoire hématologie, CHU Timone, Inserm UMR_S 1062, Inra UMR_1260, Aix-Marseille Université, Marseille, France
| | - P Suchon
- Laboratoire hématologie, CHU Timone, Inserm UMR_S 1062, Inra UMR_1260, Aix-Marseille Université, Marseille, France
| | - H Chambost
- Laboratoire hématologie, CHU Timone, Inserm UMR_S 1062, Inra UMR_1260, Aix-Marseille Université, Marseille, France
- Service d'Hématologie Oncologie Pédiatrique, CHU Timone, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - P E Morange
- Laboratoire hématologie, CHU Timone, Inserm UMR_S 1062, Inra UMR_1260, Aix-Marseille Université, Marseille, France
| | - C Frere
- Laboratoire hématologie, CHU Timone, Inserm UMR_S 1062, Inra UMR_1260, Aix-Marseille Université, Marseille, France
| | - M C Alessi
- Laboratoire hématologie, CHU Timone, Inserm UMR_S 1062, Inra UMR_1260, Aix-Marseille Université, Marseille, France.
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11
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Suchon P, Al Frouh F, Ibrahim M, Sarlon G, Venton G, Alessi MC, Trégouët DA, Morange PE. Genetic risk factors for venous thrombosis in women using combined oral contraceptives: update of the PILGRIM study. Clin Genet 2016; 91:131-136. [PMID: 27414984 DOI: 10.1111/cge.12833] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 05/03/2016] [Revised: 07/07/2016] [Accepted: 07/11/2016] [Indexed: 11/29/2022]
Abstract
Identifying women at risk of venous thrombosis (VT) under combined oral contraceptives (COC) is a major public health issue. The aim of this study was to investigate in COC users the impact on disease of genetic polymorphisms recently identified to associate with VT risk in the general population. Nine polymorphisms located on KNG1, F11, F5, F2, PROCR, FGG, TSPAN and SLC44A2 genes were genotyped in a sample of 766 patients and 464 controls as part of the PILGRIM (PILl Genetic Risk Monitoring) study. Cases were women who experienced an episode of documented VT during COC use, while controls were women with no history of VT using COC at the time of inclusion. Among the studied polymorphisms, only F11 rs2289252 was significantly associated with VT. The F11 rs2289252-A allele was associated with a 1.6-fold increased risk of VT (p < 0.0001). Besides, the combination of the rs2289252-A allele with non-O blood group, present in 52% of the cohort, was associated with an odds ratio of 4.00 (2.49-6.47; p < 10-4 ). The consideration of this genetic risk factor could help to better assess the risk of VT in COC users.
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Affiliation(s)
- P Suchon
- AIx Marseille Univ, INSERM, INRA, NORT, Marseille, France.,APHM, Hôpital de la Timone, Service d'hématologie biologique, Marseille, France
| | - F Al Frouh
- APHM, Hôpital de la Timone, Service d'hématologie biologique, Marseille, France
| | - M Ibrahim
- AIx Marseille Univ, INSERM, INRA, NORT, Marseille, France.,APHM, Hôpital de la Timone, Service d'hématologie biologique, Marseille, France
| | - G Sarlon
- Médecine vasculaire et Hypertension artérielle, Faculté de Médecine de Marseille, Aix-Marseille Université, Assistance Publique Hôpitaux de Marseille - Hôpital de La Timone, Marseille, France
| | - G Venton
- INSERM, UMR1090 TAGC, Aix-Marseille University, Marseille, France.,Service d'hématologie, APHM, Hôpital de la Conception, Marseille, France
| | - M-C Alessi
- AIx Marseille Univ, INSERM, INRA, NORT, Marseille, France.,APHM, Hôpital de la Timone, Service d'hématologie biologique, Marseille, France
| | - D-A Trégouët
- Sorbonne Universités, UPMC Univ Paris 06, INSERM UMR_S 1166, Paris, France.,ICAN Institute for Cardiometabolism and Nutrition, Paris, France
| | - P-E Morange
- AIx Marseille Univ, INSERM, INRA, NORT, Marseille, France.,APHM, Hôpital de la Timone, Service d'hématologie biologique, Marseille, France
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12
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Venton G, Adam H, Colle J, Labiad Y, Mercier C, Ivanov V, Suchon P, Fanciullino R, Farnault L, Costello R. Micafungin as primary antifungal prophylaxis in patients presenting with acute myeloid leukemia. Med Mal Infect 2016; 46:226-9. [PMID: 27126350 DOI: 10.1016/j.medmal.2016.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 12/11/2015] [Revised: 01/29/2016] [Accepted: 03/18/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To study the efficacy and safety of micafungin for prophylaxis of invasive fungal infections in patients undergoing induction chemotherapy for acute myeloid leukemia. PATIENTS AND METHODS A prospective observational single-center study of 41 patients from the hematology department between May 2012 and April 2015. Micafungin was administered once daily from the first day of induction chemotherapy to the end of the neutropenic phase. RESULTS Neither Candida nor Aspergillus infection was documented in our 41 patients from the first day of micafungin infusion to the end of the neutropenic phase. Patients were followed for three months after discontinuation of micafungin and none of them contracted an invasive fungal infection. Only one patient presented with grade III-IV hepatic and ionic toxicities. CONCLUSION Micafungin is associated with a good safety profile and is an interesting option for preventing invasive fungal infections in the high-risk population of patients presenting with hematological disorders.
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Affiliation(s)
- G Venton
- Inserm, UMR1090 TAGC, 13288 Marseille, France; Aix-Marseille université, UMR1090 TAGC, 13288 Marseille, France; Service d'hématologie et de thérapie cellulaire AP-HM, hôpital de la Conception, Marseille, France
| | - H Adam
- Unité pharmacie hospitalière hôpital de la Conception, Marseille, France
| | - J Colle
- Inserm, UMR1090 TAGC, 13288 Marseille, France; Aix-Marseille université, UMR1090 TAGC, 13288 Marseille, France; Service d'hématologie et de thérapie cellulaire AP-HM, hôpital de la Conception, Marseille, France
| | - Y Labiad
- Inserm, UMR1090 TAGC, 13288 Marseille, France; Aix-Marseille université, UMR1090 TAGC, 13288 Marseille, France
| | - C Mercier
- Service d'hématologie et de thérapie cellulaire AP-HM, hôpital de la Conception, Marseille, France; UMR-911 Inserm laboratoire de toxicocinétique et pharmacocinétique, faculté de pharmacie, Marseille, France
| | - V Ivanov
- Service d'hématologie et de thérapie cellulaire AP-HM, hôpital de la Conception, Marseille, France
| | - P Suchon
- Laboratoire d'hématologie, AP-HM, hôpital de la Timone, Marseille, France; UMR 1062 NORT, Inserm, Marseille, France
| | - R Fanciullino
- UMR-911 Inserm laboratoire de toxicocinétique et pharmacocinétique, faculté de pharmacie, Marseille, France; Unité pharmacie hospitalière hôpital de la Conception, Marseille, France
| | - L Farnault
- Service d'hématologie et de thérapie cellulaire AP-HM, hôpital de la Conception, Marseille, France
| | - R Costello
- Inserm, UMR1090 TAGC, 13288 Marseille, France; Aix-Marseille université, UMR1090 TAGC, 13288 Marseille, France; Service d'hématologie et de thérapie cellulaire AP-HM, hôpital de la Conception, Marseille, France.
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13
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Montoya J, Matta NB, Suchon P, Guzian MC, Lambert NC, Mattei JP, Guis S, Breban M, Roudier J, Balandraud N. Patients with ankylosing spondylitis have been breast fed less often than healthy controls: a case–control retrospective study. Ann Rheum Dis 2015; 75:879-82. [DOI: 10.1136/annrheumdis-2015-208187] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 09/20/2015] [Indexed: 11/04/2022]
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14
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Rubio-Terrés C, Soria JM, Morange PE, Souto JC, Suchon P, Mateo J, Saut N, Rubio-Rodríguez D, Sala J, Gracia A, Pich S, Salas E. Economic analysis of thrombo inCode, a clinical-genetic function for assessing the risk of venous thromboembolism. Appl Health Econ Health Policy 2015; 13:233-242. [PMID: 25652150 PMCID: PMC4376955 DOI: 10.1007/s40258-015-0153-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Patients with venous thromboembolism (VTE) commonly have an underlying genetic predisposition. However, genetic tests nowadays in use have very low sensitivity for identifying subjects at risk of VTE. Thrombo inCode(®) is a new genetic tool that has demonstrated very good sensitivity, thanks to very good coverage of the genetic variants that modify the function of the coagulation pathway. OBJECTIVE To conduct an economic analysis of risk assessment of VTE from the perspective of the Spanish National Health System with Thrombo inCode(®) (a clinical-genetic function for assessing the risk of VTE) versus the conventional/standard method used to date (factor V Leiden and prothrombin G20210A). METHODS An economic model was created from the National Health System perspective, using a decision tree in patients aged 45 years with a life expectancy of 81 years. The predictive capacity of VTE, based on identification of thrombophilia using Thrombo inCode(®) and using the standard method, was obtained from two case-control studies conducted in two different populations (S. PAU and MARTHA; 1,451 patients in all). Although this is not always the case, patients who were identified as suffering from thrombophilia were subject to preventive treatment of VTE with warfarin, leading to a reduction in the number of VTE events and an increased risk of severe bleeding. The health state utilities (quality-adjusted life-years [QALYs]) and costs (in 2013 EUR values) were obtained from the literature and Spanish sources. RESULTS On the basis of a price of EUR 180 for Thrombo inCode(®), this would be the dominant option (more effective and with lower costs than the standard method) in both populations. The Monte Carlo probabilistic analyses indicate that the dominance would occur in 100 % of the simulations in both populations. The threshold price of Thrombo inCode(®) needed to reach the incremental cost-effectiveness ratio (ICER) generally accepted in Spain (EUR 30,000 per QALY gained) would be between EUR 3,950 (in the MARTHA population) and EUR 11,993 (in the S. PAU population). CONCLUSION According to the economic model, Thrombo inCode(®) is the dominant option in assessing the risk of VTE, compared with the standard method currently used.
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Affiliation(s)
- C. Rubio-Terrés
- Health Value, C/-Virgen de Aránzazu, 21, 5°B, 28034 Madrid, Spain
| | - J. M. Soria
- Unitat de Genòmica de Malalties Complexes, IIB-Sant Pau, Barcelona, Spain
| | - P. E. Morange
- Inserm UMR_S 1062, 13385 Marseille, France
- Aix-Marseille Université, Marseille, France
| | - J. C. Souto
- Unitat d’Hemostasia i Trombosis IIB-Sant Pau, Barcelona, Spain
| | - P. Suchon
- Inserm Unité Mixte de Recherche en Santé (UMR_S) 937, Paris, France
- ICAN Institute for Cardiometabolism and Nutrition, Université Pierre et Marie Curie Paris 6, Paris, France
| | - J. Mateo
- Unitat d’Hemostasia i Trombosis IIB-Sant Pau, Barcelona, Spain
| | - N. Saut
- Inserm Unité Mixte de Recherche en Santé (UMR_S) 937, Paris, France
- ICAN Institute for Cardiometabolism and Nutrition, Université Pierre et Marie Curie Paris 6, Paris, France
| | | | - J. Sala
- Scientific Department, Ferrer inCode, Barcelona, Spain
| | - A. Gracia
- Scientific Department, Ferrer inCode, Barcelona, Spain
| | - S. Pich
- Scientific Department, Gendiag.exe, Barcelona, Spain
| | - E. Salas
- Scientific Department, Gendiag.exe, Barcelona, Spain
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15
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Rubio-Terrés C, Soria JM, Morange PE, Suchon P, Souto JC, Mateo J, Saut N, Rubio-Rodríguez D, Sala J, Gracia A, Pich S, Salas E. Economic Analysis Of Thrombo Incode, A Clinical-Genetic Function For Assessing The Risk Of Venous Thromboembolism. Value Health 2014; 17:A488. [PMID: 27201446 DOI: 10.1016/j.jval.2014.08.1437] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | - J M Soria
- Unitat de Genòmica de Malalties Complexes Sant Pau, Barcelona, Spain
| | - P E Morange
- Inserm UMR_S 1062, F-13385, and Aix-Marseille Université, Marseille, France
| | - P Suchon
- Inserm UMR_S 1062, F-13385, and Aix-Marseille Université, Marseille, France
| | - J C Souto
- Unitat d'Hemostasia i Trombosis IIB-Sant Pau, Barcelona, Spain
| | - J Mateo
- Unitat d'Hemostasia i Trombosis IIB-Sant Pau, Barcelona, Spain
| | - N Saut
- Inserm Unité Mixte de Recherche en Santé (UMR_S) 937; ICAN Institute for Cardiometabolism and Nutrition, Université Pierre et Marie Curie, Paris, France
| | | | - J Sala
- Scientific Department Ferrer inCode, Barcelona, Spain
| | - A Gracia
- Scientific Department Ferrer inCode, Barcelona, Spain
| | - S Pich
- Scientific Department Gendiag. exe, Barcelona, Spain
| | - E Salas
- Scientific Department Gendiag. exe, Barcelona, Spain
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16
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Cohen W, Castelli C, Suchon P, Bouvet S, Aillaud MF, Brunet D, Barthet MC, Alessi MC, Trégouët DA, Morange PE. Risk assessment of venous thrombosis in families with known hereditary thrombophilia: the MARseilles-NImes prediction model. J Thromb Haemost 2014; 12:138-146. [PMID: 24738120] [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: 06/03/2023]
Abstract
BACKGROUND Although predicting the risk of venous thrombosis (VT) in an individual from a family with inherited thrombophilia is of major importance, it is often not feasible. OBJECTIVES To develop a simple risk assessment model that improves prediction of the risk of VT for individuals of families with inherited thrombophilia. PATIENTS/METHODS 1201 relatives from 430 families with inherited thrombophilia (deficiencies of antithrombin, protein C or protein S, and the factor V Leiden and F2 20210A mutations) were recruited at the referral center for thrombophilia in Marseilles, France, from 1986 to 2008. One hundred and twenty-two individuals had a personal history of VT. Sixteen preselected clinical and laboratory variables were used to derive the VT risk score. RESULTS The scores based on the 16 variables and on the five most strongly associated variables performed similarly (areas under receiver operating characteristic curves of 0.85 and 0.83, respectively). For the five-variable score, named the MARNI score, derived from family history score of VT, von Willebrand factor antigen levels, age, severity of thrombophilia, and FGG rs2066865, the risk of VT ranged from 0.2% for individuals with a score of 0 (n = 186) to > 70% for individuals with a score of ≥ 7 (n = 27). The model was validated with an internal bootstrap method. CONCLUSIONS With the use of a simple scoring system, assessment of the risk of VT in subjects from families with inherited thrombophilia can be greatly improved. External validation is now needed to replicate these findings.
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17
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Cohen W, Castelli C, Suchon P, Bouvet S, Aillaud MF, Brunet D, Barthet MC, Alessi MC, Trégouët DA, Morange PE. Risk assessment of venous thrombosis in families with known hereditary thrombophilia: the MARseilles-NImes prediction model. J Thromb Haemost 2014; 12:138-146. [PMID: 24735115 DOI: 10.1111/jth.12461] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [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: 05/27/2013] [Indexed: 12/01/2022]
Abstract
BACKGROUND Although predicting the risk of venous thrombosis (VT) in an individual from a family with inherited thrombophilia is of major importance, it is often not feasible. OBJECTIVES To develop a simple risk assessment model that improves prediction of the risk of VT for individuals of families with inherited thrombophilia. PATIENTS/METHODS 1201 relatives from 430 families with inherited thrombophilia (deficiencies of antithrombin, protein C or protein S, and the factor V Leiden and F2 20210A mutations) were recruited at the referral center for thrombophilia in Marseilles, France, from 1986 to 2008. One hundred and twenty-two individuals had a personal history of VT. Sixteen preselected clinical and laboratory variables were used to derive the VT risk score. RESULTS The scores based on the 16 variables and on the five most strongly associated variables performed similarly (areas under receiver operating characteristic curves of 0.85 and 0.83, respectively). For the five-variable score, named the MARNI score, derived from family history score of VT, von Willebrand factor antigen levels, age, severity of thrombophilia, and FGG rs2066865, the risk of VT ranged from 0.2% for individuals with a score of 0 (n = 186) to > 70% for individuals with a score of ≥ 7 (n = 27). The model was validated with an internal bootstrap method. CONCLUSIONS With the use of a simple scoring system, assessment of the risk of VT in subjects from families with inherited thrombophilia can be greatly improved. External validation is now needed to replicate these findings.
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Affiliation(s)
- W Cohen
- INSERM, UMR1062, 'Nutrition, Obesity and Risk of Thrombosis', Aix-Marseille University, Marseille, France; Laboratoire d'Hématologie, APHM, Hopital Timone, Marseille, France
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