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de Jong CMM, Visser C, Bemelmans RHH, Boersma WG, van den Borst B, Burggraaf JLI, Cannegieter SC, Ten Cate-Hoek AJ, Croles FN, Faber HJ, Faber LM, Hellemons ME, Hessels LM, Huisman MV, Kamphuisen PW, Koster SCE, Kroft LJM, van der Lee I, Leentjens J, Meijer K, Ninaber MK, Sondermeijer BM, Stads S, Vonk Noordegraaf A, Winckers K, Kruip MJHA, Klok FA. Chronic thromboembolic pulmonary hypertension and clot resolution after COVID-19-associated pulmonary embolism. Eur Respir J 2023; 61:13993003.00171-2023. [PMID: 37080574 PMCID: PMC10116061 DOI: 10.1183/13993003.00171-2023] [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: 01/03/2023] [Accepted: 02/20/2023] [Indexed: 04/22/2023]
Affiliation(s)
- Cindy M M de Jong
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Chantal Visser
- Department of Haematology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Remy H H Bemelmans
- Department of Internal Medicine, Hospital Gelderse Vallei, Ede, The Netherlands
| | - Wim G Boersma
- Department of Pulmonology, North West Hospital Alkmaar, Alkmaar, The Netherlands
| | - Bram van den Borst
- Department of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J Louise I Burggraaf
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Suzanne C Cannegieter
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Arina J Ten Cate-Hoek
- Thrombosis Expertise Center Maastricht and Department of Internal Medicine, Section Vascular Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), School for Cardiovascular Diseases, Maastricht, The Netherlands
| | - F Nanne Croles
- Department of Internal Medicine, Hospital St. Jansdal, Harderwijk, The Netherlands
| | - Harald J Faber
- Department of Intensive Care, Wilhelmina Hospital Assen, Assen, The Netherlands
| | - Laura M Faber
- Department of Internal Medicine, Rode Kruis Hospital, Beverwijk, The Netherlands
| | - Merel E Hellemons
- Department of Respiratory Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
- Erasmus MC Transplant Institute, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Lisa M Hessels
- Department of Pulmonology, North West Hospital Alkmaar, Alkmaar, The Netherlands
| | - Menno V Huisman
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Pieter W Kamphuisen
- Department of Internal Medicine, Tergooi Hospital, Hilversum, The Netherlands
- Department of Vascular Medicine, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | | | - Lucia J M Kroft
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ivo van der Lee
- Department of Pulmonology, Spaarne Hospital, Haarlem, The Netherlands
| | - Jenneke Leentjens
- Department of Internal Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Karina Meijer
- Department of Haematology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Maarten K Ninaber
- Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Susanne Stads
- Department of Intensive Care, Ikazia Hospital, Rotterdam, The Netherlands
| | - Anton Vonk Noordegraaf
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Kristien Winckers
- Thrombosis Expertise Center Maastricht and Department of Internal Medicine, Section Vascular Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), School for Cardiovascular Diseases, Maastricht, The Netherlands
| | - Marieke J H A Kruip
- Department of Haematology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Frederikus A Klok
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
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Croles FN, Te Boekhorst PAW, Leebeek FWG, Jansen AJG. Therapeutic plasma exchange for anticoagulant-refractory antiphospholipid syndrome with severe ischemic and necrotic skin lesions: A case series. Transfus Apher Sci 2021; 60:103192. [PMID: 34226147 DOI: 10.1016/j.transci.2021.103192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/01/2021] [Accepted: 06/11/2021] [Indexed: 11/17/2022]
Abstract
Antiphospholipid syndrome (APS) is a systemic autoimmune disease characterized by clinical findings including thrombosis and/or obstetric complication and laboratory findings, e.g. ≥1 positive antiphospholipid antibodies (aPL) (lupus anticoagulant, anticardiolipin IgG/IgM and/or anti-β2-glycoprotein IgG/IgM). A rare APS clinical entity is severe necrosis which is difficult to treat and often does not respond to anticoagulant therapy. Three consecutive patients with primary or secondary APS who presented with necrotic skin lesions secondary to APS were treated with therapeutic plasma exchange (TPE), glucocorticoids and low-molecular-weight heparin. All patients had a rapid-onset, either full or significant recovery of their APS-related necrotic lesions. Upon treatment, one patients showed resolution of lupus anticoagulant. Two patients had a decrease of at least 88 % in aPL titers after the initial treatment, and were kept on TPE maintenance every 5-6 weeks. None of the patients experienced significant side effects of the TPE. This is the first case series showing the clinical benefits of TPE in patients with ischemic and necrotic skin lesions due to severe anticoagulant-refractory vascular APS.
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Affiliation(s)
- F Nanne Croles
- Department of Hematology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Peter A W Te Boekhorst
- Department of Hematology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Frank W G Leebeek
- Department of Hematology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - A J Gerard Jansen
- Department of Hematology, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
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Dreijer AR, Kruip MJHA, Diepstraten J, Polinder S, Brouwer R, Mol PGM, Croles FN, Kragten E, Leebeek FWG, van den Bemt PMLA. Effect of antithrombotic stewardship on the efficacy and safety of antithrombotic therapy during and after hospitalization. PLoS One 2020; 15:e0235048. [PMID: 32584857 PMCID: PMC7316339 DOI: 10.1371/journal.pone.0235048] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 06/05/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Although the benefits of antithrombotic drugs are indisputable to reduce thrombotic events, they carry a high risk of compromising patient safety. No previous studies investigated the implementation and (cost-) effectiveness of a hospital-based multidisciplinary antithrombotic team on bleeding and thrombotic outcomes. The primary aim of this study was to compare the proportion of patients with a composite end point consisting of one or more bleeding episodes or one or more thrombotic event from hospitalization until three months after hospitalization. METHODS AND FINDINGS A prospective, multicenter before-after intervention study was conducted in two Dutch hospitals. Adult patients hospitalized between October 2015 and December 2017 treated with anticoagulant therapy were included. The primary aim was to estimate the proportion of patients with a composite end point consisting of one or more bleeding episodes or one or more thrombotic event from hospitalization until three months after hospitalization. The intervention was the implementation of a multidisciplinary antithrombotic team focusing on education, medication reviews by pharmacists, implementing of local anticoagulant therapy guidelines based on national guidelines, patient counselling and medication reconciliation at admission and discharge. The primary endpoint was analysed using segmented linear regression. We obtained data for 1,886 patients: 941 patients were included in the usual care period and 945 patients in the intervention period. The S-team study showed that implementation of a multidisciplinary antithrombotic team over time significantly reduced the composite end point consisting of one or more bleeding episodes or one or more thrombotic event from hospitalization until three months after hospitalization in patients using anticoagulant drugs (-1.83% (-2.58% to -1.08%) per 2 month period). CONCLUSIONS This study shows that implementation of a multidisciplinary antithrombotic team over time significantly reduces the composite end point consisting of one or more bleeding episodes or one or more thrombotic event from hospitalization until three months after hospitalization in patients using anticoagulant drugs. TRIAL REGISTRATION Trialregister.nl NTR4887.
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Affiliation(s)
- Albert R. Dreijer
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Hospital Pharmacy, Reinier de Graaf Hospital, Delft, The Netherlands
| | - Marieke J. H. A. Kruip
- Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Thrombosis Service STAR-SHL, Rotterdam, The Netherlands
| | - Jeroen Diepstraten
- Department of Hospital Pharmacy, Reinier de Graaf Hospital, Delft, The Netherlands
| | - Suzanne Polinder
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Rolf Brouwer
- Department of Hematology, Reinier de Graaf Hospital, Delft, The Netherlands
| | - Peter G. M. Mol
- Department of Clinical Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - F. Nanne Croles
- Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Esther Kragten
- Department of Hematology, Reinier de Graaf Hospital, Delft, The Netherlands
| | - Frank W. G. Leebeek
- Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Patricia M. L. A. van den Bemt
- Department of Clinical Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Affiliation(s)
- Gienke Bomhof
- Department of Internal Medicine, Hospital St Jansdal, Harderwijk, the Netherlands
| | - Pim G N J Mutsaers
- Department of Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Frank W G Leebeek
- Department of Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Johannes Hofland
- Department of Internal Medicine, Section of Endocrinology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - F Nanne Croles
- Department of Internal Medicine, Hospital St Jansdal, Harderwijk, the Netherlands
| | - A J Gerard Jansen
- Department of Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands
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Dreijer AR, Diepstraten J, Brouwer R, Croles FN, Kragten E, Leebeek FWG, Kruip MJHA, van den Bemt PMLA. Risk of bleeding in hospitalized patients on anticoagulant therapy: Prevalence and potential risk factors. Eur J Intern Med 2019; 62:17-23. [PMID: 30686662 DOI: 10.1016/j.ejim.2019.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 01/15/2019] [Accepted: 01/16/2019] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Bleeding is the most important complication of treatment with anticoagulant therapy. Although several studies have identified risk factors of bleeding in outpatients, no studies have been performed that evaluated prevalence and potential risk factors of bleeding in hospitalized patients treated with anticoagulant therapy. METHODS The primary objective of this study was to determine the prevalence of bleeding in anticoagulant users during hospitalization. The secondary objective was to identify potential risk factors of bleeding in hospitalized patients on anticoagulant therapy. A prospective, observational cohort study was conducted in two Dutch hospitals. Adult patients hospitalized between October 2015 and October 2016 treated with anticoagulant therapy were included. Bleeding was defined as a composite endpoint of major bleeding and non-major bleeding according to the International Society on Thrombosis and Heamostasis (ISTH) criteria. Data analysis was performed by multivariate logistic regression. RESULTS The prevalence of in-hospital bleeding in patients using anticoagulant therapy was 7.2%; 95% confidence interval [95% CI] 5.5-9.1 (65 out of 906 patients). Multivariate logistic regression analysis indicated that female gender (adjusted odds ratio [ORadj] 2.1; 95% CI 1.2-3.7), high-bleeding-risk surgical procedure (ORadj 5.3; 95% CI 2.7-10.2), low-bleeding-risk surgical procedure (ORadj 4.9; 95% CI 1.9-12.6), and non-surgical interventions (ORadj 6.2; 95% CI 3.0-12.6) were associated with bleeding events in hospitalized patients treated with anticoagulants. CONCLUSIONS The prevalence of bleeding in anticoagulant users during hospitalization was 7.2%. This study detected potential risk factors that can help to identify patients on anticoagulants who have an increased risk of bleeding during hospitalization.
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Affiliation(s)
- Albert R Dreijer
- Erasmus University Medical Center, Rotterdam, Department of Hospital Pharmacy, The Netherlands; Reinier de Graaf Hospital, Department of Hospital Pharmacy, Delft, The Netherlands.
| | - Jeroen Diepstraten
- Reinier de Graaf Hospital, Department of Hospital Pharmacy, Delft, The Netherlands
| | - Rolf Brouwer
- Reinier de Graaf Hospital, Department of Hematology, Delft, The Netherlands
| | - F Nanne Croles
- Erasmus University Medical Center, Department of Hematology, Rotterdam, The Netherlands
| | - Esther Kragten
- Reinier de Graaf Hospital, Department of Hematology, Delft, The Netherlands
| | - Frank W G Leebeek
- Erasmus University Medical Center, Department of Hematology, Rotterdam, The Netherlands
| | - Marieke J H A Kruip
- Erasmus University Medical Center, Department of Hematology, Rotterdam, The Netherlands
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Croles FN, Nasserinejad K, Duvekot JJ, Kruip MJ, Meijer K, Leebeek FW. Pregnancy, thrombophilia, and the risk of a first venous thrombosis: systematic review and bayesian meta-analysis. BMJ 2017; 359:j4452. [PMID: 29074563 PMCID: PMC5657463 DOI: 10.1136/bmj.j4452] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Objective To provide evidence to support updated guidelines for the management of pregnant women with hereditary thrombophilia in order to reduce the risk of a first venous thromboembolism (VTE) in pregnancy.Design Systematic review and bayesian meta-analysis.Data sources Embase, Medline, Web of Science, Cochrane Library, and Google Scholar from inception through 14 November 2016.Review methods Observational studies that reported on pregnancies without the use of anticoagulants and the outcome of first VTE for women with thrombophilia were eligible for inclusion. VTE was considered established if it was confirmed by objective means, or when the patient had received a full course of a full dose anticoagulant treatment without objective testing. Results 36 studies were included in the meta-analysis. All thrombophilias increased the risk for pregnancy associated VTE (probabilities ≥91%). Regarding absolute risks of pregnancy associated VTE, high risk thrombophilias were antithrombin deficiency (antepartum: 7.3%, 95% credible interval 1.8% to 15.6%; post partum: 11.1%, 3.7% to 21.0%), protein C deficiency (antepartum: 3.2%, 0.6% to 8.2%; post partum: 5.4%, 0.9% to 13.8%), protein S deficiency (antepartum: 0.9%, 0.0% to 3.7%; post partum: 4.2%; 0.7% to 9.4%), and homozygous factor V Leiden (antepartum: 2.8%, 0.0% to 8.6%; post partum: 2.8%, 0.0% to 8.8%). Absolute combined antepartum and postpartum risks for women with heterozygous factor V Leiden, heterozygous prothrombin G20210A mutations, or compound heterozygous factor V Leiden and prothrombin G20210A mutations were all below 3%. Conclusions Women with antithrombin, protein C, or protein S deficiency or with homozygous factor V Leiden should be considered for antepartum or postpartum thrombosis prophylaxis, or both. Women with heterozygous factor V Leiden, heterozygous prothrombin G20210A mutation, or compound heterozygous factor V Leiden and prothrombin G20210A mutation should generally not be prescribed thrombosis prophylaxis on the basis of thrombophilia and family history alone. These data should be considered in future guidelines on pregnancy associated VTE risk.
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Affiliation(s)
- F Nanne Croles
- Department of Hematology, Erasmus University Medical Centre, Postbus 2040, 3000 CA, Rotterdam, Netherlands
| | - Kazem Nasserinejad
- Department of Hematology, Erasmus University Medical Centre, Postbus 2040, 3000 CA, Rotterdam, Netherlands
| | - Johannes J Duvekot
- Department of Obstetrics and Gynaecology, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Marieke Jha Kruip
- Department of Hematology, Erasmus University Medical Centre, Postbus 2040, 3000 CA, Rotterdam, Netherlands
| | - Karina Meijer
- Department of Haematology, University Medical Centre, University of Groningen, Groningen, Netherlands
| | - Frank Wg Leebeek
- Department of Hematology, Erasmus University Medical Centre, Postbus 2040, 3000 CA, Rotterdam, Netherlands
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Mulder R, Croles FN, Mulder AB, Huntington JA, Meijer K, Lukens MV. SERPINC1 gene mutations in antithrombin deficiency. Br J Haematol 2017; 178:279-285. [PMID: 28317092 DOI: 10.1111/bjh.14658] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [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: 10/04/2016] [Accepted: 01/16/2017] [Indexed: 12/13/2022]
Abstract
Existing evidence suggests that in most cases antithrombin deficiency can be explained by mutations in its gene, SERPINC1. We investigated the molecular background of antithrombin deficiency in a single centre family cohort study. We included a total of 21 families comprising 15 original probands and sixty-six relatives, 6 of who were surrogate probands for the genetic analysis. Antithrombin activity and antigen levels were measured. The heparin-antithrombin binding ratio assay was used to distinguish between the different subtypes of type II antithrombin deficiency. SERPINC1 mutations were detected by direct sequencing of all 7 exons and regulatory regions, and multiplex ligation-dependent probe amplification. Eighty-six per cent of the families had a detrimental SERPINC1 gene mutation that segregated in the family. We detected 13 different SERPINC1 gene mutations of which 5 were novel. Among all these mutations, 44% was associated with type I deficiency, whereas the remainder was associated with type II heparin binding site (11%), type II pleiotropic effect (33%), type II reactive site (6%) or had the antithrombin Cambridge II mutation (6%). The current study reports several novel SERPINC1 mutations, thereby adding to our knowledge of the molecular background of antithrombin deficiency. Finally, our results point out the importance of future research outside the conventional SERPINC1 gene approach.
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Affiliation(s)
- René Mulder
- Department of Laboratory Medicine, University Medical Centre Groningen, Groningen, the Netherlands
| | - F Nanne Croles
- Division of Haemostasis and Thrombosis, Department of Haematology, University Medical Centre Groningen, Groningen, the Netherlands.,Department of Haematology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - André B Mulder
- Department of Laboratory Medicine, University Medical Centre Groningen, Groningen, the Netherlands
| | - James A Huntington
- Department of Haematology, Cambridge Institute for Medical Research, University of Cambridge, Cambridge, UK
| | - Karina Meijer
- Division of Haemostasis and Thrombosis, Department of Haematology, University Medical Centre Groningen, Groningen, the Netherlands
| | - Michaël V Lukens
- Department of Laboratory Medicine, University Medical Centre Groningen, Groningen, the Netherlands
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Stolmeijer TM, van der Berg AP, Koeze J, Gouw ASH, Croles FN, Sieders E, Zijlstra JG. Interplay of co-inherited diseases can turn benign syndromes in a deadly combination: haemoglobinopathy and bilirubin transport disorder. Neth J Med 2015; 73:247-252. [PMID: 26087805] [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: 06/04/2023]
Abstract
We present a case about a 25-year-old male patient suffering from a rare genetic disorder called Mizuho haemoglobin. He was admitted to the Intensive Care Unit with acute liver and renal failure. During admission he also developed a cardiac tamponade twice. Finally he received a liver transplantation. Hereafter the patient stabilised and his liver and renal functions improved. His symptoms could not be explained solely by his known disease. After searching the literature, similarities between his symptoms and a rare complication of sickle cell disease were found. Molecular diagnostics showed that the patient also suffered from Gilbert's syndrome. Due to his chronic haemolysis, symptoms of this other disease were masked. This stresses the importance of always looking for other causes if symptoms or changes cannot be explained by a known rare disorder.
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Affiliation(s)
- T M Stolmeijer
- Departments of Critical Care,Emergency Medicine, University Medical Center Groningen, University of Groningen, the Netherlands
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Mulder R, Croles FN, Lukens MV, Meijer K, Mulder AB. A novel c.290G>A mutation in the Factor 11 gene in a Dutch Caucasian family with a Factor XI deficiency. Thromb Res 2015; 135:767-9. [PMID: 25618263 DOI: 10.1016/j.thromres.2015.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 12/20/2014] [Accepted: 01/11/2015] [Indexed: 10/24/2022]
Affiliation(s)
- R Mulder
- Department of Laboratory Medicine, Department of Haematology, University of Groningen, University Medical Centre Groningen, the Netherlands.
| | - F N Croles
- Division of Haemostasis and Thrombosis, Department of Haematology, University of Groningen, University Medical Centre Groningen, the Netherlands
| | - M V Lukens
- Department of Laboratory Medicine, Department of Haematology, University of Groningen, University Medical Centre Groningen, the Netherlands
| | - K Meijer
- Division of Haemostasis and Thrombosis, Department of Haematology, University of Groningen, University Medical Centre Groningen, the Netherlands
| | - A B Mulder
- Department of Laboratory Medicine, Department of Haematology, University of Groningen, University Medical Centre Groningen, the Netherlands
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Verbeek DE, Waanders F, Mulder AB, Bierman WF, Croles FN. Quiz Page May 2014. Am J Kidney Dis 2014; 63:A21-4. [PMID: 24725921 DOI: 10.1053/j.ajkd.2013.09.024] [Citation(s) in RCA: 3] [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] [Received: 07/01/2013] [Accepted: 09/16/2013] [Indexed: 11/11/2022]
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Croles FN, Beerenhout CH, Mulder AB, Meijer K, Nijziel MR. [AL amyloidosis-associated factor X deficiency]. Ned Tijdschr Geneeskd 2014; 158:A6678. [PMID: 24495369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND An acquired bleeding tendency is a specific symptom that can indicate an underlying disease. CASE DESCRIPTION Here we describe a 69-year-old patient with an acquired bleeding tendency resulting from a factor X deficiency due to an underlying amyloid light-chain (AL) amyloidosis. Factor X deficiency in AL amyloidosis arises from a quantitative and qualitative deficiency of factor X because it binds to amyloid fibrils exposed to circulating blood. CONCLUSION Bleeding tendency is a rare complication of AL amyloidosis, often resulting from a factor X deficiency.
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Croles FN, Brassé BP, Duisenberg-van Essenberg M, Baars HF, Schweitzer CM. [Connection between hypertension and myocardial infarction and chewing of khat leaves]. Ned Tijdschr Geneeskd 2009; 153:38-43. [PMID: 19198211] [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] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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