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Arvanitakis A, Jepsen C, Andersson NG, Baghaei F, Astermark J. Primary prophylaxis implementation and long-term joint outcomes in Swedish haemophilia A patients. Haemophilia 2024; 30:671-677. [PMID: 38575549 DOI: 10.1111/hae.15013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 03/21/2024] [Accepted: 03/26/2024] [Indexed: 04/06/2024]
Abstract
INTRODUCTION Primary prophylaxis is the gold standard in severe haemophilia A (SHA) but time to escalate the prophylaxis regimen varies. AIM Assess prophylaxis implementation and long-term joint health outcomes in SHA with primary prophylaxis. METHODS Adult male patients born after 1980, with SHA on primary prophylaxis, started before the age of 3 years and second joint bleed, and no history of FVIII inhibitors, were enrolled. Repeated joint-health examinations were performed with HJHS or HEAD-US; VERITAS-PRO assessed adherence. RESULTS Thirty patients were enrolled with, at inclusion, median age 33.5 years, annualized bleed rate and joint bleed rate 0, and FVIII consumption 4232 IU/kg/year, respectively. The median age was 1.2 years, at prophylaxis start once weekly with a median FVIII dose of 47.7 IU/kg, and 1.7 years, by the time escalation to a final regimen had occurred, with a median infusion frequency of thrice weekly and FVIII dose 41.7 IU/kg, respectively. Older age correlated with later transition to escalated prophylaxis (p < .001). Longer time to escalated prophylaxis correlated to more bleeds (p < .001). Median HJHS increased slowly, reaching 4 at 35-40 years. HJHS at 15-20 years correlated with higher HJHS afterwards. Median total HEAD-US score was 1 and correlated with HJHS (p < .001). Median VERITAS-PRO score was 36, indicating good treatment adherence. CONCLUSION Primary prophylaxis is effective but does not completely prevent the gradual development of arthropathy in SHA. Joint assessments with HJHS should start at an early age, as they correlate with arthropathy in later life. Prophylaxis escalation should proceed expeditiously to prevent bleeds.
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Affiliation(s)
- Alexandros Arvanitakis
- Department of Translational Medicine, Lund University, Malmö, Sweden
- Department of Haematology, Oncology and Radiation Physics, Skåne University Hospital, Malmö, Sweden
| | - Caroline Jepsen
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Medicine, Coagulation Centre, Gothenburg, Sweden
| | - Nadine G Andersson
- Department for Paediatric Haematology and Oncology, Children's Hospital, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences, Paediatrics, Lund University, Malmö, Sweden
| | - Fariba Baghaei
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Medicine, Coagulation Centre, Gothenburg, Sweden
| | - Jan Astermark
- Department of Translational Medicine, Lund University, Malmö, Sweden
- Department of Haematology, Oncology and Radiation Physics, Skåne University Hospital, Malmö, Sweden
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Boban A, Baghaei F, Karin F, Klamroth R, Miesbach W, Stephensen D, Kavanagh M, Noone D, Crato M, Peyvandi F. Accreditation model of European Haemophilia Centres in the era of novel treatments and gene therapy. Haemophilia 2023; 29:1442-1449. [PMID: 37819168 DOI: 10.1111/hae.14887] [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: 08/31/2022] [Revised: 10/03/2023] [Accepted: 10/03/2023] [Indexed: 10/13/2023]
Abstract
INTRODUCTION The international certification of haemophilia centres in Europe is run by the European Association of Haemophilia and Allied Disorders (EAHAD) and European Haemophilia Consortium (EHC) since 2013. The centres are designated as European Haemophilia Comprehensive Care Centres (EHCCC) or European Haemophilia Treatment Centres (EHTC), based on the specific requirements which evaluate centres' ability to provide care for patients with haemophilia and allied disorders. AIM To establish the new protocol for accreditation of European Haemophilia Centres. METHODS EAHAD, in collaboration with EHC, established Accreditation Working Group with the aim to define necessary measures to safeguard quality and improvement of bleeding disorders care throughout Europe and to build a novel model for accreditation of European Haemophilia Centres. RESULTS The European guidelines for certification of haemophilia centres have been updated to guidelines for the accreditation and include all the requirements regarding facilities, laboratory and personnel needed for optimal management of novel treatment options, including the introduction of the hub-and-spoke model for delivery of gene therapy. A pilot project for the accreditation of haemophilia centres including on-site audit has been designed. CONCLUSION Implementation of the novel accreditation protocol of the haemophilia treatment and haemophilia gene therapy centres has been made to further improve the quality of care for patients with haemophilia and other inherited bleeding disorders.
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Affiliation(s)
- Ana Boban
- Haemophilia Centre, Department of Haematology, University Hospital Centre Zagreb, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Fariba Baghaei
- Coagulation Centre, Department of Medicine, Section of Haematology and Coagulation, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Fijnvandraat Karin
- Amsterdam UMC, Emma Children's Hospital, Pediatric Hematology, University of Amsterdam, Amsterdam, Netherlands
| | - Robert Klamroth
- Department of Internal Medicine - Vascular Medicine and Haemostaseology, Haemophilia Treatment Centre, Vivantes Clinic im Friedrichshain, Berlin, Germany
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Medical Faculty, University of Bonn, Bonn, Germany
| | - Wolfgang Miesbach
- Department of Haemostaseology and Haemophilia Centre, Medical Clinic 2, Institute of Transfusion Medicine, University Hospital Frankfurt, Frankfurt, Germany
| | - David Stephensen
- Kent Haemophilia and Thrombosis Centre, East Kent Hospitals University NHS Trust, Canterbury, UK
| | - Mary Kavanagh
- Paediatric Coagulation Centre, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Declan Noone
- European Haemophilia Consortium, Bruxelles, Belgium
| | - Miguel Crato
- European Haemophilia Consortium, Bruxelles, Belgium
| | - Flora Peyvandi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi, Hemophilia and Thrombosis Center, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
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Astermark J, Baghaei F, Strandberg K, Toplican PG, Birkedal MF, Grahn EE, Hansson C, Kampmann P, Lehtinen AE, Täckström K, Holme PA, Magnusson M. Infrastructural considerations of implementing gene therapy for hemophilia in the Nordic context. Ther Adv Hematol 2023; 14:20406207231202306. [PMID: 37859645 PMCID: PMC10583513 DOI: 10.1177/20406207231202306] [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] [Received: 04/05/2023] [Accepted: 08/18/2023] [Indexed: 10/21/2023] Open
Abstract
Background Despite improvements in hemophilia care, challenges remain, including treatment burden and impaired quality of life. Gene therapy may overcome these. However, its introduction presents a challenge. Objectives To outline a function-based gene therapy working model describing critical milestones associated with gene therapy handling, administration, and follow-up to facilitate and implement an effective infrastructure for gene therapy introduction. Design Literature review and consensus discussion among Hemophilia Comprehensive Care centers (HCCCs) in the Nordic region. Methods Representatives from six HCCCs sought to pinpoint milestones and key stakeholders for site readiness at the pre-, peri-, and post-infusion stages, including authority and genetically modified organism (GMO) product requirements, awareness, medical eligibility, logistics and product handling for infusion, laboratory monitoring, and follow-up. Results A gene therapy transit map was developed with key stakeholders identified. The approach to prepare the vector will differ between the Nordic centers, but the contracted pharmacy unit will be a key stakeholder. Therefore, a pharmacy checklist for the implementation of gene therapy was developed. For the future, Advanced Therapy Medicinal Product centers will also be implemented. Patients' expectations, commitments, and concerns need to be addressed repeatedly and education of patients and the expanded health-care professionals team will be the key to successful and optimal clinical management. Eligibility testing according to the product's summary of product characteristics and frequent follow-up and monitoring post-infusion according to the World Federation of Hemophilia chart will be crucial. Conclusion The approach to deliver gene therapy in the Nordic region will differ partly between the hemophilia centers, but the defined road map with checklists for the implementation of this advanced therapy will be applicable to all. The map may also serve as a platform for the use of future GMO product options both within and outside the area of hemophilia.
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Affiliation(s)
- Jan Astermark
- Department of Translational Medicine, Lund University, Malmö, Sweden
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Jan Waldenströms gata 14, Malmö, SE-205 02, Sweden
| | - Fariba Baghaei
- Department of Medicine, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Karin Strandberg
- Division of Laboratory Medicine, Department of Clinical Chemistry and Pharmacology, Coagulation, University and Regional Laboratories Region Skåne, Malmö, Sweden
| | | | - Maj Friberg Birkedal
- Department of Pediatric Hematology/Oncology, Rigshospitalet, Copenhagen, Denmark
| | - Emma Engman Grahn
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Malmö, Sweden
| | | | - Peter Kampmann
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark
| | - Anna-Elina Lehtinen
- Coagulation Disorders Unit, Department of Hematology, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland
| | | | - Pål Andre Holme
- Department of Hematology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Maria Magnusson
- Coagulation Unit, Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
- Clinical Chemistry and Blood Coagulation Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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4
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Kihlberg K, Baghaei F, Bruzelius M, Funding E, Andre Holme P, Lassila R, Nummi V, Ranta S, Gretenkort Andersson N, Berntorp E, Astermark J. No difference in quality of life between persons with severe haemophilia A and B. Haemophilia 2023; 29:987-996. [PMID: 36791275 DOI: 10.1111/hae.14759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/24/2023] [Accepted: 01/29/2023] [Indexed: 02/17/2023]
Abstract
INTRODUCTION Good health-related quality of life (HRQoL) is an important goal in the treatment of persons with haemophilia B (PwHB). Studies focusing on this population are limited, however, and data are insufficient. AIM To assess the HRQoL in PwHB and to compare this to data on persons with haemophilia A (PwHA), as well as to evaluate the impact of joint health on HRQoL and to identify areas of insufficient care. METHODS The B-NORD study enrolled persons with severe haemophilia B and matched controls with haemophilia A. HRQoL was assessed using the EQ-5D-3L questionnaire and joint health using Haemophilia Joint Health Score 2.1 (HJHS). RESULTS The EQ-5D-3L was completed by 63 PwHB and 63 PwHA. Mobility problems were reported by 46% of PwHB and 44% of PwHA, pain/discomfort by 62% and 56%, and anxiety/depression by 33% and 17%, respectively. No significant difference was observed between PwHA and PwHB in EQ-5D profiles, level sum score, EQ-5D index (PwHB mean .80, PwHA mean .83, p = .24), or EQ VAS score (PwHB: mean 70, PwHA: mean 77, p = .061). Linear regression adjusted for age demonstrated that an increase in HJHS score was associated with a significant decrease in both EQ-5D index (B -.003, R2 .22) and EQ VAS score (B -.37, R2 .17). CONCLUSION Despite the majority of patients being treated with prophylaxis, impaired HRQoL was reported in both PwHB and PwHA. No differences in HRQoL were found between the two groups. Impaired joint health had a significant negative impact on HRQoL.
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Affiliation(s)
- Kristina Kihlberg
- Clinical Coagulation Research, Department of Translational Medicine, Lund University, Malmö, Sweden
- Department of Haematology, Oncology and Radiation Physics, Centre for Thrombosis and Haemostasis, Skåne University Hospital, Malmö, Sweden
| | - Fariba Baghaei
- Department of Haematology and Coagulation, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maria Bruzelius
- Department of Haematology, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Eva Funding
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark
- Institute of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - Pål Andre Holme
- Department of Haematology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Riitta Lassila
- Department of Haematology, Coagulation Disorders Unit, Comprehensive Cancer Centre, Helsinki University Hospital, Helsinki, Finland
- Research Programme in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Vuokko Nummi
- Department of Haematology, Coagulation Disorders Unit, Comprehensive Cancer Centre, Helsinki University Hospital, Helsinki, Finland
- Research Programme in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Susanna Ranta
- Paediatric Coagulation, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
- Paediatric Oncology, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Nadine Gretenkort Andersson
- Department of Haematology, Oncology and Radiation Physics, Centre for Thrombosis and Haemostasis, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences and Paediatrics, Lund University, Lund, Sweden
- Department of Paediatric Haematology and Oncology, Skåne University Hospital, Lund, Sweden
| | - Erik Berntorp
- Clinical Coagulation Research, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Jan Astermark
- Clinical Coagulation Research, Department of Translational Medicine, Lund University, Malmö, Sweden
- Department of Haematology, Oncology and Radiation Physics, Centre for Thrombosis and Haemostasis, Skåne University Hospital, Malmö, Sweden
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5
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Steen Carlsson K, Winding B, Astermark J, Baghaei F, Brodin E, Funding E, Holmström M, Österholm K, Bergenstråle S, Lethagen S. High use of pain, depression, and anxiety drugs in hemophilia: more than 3000 people with hemophilia in an 11-year Nordic registry study. Res Pract Thromb Haemost 2023; 7:100061. [PMID: 36908766 PMCID: PMC9999211 DOI: 10.1016/j.rpth.2023.100061] [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: 08/25/2022] [Revised: 12/16/2022] [Accepted: 12/21/2022] [Indexed: 02/01/2023] Open
Abstract
Background Pain is a common feature of hemophilia, but prevalence of depression and anxiety is less studied. Registry data on prescription drugs can provide an objective measure of the magnitude of these complications. Objectives To identify treatment patterns of prescribed pain, antidepressant, and antianxiety medications compared with those of matched controls in 4 Nordic countries. Methods The MIND study (NCT03276130) analyzed longitudinal individual-level national data during 2007-2017. People with hemophilia (PwH) were identified from National Health Data Registers by diagnosis or factor replacement treatment and compared with population controls. Three subgroups were defined by the use of factor concentrates and sex (moderate-to-high factor consumption (factor VIII [FVIII] use of ≥40 IU/kg/week or FIX use of ≥10 IU/kg/week), low factor consumption, and women including carriers). Results Data of 3246 PwH, representing 30,184 person-years, were analyzed. PwH (including children and adults) used more pain, depression, and anxiety medications compared with controls. This was most accentuated in the moderate-to-high factor consumption group and notably also observed in men with low factor consumption and women including carriers, usually representing a milder phenotype. A higher opioid use was observed across all age groups: 4- to 6-fold higher in the moderate-to-high factor consumption group and 2- to 4-fold higher in the low factor consumption group. Conclusion The consistent higher use of pain, depression, and anxiety medications among PwH compared with population controls, regardless of age, sex, or factor consumption, in broad national data suggests a need for improved bleed protection and hemophilia care for all severities including mild hemophilia.
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Affiliation(s)
- Katarina Steen Carlsson
- The Swedish Institute for Health Economics, Lund, Sweden.,Lund University, Department of Clinical Sciences, Malmö, Lund, Sweden
| | | | - Jan Astermark
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Malmö, Sweden
| | - Fariba Baghaei
- Coagulation Centre, Department of Medicine/Section of Hematology and Coagulation, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Elisabeth Brodin
- Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Neuroscience and Physiology, Section for Clinical Neuroscience and Rehabilitation, The Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Eva Funding
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark.,Copenhagen University, Copenhagen, Denmark
| | - Margareta Holmström
- Coagulation Unit, Centre of Hematology, Karolinska University Hospital, Stockholm, Sweden.,Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Klaus Österholm
- HUS Internal Medicine and Rehabilitation, Physiatric Outpatient Clinic, Helsinki University Hospital, Helsinki, Finland
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Olsson A, Westesson LM, Baghaei F, Holmström M, Olsson E, Magnusson M, Ranta S, Astermark J, Andersson NG, Thanner J, Szamosi J, Daoura L, Sennfält K. Real-world prophylactic usage of recombinant factor IX Fc in Sweden: A report from the Swedish National Registry for bleeding disorders. Haemophilia 2023; 29:377-381. [PMID: 36469854 DOI: 10.1111/hae.14704] [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: 06/29/2022] [Revised: 11/08/2022] [Accepted: 11/16/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Anna Olsson
- Department of Medicine, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Linda Myrin Westesson
- Department of Medicine, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.,Sahlgrenska Academy, Institution for Nursing Science and Health at Gothenburg University, Gothenburg, Sweden
| | - Fariba Baghaei
- Department of Medicine, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Margareta Holmström
- Department of Hematology, Coagulation Unit, Karolinska University Hospital, Stockholm, Sweden.,Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Acute Internal Medicine and Geriatrics, Linköping University, Linköping, Sweden
| | - Elsa Olsson
- Department of Hematology, Coagulation Unit, Karolinska University Hospital, Stockholm, Sweden
| | - Maria Magnusson
- Department of Hematology, Coagulation Unit, Karolinska University Hospital, Stockholm, Sweden.,Pediatric Coagulation Unit, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,MMK and CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Susanna Ranta
- Pediatric Coagulation Unit, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Jan Astermark
- Department of Translational Medicine and Department of Hematology, Oncology and Radiation Physics, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Nadine G Andersson
- Department for Paediatric Haematology and Oncology, Children's Hospital, Skåne University Hospital, Malmö, Sweden.,Department of Clinical Sciences, Paediatrics, Lund University, Malmö, Sweden
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7
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Lundin B, Baghaei F, Holmström M, Petrini P, Müller G, Månsson S, Ljung R. Haemophilia A and B - evaluation of the Swedish prophylactic regimen by magnetic resonance imaging. Haemophilia 2023; 29:193-198. [PMID: 36469433 PMCID: PMC10107095 DOI: 10.1111/hae.14693] [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: 01/05/2022] [Revised: 10/26/2022] [Accepted: 10/26/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Sweden has been a pioneer in the prophylactic treatment of haemophilia. Magnetic resonance imaging (MRI) can detect small changes in joints and can therefore give an indication of a risk of developing arthropathy. AIM To use MRI to evaluate the outcome of the Swedish 'high-dose regimen' and correlate the findings to age, bleeds, joint score and physical activity. METHODS The study group comprised 48 Swedish male patients, mean age 25 years (range 12-33 years), with severe or moderate haemophilia A or B. Data on the Haemophilia Joint Health Score (HJHS) were available and physical activity was evaluated by a self-reported questionnaire. RESULTS MRI score was recorded in 188 joints. Twenty out of 48 patients had a score of ≥1 (range 1-13) in 31 joints of which 3/31 scores were in the knees and 28/31 in the ankles. No correlation was found between the number of recorded bleeds and the MRI score or between HJHS and MRI score. There was no correlation between the physical activity and the number of joint bleeds per se, but a trend (OR 3.0) that those most physically active (19/48; 39.6%), more frequently had an MRI score of ≥1 with an overweight for the right ankle. CONCLUSION The Swedish prophylactic model offers protection against haemophilia joint arthropathy but will still not prevent osteochondral changes in some patients at young age. MRI of the ankles can signal risk of future arthropathy and indicate need to modify the prophylactic regimen.
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Affiliation(s)
- Björn Lundin
- Department of Clinical Sciences Lund (IKVL) - Radiology, Lund University, Lund, Sweden and Dept. of Medical Imaging and Physiology, Skåne University Hospital, Lund/Malmö, Sweden
| | - Fariba Baghaei
- Coagulation Centre, Department of Medicine/Section of Hematology and Coagulation, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Margareta Holmström
- Coagulation Unit, Department of Hematology, Karolinska University Hospital, Stockholm, Sweden.,Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Pia Petrini
- Astrid Lindgren Children´s Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Gunilla Müller
- Institut für Radiologie und Nuklearmedizin, Stadtspital Triemli, Zürich, Switzerland
| | - Sven Månsson
- Medical Radiation Physics, Department of Translational Medicine, Lund University, Malmö, Sweden.,Hematology, Oncology and Radiation Physics, Skåne University Hospital, Malmö, Sweden
| | - Rolf Ljung
- Department of Clinical Sciences Lund (IKVL) - Paediatrics, Lund University, Lund, Sweden
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Bian L, Baghaei F, Antovic J, Fagerberg Blixter I, Hillarp A, Strandberg K, Willman D, L Lindahl T. [Routine screening with APTT is not indicated before surgery]. Lakartidningen 2022; 119:21240. [PMID: 35713306] [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: 06/15/2023]
Abstract
Activated partial thromboplastin time (APTT) is widely practiced in preoperative screening. The value of using this test to predict the risk of perioperative bleeding is not well documented in Sweden. In this article, a literature review is performed to determine whether unselected APTT testing can predict abnormal perioperative bleeding. The current literature does not support coagulation screening with APTT in routine perioperative bleeding assessment, as preoperative screening with APTT has a low sensitivity for detection of clinically significant bleeding disorder. While a comprehensive bleeding history is crucial, the APTT test should only be performed on patients with a history of increased bleeding tendency. The conclusion of this literature review is that patients with a negative bleeding history do not require routine screening with APTT prior to surgery, which, if implemented, would lead to a more cost-effective perioperative routine.
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Affiliation(s)
- Li Bian
- med dr, specialistläkare, klinisk kemi, Sahlgrenska universitetssjukhuset, Göteborg
| | - Fariba Baghaei
- med dr, överläkare, Koagulationscentrum, sektionen för hematologi och koagulation, VO specialistmedicin, Sahlgrenska universitetssjukhuset, Göteborg
| | - Jovan Antovic
- Karolinska universitetssjukhuset, Stockholm, klinisk kemi, Karolinska universitetssjukhuset, Stockholm
| | - Inger Fagerberg Blixter
- med mag, teknisk specialist, klinisk kemi och transfusionsmedicin, Sahlgrenska universitetssjukhuset, Göteborg
| | - Andreas Hillarp
- docent, biokemiker, Klinikk for laboratorie-medisin, Sekjson for hemostase og trombose, Oslo Universitetssykehus
| | - Karin Strandberg
- docent, överläkare, Laboratorie-medicin, Medicinsk service, Region Skåne
| | - David Willman
- med dr, leg biomedicinsk analytiker, klinisk kemi, Norrlands universitetssjukhus, Umeå
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Lehtinen AE, Baghaei F, Astermark J, Holme PA. Surgical outcomes in patients with haemophilia A or B receiving extended half-life recombinant factor VIII and IX Fc fusion proteins: Real-world experience in the Nordic countries. Haemophilia 2022; 28:713-719. [PMID: 35575446 PMCID: PMC9542088 DOI: 10.1111/hae.14585] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 04/13/2022] [Accepted: 04/27/2022] [Indexed: 11/28/2022]
Abstract
Introduction Perioperative dosing recommendations vary across Nordic haemophilia treatment centres (HTCs) for extended half‐life (EHL) factor concentrates in haemophilia A/B (HA/HB) patients. Aim To summarise Nordic real‐world surgical experiences with EHL recombinant factor VIII/IX Fc (rFVIIIFc/rFIXFc) fusion proteins using retrospective data from clinical records at four HTCs in Finland, Sweden and Norway. Methods Factor dosing and surgical outcomes were recorded from HA/HB patients who underwent surgery and were treated with rFVIIIFc/rFIXFc. Perioperative factor dosing regimens were clinician‐determined based on local practises. Results Twenty five surgeries were performed on 20 patients, all covered by bolus injections except one minor HA surgery; eight minor surgeries were in paediatric patients. Median preoperative rFVIIIFc dose for major HA surgeries (n = 8) was 48 IU/kg (range: 35–57), with total consumption up to Day 14 of 427 IU/kg (196–568). For the two major HB surgeries (in one patient), preoperative rFIXFc doses were 50 IU/kg and 20 IU/kg; total consumption up to Day 14 was 130 IU/kg and 40 IU/kg. Median preoperative rFVIIIFc/rFIXFc bolus doses for minor HA (n = 10) and HB (n = 4) surgeries were 50 IU/kg (24–79) and 47 IU/kg (40–71), with total consumption up to Day 5 of 138 IU/kg (49–404) and 100 IU/kg (43–125), respectively. Intraoperative and postoperative haemostatic responses were rated as at least good/excellent for 24/25 surgeries, with bleeding episodes reported in only three surgeries. Conclusion Nordic real‐world experiences suggest that EHL products can be used safely and effectively for peri‐operative haemostasis. Further research is required to develop local dosing guidelines for optimised treatment schedules.
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Affiliation(s)
- Anna-Elina Lehtinen
- Coagulation Disorders Unit, Department of Haematology, Helsinki University Hospital Comprehensive Cancer Centre and University of Helsinki, Helsinki, Finland
| | - Fariba Baghaei
- Coagulation Centre, Department of Medicine/Section of Haematology and Coagulation, Sahlgrenska University Hospital and Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jan Astermark
- Institution for Translational Medicine, Lund University and Department for Haematology, Oncology and Radiation Physics, Skåne University Hospital, Malmö, Sweden
| | - Pål André Holme
- Department of Haematology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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10
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Steen Carlsson K, Winding B, Astermark J, Baghaei F, Brodin E, Funding E, Holmström M, Österholm K, Bergenstråle S, Andersson E, Lethagen S. Pain, depression and anxiety in people with haemophilia from three Nordic countries: Cross-sectional survey data from the MIND study. Haemophilia 2022; 28:557-567. [PMID: 35460313 PMCID: PMC9543565 DOI: 10.1111/hae.14571] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 03/15/2022] [Accepted: 04/08/2022] [Indexed: 11/29/2022]
Abstract
Introduction People with haemophilia (PwH) may experience symptoms of haemophilia‐related pain, depression or anxiety, which can negatively impact health‐related quality of life. Aim To obtain the perspective of PwH and treaters from Sweden, Finland and Denmark on the management of haemophilia‐related pain, depression and anxiety using cross‐sectional survey data from the MIND study (NCT03276130). Methods PwH or their caregivers completed a survey about experiences of pain, depression and anxiety related to haemophilia, and the standard EQ‑5D‐5L instrument. Five investigators at haemophilia treatment centres (HTC) were sent a complementary survey containing questions about the management of pain and depression/anxiety. Results There were 343 PwH (mild: 103; moderate: 53; severe: 180; seven lacking severity information) and 71 caregiver responses. Experience of pain in the last 6 months was reported by 50% of PwH respondents and 46% of caregiver respondents. Anxiety/depression was reported by 28% of PwH respondents. Reporting of pain and anxiety/depression was associated with disease severity. Whilst 62% of PwH who had experienced pain at any time point (n = 242) felt this was adequately addressed and treated at their HTC, only 24% of those who had experienced depression/anxiety (n = 127) felt this was adequately addressed. Disease severity was negatively associated with EQ‐5D‐5L utility value (p < .001). In the HTC survey, 4/5 and 2/5 agreed that pain and depression/anxiety, respectively, are adequately addressed. Conclusions Pain and depression/anxiety occur more frequently with increasing haemophilia severity, with negative impacts on health‐related quality of life. PwH with depression/anxiety or unaddressed pain could benefit from improved management strategies.
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Affiliation(s)
- Katarina Steen Carlsson
- The Swedish Institute for Health Economics, Lund, Sweden.,Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
| | | | - Jan Astermark
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Malmö, Sweden
| | - Fariba Baghaei
- Coagulation Centre, Department of Medicine/Section of Hematology and Coagulation, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Elisabeth Brodin
- Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Neuroscience and Physiology, Section for Clinical Neuroscience and Rehabilitation, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eva Funding
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Margareta Holmström
- Coagulation Unit, Centre of Hematology, Karolinska University Hospital, Stockholm, Sweden.,Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Klaus Österholm
- HUS Internal Medicine and Rehabilitation, Physiatry Outpatient Clinic, Helsinki University Hospital, Helsinki, Finland
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11
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Miesbach W, Baghaei F, Boban A, Chowdary P, Coppens M, Hart DP, Jimenez-Yuste V, Klamroth R, Makris M, Noone D, Peyvandi F. Gene therapy of hemophilia: Hub centres should be haemophilia centres: A joint publication of EAHAD and EHC. Haemophilia 2022; 28:e86-e88. [PMID: 35263819 DOI: 10.1111/hae.14546] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/22/2022] [Accepted: 02/27/2022] [Indexed: 12/27/2022]
Affiliation(s)
- Wolfgang Miesbach
- Medical Clinic, Institute of Transfusion Medicine, University Hospital Frankfurt, Frankfurt, Germany
| | - Fariba Baghaei
- Coagulation Centre, Department of Medicine, Section of Hematology and Coagulation, Sahlgrenska University Hospital and Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ana Boban
- Haemophilia Centre, Department of Haematology, University Hospital Centre Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Pratima Chowdary
- Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London, UK
| | - Michiel Coppens
- Department of Vascular Medicine, Hemophilia Treatment Center, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Daniel P Hart
- The Royal London Hospital Haemophilia Centre, Barts and The London School of Medicine & Dentistry, QMUL, London, UK
| | - Victor Jimenez-Yuste
- Hematology Department, Hospital Universitario La Paz, Autonoma University, Madrid, Spain
| | - Robert Klamroth
- Department for Internal Medicine and Vascular Medicine, Haemophilia Treatment Center, Vivantes Hospital im Friedrichshain, Berlin, Germany
| | - Mike Makris
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Declan Noone
- European Haemopilia Consortium, Brussels, Belgium
| | - Flora Peyvandi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
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12
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Kihlberg K, Baghaei F, Bruzelius M, Funding E, Andre Holme P, Lassila R, Nummi V, Ranta S, Osooli M, Berntorp E, Astermark J. Treatment outcomes in persons with severe haemophilia B in the Nordic region: The B-NORD study. Haemophilia 2021; 27:366-374. [PMID: 33780113 DOI: 10.1111/hae.14299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/01/2021] [Accepted: 03/06/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Data on outcome in persons with haemophilia B (PwHB) are limited and mainly extrapolated from studies of haemophilia A (HA). AIM To characterize treatment outcomes in persons with severe HB in the Nordic region, with a focus on joint health, compared with matched controls with HA. METHODS PwHB attending haemophilia centres in Denmark, Finland, Norway and Sweden were enrolled and matched with controls with HA. Joint assessment using Haemophilia Joint Health Score (HJHS) and ultrasound according to Haemophilia Early Arthropathy Detection protocol (HEAD-US) was conducted. Adherence was evaluated using the Validated Haemophilia Regimen Treatment Adherence Scale (VERITAS). RESULTS Seventy-nine males with HB, with median age of 30 years (range 1-75), were enrolled. Eleven patients (14%) had a history of or current inhibitor. Twenty-nine PwHB (37%) reported joint bleeds during the prior year, and 35% had previously undergone joint surgery. Ninety-five per cent were on prophylaxis, and 70% used recombinant concentrates, with a median factor consumption of 3,900 IU/kg/year for standard half-life products. Only two patients had a VERITAS score corresponding to 'non-adherence'. Joint health, assessed with HJHS, showed a significant lower score among PwHB compared with HA controls, explained by a difference in the 18-49 age group, without observed differences in older or younger subgroups. The HEAD-US scores were overall low. CONCLUSION The Nordic cohort of PwHB is well treated by prophylaxis, but the goal of zero bleeds for all is not reached. Our findings suggest that patients with severe HB suffer from a milder arthropathy than patients with severe HA.
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Affiliation(s)
- Kristina Kihlberg
- Clinical Coagulation Research, Department of Translational Medicine, Lund University, Malmö, Sweden.,Department of Haematology, Oncology and Radiation Physics, Centre for Thrombosis and Haemostasis, Skåne University Hospital, Malmö, Sweden
| | - Fariba Baghaei
- Department of Medicine/Hematology and Coagulation, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Maria Bruzelius
- Department of Haematology, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Eva Funding
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark.,Institute of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - Pål Andre Holme
- Department of Haematology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Riitta Lassila
- Department of Hematology, Coagulation Disorders Unit, Comprehensive Cancer Centre, Helsinki University Hospital, Helsinki, Finland.,Research Program in Systems Oncology, Faculty of Medicine, Helsinki University, Helsinki, Finland
| | - Vuokko Nummi
- Department of Hematology, Coagulation Disorders Unit, Comprehensive Cancer Centre, Helsinki University Hospital, Helsinki, Finland.,Research Program in Systems Oncology, Faculty of Medicine, Helsinki University, Helsinki, Finland
| | - Susanna Ranta
- Pediatric Coagulation, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Mehdi Osooli
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Erik Berntorp
- Clinical Coagulation Research, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Jan Astermark
- Clinical Coagulation Research, Department of Translational Medicine, Lund University, Malmö, Sweden.,Department of Haematology, Oncology and Radiation Physics, Centre for Thrombosis and Haemostasis, Skåne University Hospital, Malmö, Sweden
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13
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Myrin Westesson L, Sparud‐Lundin C, Baghaei F, Khair K, Mackensen S, Acuña Mora M, Wallengren C. Burden on parents of children with haemophilia: The impact of sociodemographic and child's medical condition. J Clin Nurs 2019; 28:4077-4086. [DOI: 10.1111/jocn.15003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 06/17/2019] [Accepted: 06/30/2019] [Indexed: 12/16/2022]
Affiliation(s)
- Linda Myrin Westesson
- Sahlgrenska University Hospital Gothenburg Sweden
- Institute of Health and Care Sciences The Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
| | - Carina Sparud‐Lundin
- Institute of Health and Care Sciences The Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
| | | | - Kate Khair
- Centre for Outcomes and Experience Research in Children’s Health, Illness and Disability (ORCHID) Great Ormond Street Hospital for Children NHS Trust London UK
| | - Sylvia Mackensen
- Department of Medical Psychology University Medical Centre Hamburg‐Eppendorf Hamburg Germany
| | - Mariela Acuña Mora
- Institute of Health and Care Sciences The Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
- Department of Public Health and Primary Care KU Leuven Leuven Belgium
| | - Catarina Wallengren
- Institute of Health and Care Sciences The Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
- Centre for Person‐Centred Care (GPCC) University of Gothenburg Gothenburg Sweden
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14
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Lövdahl S, Henriksson KM, Baghaei F, Holmström M, Berntorp E, Astermark J. Hypertension and cardiovascular diseases in Swedish persons with haemophilia — A longitudinal registry study. Thromb Res 2019; 181:106-111. [DOI: 10.1016/j.thromres.2019.07.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 06/25/2019] [Accepted: 07/19/2019] [Indexed: 11/28/2022]
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15
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Osooli M, Donfield SM, Carlsson KS, Baghaei F, Holmström M, Berntorp E, Astermark J. Joint comorbidities among Swedish carriers of haemophilia: A register-based cohort study over 22 years. Haemophilia 2019; 25:845-850. [PMID: 31411798 DOI: 10.1111/hae.13831] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 06/24/2019] [Accepted: 07/11/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND A significant fraction of women with an impaired factor VIII or IX gene in the X chromosome, carriers of haemophilia, will have clotting factor activities corresponding to those seen in males with non-severe haemophilia, hence, experience an increased bleeding tendency. Data describing the long-term joint outcomes among carriers are limited. We compared the age at onset, frequency of joint-related diagnoses as well as joint surgery and related hospitalizations among carriers of haemophilia with sex- and birthdate-matched controls from the general population. METHODS Carriers of haemophilia born 1941-2008 were identified through the haemophilia treatment centres' (HTCs) databases and the National Patient Register of Sweden. For each carrier, we included up to five individuals using the Swedish population register as comparisons. Data for the period 1987-2008 were obtained. RESULTS Among 539 potential carriers identified, 213 had a known factor activity. Carriers with reduced factor activity and those with unknown factor activity had received their first joint-related diagnosis at a significantly earlier age than their comparisons. The same subgroups showed an overall 2.3- and 2.4-fold higher hazard for joint-related diagnoses compared with the general population. In addition, the hazards of joint-related outpatient hospitalization were 3.2-fold (95% CI: 1.2, 9.1) and 2.5-fold (95% CI: 1.6, 3.7). This was not observed for those with normal factor activity. CONCLUSION Carriers of haemophilia suffer a significant risk for joint comorbidities. This risk seems to correlate to the factor activity. Our findings underline the importance of regular clinical follow-up of carriers at HTCs.
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Affiliation(s)
- Mehdi Osooli
- Centre for Thrombosis and Hemostasis, Skåne University Hospital, Lund University, Malmö, Sweden.,Department of Translational Sciences, Faculty of Medicine, Lund University, Malmö, Sweden
| | | | - Katarina Steen Carlsson
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Swedish Institute for Health Economics, Lund, Sweden
| | - Fariba Baghaei
- Coagulation Centre, Department of Haematology and Coagulation, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Margareta Holmström
- Coagulation Unit, Patient Area Hematology, Karolinska University Hospital, Stockholm, Sweden.,Department of Internal Medicine, Karolinska Institute, Stockholm, Sweden
| | - Erik Berntorp
- Centre for Thrombosis and Hemostasis, Skåne University Hospital, Lund University, Malmö, Sweden.,Department of Translational Sciences, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Jan Astermark
- Centre for Thrombosis and Hemostasis, Skåne University Hospital, Lund University, Malmö, Sweden.,Department of Translational Sciences, Faculty of Medicine, Lund University, Malmö, Sweden
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16
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Myrin Westesson L, Wallengren C, Baghaei F, Sparud-Lundin C. Reaching Independence Through Forced Learning: Learning Processes and Illness Management in Parents of Children Affected by Hemophilia. Qual Health Res 2018; 28:2142-2154. [PMID: 30066606 DOI: 10.1177/1049732318789631] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Hemophilia is a complex condition to manage, especially for parents to newly diagnosed children. This grounded theory study explores parents' learning processes and illness management in daily life during the first year after the start of their child's treatment. Using a longitudinal qualitative design, eight parents of four children were interviewed repeatedly during 12 to 14 months. The core category, reaching independence through forced learning, reflected the parents' learning process and their experiences of the challenges during the first year after start of treatment. Incentives for learning were characterized by a longing to reach independence and regain control of one's life situation. The emerging key incentive for learning was a desire to become independent of health care professionals. Early home treatment reduced the impact of the illness, and by supporting parents in different ways during the learning process, health care professionals can promote the parents' trajectory toward independency.
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Affiliation(s)
| | - Catarina Wallengren
- 2 Institute of Health and Care Sciences, the Sahlgrenska Academy at University of Gothenburg, Sweden
- 3 Centre for Person-Centred Care (GPCC), University of Gothenburg, Sweden
| | | | - Carina Sparud-Lundin
- 2 Institute of Health and Care Sciences, the Sahlgrenska Academy at University of Gothenburg, Sweden
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17
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Hillarp A, Strandberg K, Baghaei F, Fagerberg Blixter I, Gustafsson KM, Lindahl TL. Effects of the oral, direct factor Xa inhibitor edoxaban on routine coagulation assays, lupus anticoagulant and anti-Xa assays. Scandinavian Journal of Clinical and Laboratory Investigation 2018; 78:575-583. [DOI: 10.1080/00365513.2018.1522664] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Andreas Hillarp
- Department of Clinical Chemistry and Transfusion Medicine, Halland County Hospital, Halmstad, Sweden
| | - Karin Strandberg
- Department of Clinical Chemistry, University and Regional Laboratories Region Skåne, Malmö, Sweden
| | - Fariba Baghaei
- Department of Medicine, Coagulation Centre, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Inger Fagerberg Blixter
- Department of Clinical Chemistry and Transfusion Medicine, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kerstin M. Gustafsson
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Tomas L. Lindahl
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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18
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Blomqvist L, Strandell A, Baghaei F, Hellgren M. 270. Acetylsalicylic acid for inhibition of platelet aggregation during pregnancy. Pregnancy Hypertens 2018. [DOI: 10.1016/j.preghy.2018.08.109] [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: 11/27/2022]
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19
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Brodin E, Hadzibajramovic E, Baghaei F, Sunnerhagen KS, Lundgren-Nilsson Å. Self-reported activity of Swedish persons with haemophilia: Change over 2.5 years. J Rehabil Med 2018; 50:643-651. [PMID: 29881866 DOI: 10.2340/16501977-2353] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To describe self-reported activity using the Haemophilia Activity List (HAL) for Swedish adults with haemophilia and to detect any changes over time. METHOD The HAL was sent to the adult population with haemophilia A and B, moderate and severe form, living in Sweden (n = 260). Participants completed the HAL and a questionnaire on sociodemographic and medical information. From a previous study cohort, 61 persons had responded twice to the HAL. The investigated group was divided into early and later treatment onset groups with regard to access to medication. RESULTS The response rate was 50%. There was a significant difference (p < 0.001) between the early and later treatment groups in all domains in HAL. When analysing HAL "question by question" from the 2 reported time-points, the most prominent outcome was that the reported ability in activities was stable over time at the group level, except for participants who had no access to the clotting factor early in life. They reported greater limitations in some of the activities in the challenging domain "leisure activities and sport". CONCLUSION The early treatment group reported a significantly better ability in all activities compared with the late treatment group.
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Affiliation(s)
- Elisabeth Brodin
- Department of Clinical Neuroscience and Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Institute of Neuroscience and Physiology, , 413 45 Göteborg, Sweden.
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20
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Romlin BS, Söderlund F, Wåhlander H, Hallhagen S, Wessman C, Baghaei F, Jeppsson A. Perioperative monitoring of platelet function in paediatric cardiac surgery by thromboelastometry, or platelet aggregometry? Br J Anaesth 2018; 116:822-8. [PMID: 27199313 DOI: 10.1093/bja/aew053] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Impaired platelet function increases the risk of bleeding complications in cardiac surgery. Reliable assessment of platelet function can improve treatment. We investigated whether thromboelastometry detects clinically significant preoperative, perioperative, and postoperative adenosine diphosphate (ADP)-dependent platelet dysfunction in paediatric cardiac surgery patients. METHODS Fifty-seven children were included in a single-centre prospective observational study. Clot formation (modified rotational thromboelastometry with heparinase, HEPTEM) and platelet aggregation (multiple electrode aggregometry) were analysed at five time points before, during, and after surgery. The accuracy of thromboelastometric indices of platelet function [maximal clot firmness (MCF) and clot formation time (CFT)] to detect ADP-dependent platelet dysfunction (defined as ADP-induced aggregation ≤30 units) was calculated with receiver operating characteristics analysis, which also identified optimal cut-off levels. Positive and negative predictive values for the identified cut-off levels (CFT≥166 s; MCF≤43 mm) to detect platelet function were determined. RESULTS The MCF and CFT were highly accurate in predicting platelet dysfunction during cardiopulmonary bypass [CPB; area under the aggregation curve 0.89 (95% confidence interval 0.80-0.97) and 0.86 (0.77-0.96), respectively] but not immediately after CPB [0.64 (0.48-0.79) and 0.67 (0.52-0.82), respectively] or on arrival at the intensive care unit [0.53 (0.37-0.69) and 0.60 (0.44-0.77), respectively]. The positive and negative predictive values were acceptable during CPB (87 and 67%, respectively, for MCF≤43 mm; 80 and 100% for CFT≥166 s) but markedly lower after surgery. CONCLUSION In paediatric cardiac surgery, thromboelastometry has acceptable ability to detect ADP-dependent platelet dysfunction during, but not after, CPB.
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Affiliation(s)
- B S Romlin
- Department of Paediatric Anaesthesia and Intensive Care
| | - F Söderlund
- Department of Paediatric Anaesthesia and Intensive Care
| | - H Wåhlander
- Departent of Paediatric Cardiology, Queen Silvia's Children's Hospital, Gothenburg, Sweden
| | - S Hallhagen
- Department of Paediatric Anaesthesia and Intensive Care
| | - C Wessman
- Centre for Applied Biostatistics, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - F Baghaei
- Department of Medicine/Haematology and Coagulation Disorders
| | - A Jeppsson
- Department Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
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21
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Blomqvist LRF, Strandell AM, Baghaei F, Hellgren MSE. Platelet aggregation in healthy women during normal pregnancy - a longitudinal study. Platelets 2018; 30:438-444. [DOI: 10.1080/09537104.2018.1492106] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Lennart Rune Fredrik Blomqvist
- Institute of Clinical Sciences, Department of Obstetrics and Gynaecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Obstetrics and Gynaecology, Södra Älvsborg Hospital, Borås, Sweden
| | - Annika Margareta Strandell
- Institute of Clinical Sciences, Department of Obstetrics and Gynaecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Fariba Baghaei
- Department of Medicine/Haematology and Coagulation Disorders, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Margareta Sofia Elisabet Hellgren
- Institute of Clinical Sciences, Department of Obstetrics and Gynaecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Gothenburg, Sweden
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22
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23
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Hamilton A, Ozelo M, Leggo J, Notley C, Brown H, Pablo Frontroth J, Angelillo-Scherrer A, Baghaei F, Enayat S, Favaloro E, Lillicrap D, Othman M. Frequency of Platelet type versus Type 2B von Willebrand Disease. Thromb Haemost 2017; 105:501-8. [DOI: 10.1160/th10-08-0523] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Accepted: 12/27/2010] [Indexed: 11/05/2022]
Abstract
SummaryLess than 50 patients are reported with platelet type von Willebrand disease (PT-VWD) worldwide. Several reports have discussed the diagnostic challenge of this disease versus the closely similar disorder type 2B VWD. However, no systematic study has evaluated this dilemma globally. Over three years, a total of 110 samples/data from eight countries were analysed. A molecular approach was utilised, analysing exon 28 of the von Willebrand factor (VWF) gene, and in mutation negative cases the platelet GP1BA gene. Our results show that 48 cases initially diagnosed as putative type 2B/PT-VWD carried exon 28 mutations consistent with type 2B VWD, 17 carried GP1BA mutations consistent with a PT-VWD diagnosis, three had other VWD types (2A and 2M) and five expressed three non-previously published exon 28 mutations. Excluding 10 unaffected family members and one acquired VWD, 26 cases did not have mutations in either genes. Based on our study, the percentage of type 2B VWD diagnosis is 44% while the percentage of misdiagnosis of PT-VWD is 15%. This is the first large international study to investigate the occurrence of PT-VWD and type 2B VWD worldwide and to evaluate DNA analysis as a diagnostic tool for a large cohort of patients. The study highlights the diagnostic limitations due to unavailability/poor application of RIPA and related tests in some centres and proposes genetic analysis as a suitable tool for the discrimination of the two disorders worldwide. Cases that are negative for both VWF and GP1BA gene mutations require further evaluation for alternative diagnoses.
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24
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Baghaei F, Blixter IF, Gustafsson K, Stigendal L, Sten-Linder M, Strandberg K, Hillarp A, Lindahl T. Effects of the oral, direct thrombin inhibitor dabigatran on five common coagulation assays. Thromb Haemost 2017; 105:371-8. [DOI: 10.1160/th10-06-0342] [Citation(s) in RCA: 205] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Accepted: 10/18/2010] [Indexed: 11/05/2022]
Abstract
SummaryDabigatran is an oral, reversible thrombin inhibitor that has shown promising results in large clinical trials. Laboratory monitoring is not needed but the effects on common coagulation assays are incompletely known. Dabigatran was added to plasma from healthy subjects in the concentration range 0–1,000 μg/l and analysed using several reagents for activated thromboplastin time (APTT), prothrombin time (PT), fibrinogen, antithrombin, and activated protein C resistance. Typical trough concentrations are about 50 μg/l, peak concentrations 100–300 μg/l. At 100 μg/l all APTT-results were prolonged. The concentration required to double APTT ranged between 227 and 286 μg/l, the responses for all five reagents were similar. PT-reagents were much less affected with almost no samples above INR 1.2 at 100 μg/l. The effect was sample dilution dependent with PT Quick type more sensitive than PT Owren type methods. If a patient on dabigatran has prolonged APTT, >90 seconds, and Quick PT INR>2 or Owren PT INR>1.5 over-dosing or accumulation of dabigatran should be considered. Two of four fibrinogen reagents underestimated the fibrinogen concentration considerably at expected peak concentration. Methods based on inhibition of thrombin over-estimated the antithrombin concentration, but not Xa-based. The APC-resistance methods over-estimated the APC-ratio, which may lead to miss-classification of factor V Leiden patients as being normal. Different coagulation assays, and even different reagents within an assay group, display variable effects at therapeutic concentrations of dabigatran. Some of these assay variations are of clinical importance, thus knowledge is needed for a correct interpretation of results.
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Osooli M, Steen Carlsson K, Baghaei F, Holmström M, Rauchensteiner S, Holme PA, Hvitfeldt L, Astermark J, Berntorp E. The association between health utility and joint status among people with severe haemophilia A: findings from the KAPPA register. Haemophilia 2017; 23:e180-e187. [DOI: 10.1111/hae.13231] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2017] [Indexed: 01/19/2023]
Affiliation(s)
- M. Osooli
- Centre for Thrombosis and Haemostasis; Skåne University Hospital; Malmö Sweden
- Department of Translational Sciences; Faculty of Medicine; Lund University; Malmo Sweden
| | - K. Steen Carlsson
- Department of Clinical Sciences; Faculty of Medicine; Lund University; Malmo Sweden
- Swedish Institute for Health Economics; Lund Sweden
| | - F. Baghaei
- Section of Haematology and Coagulation; Department of Medicine; Coagulation Centre; Sahlgrenska University Hospital; Gothenburg Sweden
| | - M. Holmström
- Coagulation Unit; Haematology Centre; Karolinska University Hospital; Stockholm Sweden
- Department of Internal Medicine; Karolinska Institute; Solna Stockholm Sweden
| | - S. Rauchensteiner
- Department of Global Medical Affairs Haematology; Bayer HealthCare Pharmaceuticals; Berlin Germany
| | - P. A. Holme
- Department of Haematology; Oslo University Hospital, Rikshospitalet; Oslo Norway
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
| | - L. Hvitfeldt
- Center for Haemophilia and Thrombosis; Aarhus University Hospital; Aarhus Denmark
| | - J. Astermark
- Centre for Thrombosis and Haemostasis; Skåne University Hospital; Malmö Sweden
- Department of Translational Sciences; Faculty of Medicine; Lund University; Malmo Sweden
| | - E. Berntorp
- Centre for Thrombosis and Haemostasis; Skåne University Hospital; Malmö Sweden
- Department of Translational Sciences; Faculty of Medicine; Lund University; Malmo Sweden
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Blomqvist L, Strandell A, Baghaei F, Hellgren M. P-034: Multiple impedance aggregometry (Multiplate®) in healthy women during normal pregnancy – a prospective and longitudinal study. Thromb Res 2017. [DOI: 10.1016/s0049-3848(17)30132-9] [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: 10/20/2022]
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Osooli M, Lövdahl S, Steen Carlsson K, Knobe K, Baghaei F, Holmström M, Astermark J, Berntorp E. Comparative burden of arthropathy in mild haemophilia: a register-based study in Sweden. Haemophilia 2017; 23:e79-e86. [PMID: 28155262 DOI: 10.1111/hae.13166] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2016] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Mild haemophilia is a congenital bleeding disorder affecting males. The burden of arthropathy in mild haemophilia has not been comprehensively described. AIM The aim of this study was to compare the incidence, age at diagnosis and surgery for arthropathy and related hospitalizations between people with mild haemophilia and the general population in Sweden. METHODS This was a register-based cohort study. Eligible participants were those with mild haemophilia born between 1941 and 2008 and a randomly selected, birthdate and sex-matched comparison group from the general population. Follow-up was from birth (or earliest 1984) until death, emigration or end of the study in 2008. Data on arthropathy were obtained from a national patient register. Negative binomial and competing risk regression and Kaplan-Meier estimate curves were used in the analysis. RESULTS Overall, 315 people with haemophilia and 1529 people in the comparison group were included. Participants with haemophilia born between 1984 and 2008 had a ninefold (95% CI: 3.3-27.2) and 16-fold (95% CI: 6.7-36.5) increased incidence of arthropathy-related hospital admission and arthropathy diagnosis respectively. None in this cohort underwent surgery. Among participants with haemophilia born prior to 1984, the rates of arthropathy diagnosis and surgery of the index joints (knee, elbow, ankle) were increased twofold (95% CI: 1.0-3.2) and fivefold (95% CI: 1.7-17.8) respectively. CONCLUSION Our data suggested a higher burden of arthropathy among individuals with mild haemophilia compared to the general population. Further research should investigate the need for targeted joint screening programmes among individuals with mild haemophilia.
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Affiliation(s)
- M Osooli
- Centre for Thrombosis and Haemostasis, Skane University Hospital, Malmo, Sweden.,Department of Translational Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - S Lövdahl
- Centre for Thrombosis and Haemostasis, Skane University Hospital, Malmo, Sweden.,Department of Translational Sciences, Faculty of Medicine, Lund University, Lund, Sweden.,Novo Nordisk A/S, Søborg, Denmark
| | - K Steen Carlsson
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden.,Swedish Institute for Health Economics, Lund, Sweden
| | - K Knobe
- Centre for Thrombosis and Haemostasis, Skane University Hospital, Malmo, Sweden.,Department of Translational Sciences, Faculty of Medicine, Lund University, Lund, Sweden.,Novo Nordisk A/S, Søborg, Denmark
| | - F Baghaei
- Coagulation Centre, Department of Medicine/Haematology and Coagulation, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - M Holmström
- Coagulation Unit, Haematology Centre, Karolinska University Hospital, Stockholm, Sweden
| | - J Astermark
- Centre for Thrombosis and Haemostasis, Skane University Hospital, Malmo, Sweden.,Department of Translational Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - E Berntorp
- Centre for Thrombosis and Haemostasis, Skane University Hospital, Malmo, Sweden.,Department of Translational Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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Olsson A, Ljung R, Hellgren M, Berntorp E, Baghaei F. Phenotype and genotype comparisons in carriers of haemophilia A. Haemophilia 2016; 22:e235-7. [DOI: 10.1111/hae.12928] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2016] [Indexed: 11/26/2022]
Affiliation(s)
- A. Olsson
- Department of Haematology and Coagulation Disorders Sahlgrenska University Hospital Gothenburg Sweden
| | - R. Ljung
- Department of Paediatrics Centre for Thrombosis and Haemostasis Skåne University Hospital Lund University Malmö Sweden
| | - M. Hellgren
- Department of Obstetrics and Gynaecology Institute of Clinical Science Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - E. Berntorp
- Centre for Thrombosis and Haemostasis Skåne University Hospital Lund University Malmö Sweden
| | - F. Baghaei
- Department of Haematology and Coagulation Disorders Sahlgrenska University Hospital Gothenburg Sweden
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Brodin E, Sunnerhagen KS, Baghaei F, Törnbom M. Persons with Haemophilia in Sweden- Experiences and Strategies in Everyday Life. A Single Centre Study. PLoS One 2015; 10:e0139690. [PMID: 26431432 PMCID: PMC4592191 DOI: 10.1371/journal.pone.0139690] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Accepted: 09/16/2015] [Indexed: 02/04/2023] Open
Abstract
Introduction/Aim Haemophilia is caused by deficiency in coagulation factor VIII or IX. Treatment with the missing coagulation factors has been available in most developed countries for several decades. The aim was to explore the experiences of adults living with severe or moderate haemophilia and their coping strategies at a single centre in Sweden. Method The interview study had a qualitative empirical approach and was analyzed on the basis of the method empirical phenomenological psychology. The sample included 14 participants, mean age 42 (19–80 y), who met the inclusion criteria and to saturation of information. Results: General characteristics were; All were satisfied with and grateful for access to medication. An acceptance of the disorder and willingness to live a normal life was identified among all participants. They were all content with the care provided by Haemophilia Treatment Centre (HTC) and felt supported by its multidisciplinary team. Four typologies were identified; Protective adults and assertive children during up-bringing, finding a role in social context, symptoms and treatments, fear of limited resources in the future. Task-, emotional- and avoidance coping strategies were seen in the interviews. The most prominent coping strategy was task oriented. Conclusion This interview study with Swedish PWH shows that they strive for normality and adaptation in social activities throughout life finding their own niche. The PWH expressed the importance of knowledge and support from the comprehensive medical team at HTC and therefore it seems important to continue comprehensive medical care at HTC in order to follow-up the haemophilia persons regularly.
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Affiliation(s)
- Elisabeth Brodin
- Institute of Neuroscience and Physiology- Rehabilitation Medicine, Section for Clinical Neuroscience and Rehabilitation, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- * E-mail:
| | - Katharina S. Sunnerhagen
- Institute of Neuroscience and Physiology- Rehabilitation Medicine, Section for Clinical Neuroscience and Rehabilitation, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Sunnaas Hospital, Oslo University, Oslo, Norway
| | - Fariba Baghaei
- Department of Medicine/Hematology and Coagulation, Coagulation Centre, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Marie Törnbom
- Institute of Neuroscience and Physiology- Rehabilitation Medicine, Section for Clinical Neuroscience and Rehabilitation, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Social Work University of Gothenburg, Gothenburg, Sweden
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Olsson A, Hellgren M, Berntorp E, Baghaei F. Association between bleeding tendency and health-related quality of life in carriers of moderate and severe haemophilia. Haemophilia 2015; 21:742-6. [DOI: 10.1111/hae.12796] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2015] [Indexed: 12/22/2022]
Affiliation(s)
- A. Olsson
- Department of Haematology and Coagulation Disorders; Sahlgrenska University Hospital; Gothenburg Sweden
| | - M. Hellgren
- Department of Antenatal Care; Närhälsan; Primary Care; Västra Götaland Sweden
- Institute of Clinical Science; Department of Obstetrics and Gynaecology; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - E. Berntorp
- Lund University; Centre for Thrombosis and Haemostasis; Skåne University Hospital; Malmö Sweden
| | - F. Baghaei
- Department of Haematology and Coagulation Disorders; Sahlgrenska University Hospital; Gothenburg Sweden
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Myrin Westesson L, Sparud-Lundin C, Wallengren C, Baghaei F. A tortuous route to a capable fatherhood: the experience of being a father to a child with severe haemophilia. Haemophilia 2015; 21:799-805. [DOI: 10.1111/hae.12781] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2015] [Indexed: 11/29/2022]
Affiliation(s)
- L. Myrin Westesson
- Coagulation Centre; Department of Medicine/Haematology and Coagulation Disorders; Sahlgrenska University Hospital; Gothenburg Sweden
| | - C. Sparud-Lundin
- Institute of Health and Care Sciences; The Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - C. Wallengren
- Institute of Health and Care Sciences; The Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - F. Baghaei
- Coagulation Centre; Department of Medicine/Haematology and Coagulation Disorders; Sahlgrenska University Hospital; Gothenburg Sweden
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Radulovic V, Laffin A, Hansson KM, Backlund E, Baghaei F, Jeppsson A. Heparin and Protamine Titration Does Not Improve Haemostasis after Cardiac Surgery: A Prospective Randomized Study. PLoS One 2015; 10:e0130271. [PMID: 26134993 PMCID: PMC4489911 DOI: 10.1371/journal.pone.0130271] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 05/18/2015] [Indexed: 11/18/2022] Open
Abstract
Background Bleeding complications are common in cardiac surgery. Perioperative handling of heparin and protamine may influence the haemostasis. We hypothesized that heparin and protamine dosing based on individual titration curves would improve haemostasis in comparison to standard dosing. Subjects and Methods Sixty patients scheduled for first time elective coronary artery bypass grafting or valve surgery were included in a prospective randomized study. The patients were randomized to heparin and protamine dosing with Hepcon HMS Plus device or to standard weight and activated clotting time (ACT) based dosing. Blood samples were collected before and 10 minutes, 2 hours and 4 hours after cardiopulmonary bypass. Primary endpoint was endogenous thrombin potential in plasma 2 hours after surgery as assessed by calibrated automated thrombography. Secondary endpoints included total heparin and protamine doses, whole blood clot formation (thromboelastometry) and post-operative bleeding volume and transfusions. Heparin effect was assessed by measuring anti-Xa activity. Results Endogenous thrombin potential and clot formation deteriorated in both groups after surgery without statistically significant intergroup difference. There were no significant differences between the groups in total heparin and protamine doses, heparin effect, or postoperative bleeding and transfusions at any time point. Significant inverse correlations between anti-Xa activity and endogenous thrombin potential were observed 10 min (r = -0.43, p = 0.001), 2 hours (r = -0.66, p<0.001) and 4 hours after surgery (r = -0.58, p<0.001). Conclusion In conclusion, the results suggest that perioperative heparin and protamine dosing based on individual titration curves does not improve haemostasis after cardiac surgery. Postoperative thrombin generation capacity correlates to residual heparin effect. Trial Registration www.isrctn.comISRCTN14201041.
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Affiliation(s)
- Vladimir Radulovic
- Department of Medicine/Hematology and Coagulation Disorders, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anna Laffin
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Erika Backlund
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Fariba Baghaei
- Department of Medicine/Hematology and Coagulation Disorders, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anders Jeppsson
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- * E-mail:
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Brodin E, Baghaei F, Sunnerhagen KS. Self-reported activity and functioning in daily life; the perspective of persons with haemophilia living in Sweden. Eur J Haematol 2015; 95:336-41. [DOI: 10.1111/ejh.12503] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Elisabeth Brodin
- Institute of Neuroscience and Physiology/Rehabilitation Medicine; The Sahlgrenska Academy at The University of Gothenburg; Gothenburg Sweden
| | - Fariba Baghaei
- Department of Medicine/Hematology and Coagulation; Coagulation Centre; Sahlgrenska University Hospital; Gothenburg Sweden
| | - Katharina S. Sunnerhagen
- Institute of Neuroscience and Physiology/Rehabilitation Medicine; The Sahlgrenska Academy at The University of Gothenburg; Gothenburg Sweden
- Sunnaas Hospital; Nesodden Norway
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Olsson A, Hellgren M, Berntorp E, Holmström M, Baghaei F. Bleeding phenotype in carriers of haemophilia A does not correlate with thrombin generation. Haemophilia 2014; 21:e111-3. [PMID: 25422177 DOI: 10.1111/hae.12585] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2014] [Indexed: 11/30/2022]
Affiliation(s)
- A Olsson
- Department of Haematology and Coagulation Disorders, Sahlgrenska University Hospital, Gothenburg, Sweden
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Romlin B, Söderlund F, Wåhlander H, Nilsson B, Baghaei F, Jeppsson A. Platelet count and function in paediatric cardiac surgery: a prospective observational study. Br J Anaesth 2014; 113:847-54. [DOI: 10.1093/bja/aeu194] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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Hillarp A, Gustafsson KM, Faxälv L, Strandberg K, Baghaei F, Fagerberg Blixter I, Berndtsson M, Lindahl TL. Effects of the oral, direct factor Xa inhibitor apixaban on routine coagulation assays and anti-FXa assays. J Thromb Haemost 2014; 12:1545-53. [PMID: 24965851 DOI: 10.1111/jth.12649] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 06/18/2014] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Apixaban is an oral direct factor Xa inhibitor developed for the prophylaxis and treatment of thromboembolic disorders. Laboratory monitoring is not necessary, but the effects on common coagulation reagents and assays constitute clinically valuable information. OBJECTIVES To investigate the effects of apixaban on commonly used coagulation methods, and to evaluate anti-FXa assays for specific determination of the drug concentration. MATERIALS AND METHODS Apixaban was added to plasma from healthy subjects in the concentration range 0-1000 μg L(-1) , and analyses were performed with different reagents for activated partial thromboplastin time (APTT), prothrombin time (PT), antithrombin, protein C, and protein S. A lupus anticoagulant assay and an APTT assay with varying phospholipid concentrations were used to study the phospholipid dependence. RESULTS In general, apixaban showed fewer effects in vitro than have been shown for rivaroxaban, another direct FXa inhibitor. The concentration needed to double the APTT varied between 2200 and 4700 μg L(-1) , and the concentration needed to double the PT varied between 700 and 3900 μg L(-1) . The effects on antithrombin, protein C and protein S assays were dependent on the type of reagent. Apixaban did not cause false-positive lupus anticoagulant results. Chromogenic anti-FXa assays showed linear dose-response curves with apixaban. CONCLUSIONS Therapeutic concentrations of apixaban variably affect different assay groups, and even different reagents within an assay group. The effects were much smaller than with rivaroxaban. The use of APTT and/or PT assays to screen the anticoagulant activity of apixaban cannot be recommended. A chromogenic anti-FXa assay can be used for reliable measurements of apixaban concentration.
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Affiliation(s)
- A Hillarp
- Clinical Chemistry, University and Regional Laboratories Region Skåne, Malmö, Sweden
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Lövdahl S, Henriksson KM, Baghaei F, Holmström M, Berntorp E, Astermark J. A longitudinal study of family structure in Swedish persons with haemophilia. Haemophilia 2013; 20:493-9. [DOI: 10.1111/hae.12350] [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] [Accepted: 11/24/2013] [Indexed: 01/13/2023]
Affiliation(s)
- S. Lövdahl
- Clinical Coagulation Research Unit; Department of Clinical Sciences; Lund University; Skåne University Hospital; Malmö Sweden
| | - K. M. Henriksson
- Cardiovascular Epidemiology; Department of Medical Science; Uppsala University Hospital; Uppsala Sweden
- Department of Epidemiology; AstraZeneca R&D; Mölndal Sweden
| | - F. Baghaei
- Coagulation Centre; Department of Medicine/Hematology and Coagulation Disorders; Sahlgrenska University Hospital; Gothenburg Sweden
| | - M. Holmström
- Coagulation Unit; Hematology Centre; Karolinska University Hospital and Department of Medicine; Karolinska Institute; Stockholm Sweden
| | - E. Berntorp
- Clinical Coagulation Research Unit; Department of Clinical Sciences; Lund University; Skåne University Hospital; Malmö Sweden
| | - J. Astermark
- Department of Hematology and Coagulation Disorders; Skåne University Hospital; Malmö Sweden
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Romlin BS, Wåhlander H, Synnergren M, Baghaei F, Jeppsson A. Earlier detection of coagulopathy with thromboelastometry during pediatric cardiac surgery: a prospective observational study. Paediatr Anaesth 2013; 23:222-7. [PMID: 23302040 DOI: 10.1111/pan.12116] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/09/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Earlier detection of coagulopathy in pediatric cardiac surgery patients. AIM To determine whether thromboelastometry (TEM) analysis before weaning from cardiopulmonary bypass (CPB) and hemoconcentration is predictive of post-CPB results and whether analysis of clot firmness already after 10 min yields reliable results. BACKGROUND Cardiac surgery with CPB induces a coagulopathy that may contribute to postoperative complications. Earlier detection increases the possibility of initiating countermeasures. METHODS/MATERIAL: Fifty-six pediatric cardiac surgery patients were included in a prospective observational study. HEPTEM and FIBTEM clotting time (CT), clot formation time (CFT), and clot firmness after 10 min (A10) and at maximum (MCF) were analyzed during CPB and after CPB and ultrafiltration with modified rotational thromboelastometry (ROTEM). The analyses were compared, and correlations and differences were calculated. RESULTS Hemoconcentration with modified ultrafiltration increased hematocrit from 28 ± 3 to 37 ± 4% (P < 0.001). Correlation coefficients of the TEM variables during and after CPB ranged from 0.61 to 0.82 (all P < 0.001). HEPTEM-CT and HEPTEM-MCF differed significantly but the differences were marginal. Both HEPTEM and FIBTEM A10 measurements during CPB were significantly less than MCF (P < 0.001 for both), but the correlations were highly significant (HEPTEM: r = 0.95, P < 0.001; FIBTEM: r = 0.96, P < 0.001), and the differences were predictable, with narrow confidence intervals (HEPTEM: -8.2 mm (-8.9 to -7.5); FIBTEM: -0.5 mm (-0.7 to -0.3). CONCLUSION The results suggest that intraoperative TEM analyses can be accelerated by analyzing HEPTEM/FIBTEM on CPB before hemoconcentration and by analyzing clot firmness already after 10 min.
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Affiliation(s)
- Birgitta S Romlin
- Department of Pediatric Anesthesia and Intensive Care, Queen Silvia's Children Hospital, Gothenburg, Sweden
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Lövdahl S, Henriksson KM, Baghaei F, Holmström M, Nilsson JÅ, Berntorp E, Astermark J. Incidence, mortality rates and causes of deaths in haemophilia patients in Sweden. Haemophilia 2013; 19:362-9. [DOI: 10.1111/hae.12092] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2012] [Indexed: 11/30/2022]
Affiliation(s)
- S. Lövdahl
- Department of Clinical Sciences, Clinical Coagulation Research Unit; Lund University; Skåne University Hospital; Malmö; Sweden
| | | | - F. Baghaei
- Department of Medicine/Hematology and Coagulation Disorders, Coagulation Centre; Sahlgrenska University Hospital; Gothenburg; Sweden
| | - M. Holmström
- Coagulation Unit; Hematology Centre; Karolinska University Hospital and Dept of Medicine Karolinska Institute; Stockholm; Sweden
| | - J.-Å. Nilsson
- Department of Clinical Sciences, Clinical Coagulation Research Unit; Lund University; Skåne University Hospital; Malmö; Sweden
| | - E. Berntorp
- Department of Clinical Sciences, Clinical Coagulation Research Unit; Lund University; Skåne University Hospital; Malmö; Sweden
| | - J. Astermark
- Department of Hematology and Coagulation Disorders, Lund University; Skane University Hospital; Malmö; Sweden
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Négrier C, Lienhart A, Numerof R, Stephens D, Wong WY, Baghaei F, Yee TT. SURgical interventions with FEIBA (SURF): international registry of surgery in haemophilia patients with inhibitory antibodies. Haemophilia 2013; 19:e143-50. [DOI: 10.1111/hae.12080] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2012] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - R. Numerof
- Baxter Healthcare Corporation; Westlake Village; CA; USA
| | - D. Stephens
- Baxter Healthcare Corporation; Westlake Village; CA; USA
| | - W. Y. Wong
- Baxter Healthcare Corporation; Westlake Village; CA; USA
| | - F. Baghaei
- Sahlgrenska University Hospital; Gothenburg; Sweden
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Olsson A, Baghaei F, Berntorp E, Hellgren M. P-005 Bleeding tendency in Swedish carriers of haemophilia A and B. Thromb Res 2013. [DOI: 10.1016/s0049-3848(13)70051-3] [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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Radulovic V, Hyllner M, Ternström L, Karlsson M, Bylock A, Hansson KM, Baghaei F, Jeppsson A. Sustained heparin effect contributes to reduced plasma thrombin generation capacity early after cardiac surgery. Thromb Res 2012; 130:769-74. [DOI: 10.1016/j.thromres.2011.12.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2011] [Revised: 12/10/2011] [Accepted: 12/19/2011] [Indexed: 01/13/2023]
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Myrin-Westesson L, Baghaei F, Friberg F. The experience of being a female carrier of haemophilia and the mother of a haemophilic child. Haemophilia 2012; 19:219-24. [DOI: 10.1111/hae.12026] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2012] [Indexed: 11/27/2022]
Affiliation(s)
- L. Myrin-Westesson
- Department of Medicine/Hematology and Coagulation; Sahlgrenska University Hospital; Coagulation Centre; Gothenburg; Sweden
| | - F. Baghaei
- Department of Medicine/Hematology and Coagulation; Sahlgrenska University Hospital; Coagulation Centre; Gothenburg; Sweden
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Radulovic V, Baghaei F, Blixter IF, Samuelsson S, Jeppsson A. Comparable effect of recombinant and plasma-derived human fibrinogen concentrate on ex vivo clot formation after cardiac surgery. J Thromb Haemost 2012; 10:1696-8. [PMID: 22712790 DOI: 10.1111/j.1538-7836.2012.04823.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Stener-Victorin E, Baghaei F, Holm G, Janson PO, Olivecrona G, Lönn M, Mannerås-Holm L. Effects of acupuncture and exercise on insulin sensitivity, adipose tissue characteristics, and markers of coagulation and fibrinolysis in women with polycystic ovary syndrome: secondary analyses of a randomized controlled trial. Fertil Steril 2011; 97:501-8. [PMID: 22154367 DOI: 10.1016/j.fertnstert.2011.11.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Revised: 11/03/2011] [Accepted: 11/14/2011] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To investigate the possible effects of low-frequency electroacupuncture (EA) and physical exercise on markers of coagulation and fibrinolysis, insulin sensitivity, and adipose tissue characteristics in women with polycystic ovary syndrome (PCOS). DESIGN Secondary analyses of a prospective, randomized controlled clinical trial. SETTING Department of Physiology and Department of Obstetrics and Gynecology, University of Gothenburg. PATIENT(S) Eighty-four women with PCOS were randomized. INTERVENTION(S) Women with PCOS were randomized to 16 weeks of low-frequency EA (14 treatments), physical exercise (at least 3 times/wk), or no intervention. MAIN OUTCOME MEASURE(S) Anthropometrics, circulating coagulation and fibrinolytic markers, insulin sensitivity (euglycemic hyperinsulinemic clamp), hemodynamics, and adipose tissue morphology/function recorded at baseline, after 16 weeks of intervention, and after a 16-week follow-up. RESULT(S) In the low-frequency EA group, circulating plasminogen activator inhibitor 1 activity decreased by 21.8% after 16 weeks of intervention and by 31.1% at the 16-week follow-up and differed from the physical exercise and the no intervention groups. The EA group had decreases in circulating fibrinogen and tissue plasminogen activator (t-PA), sagittal diameter, and diastolic blood pressure after treatment, and fibrinogen remained lower at the 16-week follow-up. In the physical exercise group, lipoprotein lipase activity increased and diastolic blood pressure decreased after treatment, and both diastolic and systolic blood pressure were lower at follow-up. No other variables were affected. CONCLUSION(S) Low-frequency EA counteracted a possible prothrombotic state in women with PCOS, as reflected by a decrease in plasminogen activator inhibitor 1 activity. Despite within-group improvements, there were no between-group differences in anthropometric, metabolic, or hemodynamic variables after 16 weeks of EA or physical exercise at the dose/intensity studied.
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Affiliation(s)
- Elisabet Stener-Victorin
- Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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Suchankova P, Baghaei F, Rosmond R, Holm G, Anckarsäter H, Ekman A. Genetic variability within the S100B gene influences the personality trait self-directedness. Psychoneuroendocrinology 2011; 36:919-23. [PMID: 21112154 DOI: 10.1016/j.psyneuen.2010.10.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Revised: 09/21/2010] [Accepted: 10/27/2010] [Indexed: 11/26/2022]
Abstract
Elevated serum levels of S100B have proven useful as an indicator of brain-injury but have also been shown in patients diagnosed with psychiatric disorders. Recently, associations were found between variations in the S100B gene and schizophrenia as well as bipolar affective disorder. The aim of the present study was to investigate whether some of these genetic variations influence general aspects of human behaviour as portrayed by normal dimensions of personality. Two single nucleotide polymorphisms within the S100B gene, 2757C>G and 5748C>T, were genotyped in two population based cohorts consisting of 42-year-old women (n=270) and 51-year-old men (n=247), respectively. The two polymorphisms were analysed with respect to personality traits assessed using the Temperament and Character Inventory (TCI). In men, the 2757C>G polymorphism was found to significantly influence the TCI dimension self-directedness with higher scores in 2757G homozygotes. A similar tendency towards association was seen in the female cohort; however, this correlation did not remain significant after correction for multiple comparisons. Furthermore, the 5748C>T polymorphism was highly associated with self-directedness in men. Self-directedness is an overall estimate of adaptive strategies to adjust behaviour to conceptual goals as well as coping strategies and is strongly correlated to general mental health and absence of personality disorder. These preliminary findings suggest that the S100B gene may be implicated not only in certain pathological brain conditions but also in processes involved in normal behaviour.
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Affiliation(s)
- Petra Suchankova
- Institute of Neuroscience and Physiology at the Sahlgrenska Academy, Department of Pharmacology, University of Gothenburg, Gothenburg, Sweden.
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Mannerås-Holm L, Baghaei F, Holm G, Janson PO, Ohlsson C, Lönn M, Stener-Victorin E. Coagulation and fibrinolytic disturbances in women with polycystic ovary syndrome. J Clin Endocrinol Metab 2011; 96:1068-76. [PMID: 21252248 DOI: 10.1210/jc.2010-2279] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Studies of fibrinolysis/coagulation status in women with polycystic ovary syndrome (PCOS) are contradictory. OBJECTIVES The aim of the study was to investigate whether women with PCOS have disturbed circulating levels of fibrinolysis/coagulation markers and, if so, whether the disturbances are related to hemodynamics, metabolic variables, sex steroids, SHBG, lipids, and inflammatory variables in women with PCOS. DESIGN/MAIN OUTCOME MEASURES: Anthropometric variables, hemodynamics, circulating hemostatic and inflammatory markers, and serum lipid profile were measured in women with untreated PCOS (n = 74) and controls (n = 31). RESULTS After adjustments for age and body mass index (BMI), circulating plasminogen activator inhibitor 1 (PAI-1) activity and fibrinogen levels were higher in women with PCOS than controls; lipid profile, blood pressure, and levels of D-dimer, von Willebrand factor, factor VIII, tissue plasminogen activator, and inflammatory markers were comparable in the two groups. In multiple linear regression analyses including women with PCOS, low SHBG and high insulin predicted high PAI-1 activity (R(2) = 0.526; P < 0.001); elevated high-sensitivity C-reactive protein and soluble E-selectin in combination with heart rate predicted high fibrinogen (R(2) = 0.333; P < 0.001). Differences in PAI-1 activity were not significant after adjustments for age, BMI, SHBG, and insulin. CONCLUSIONS PCOS is characterized by a prothrombotic state, as reflected by increased PAI-1 activity and fibrinogen, without signs of dyslipidemia or a proinflammatory state. Low SHBG and high insulin may partly explain the BMI-independent difference in PAI-1 activity between women with PCOS and controls. High-sensitivity C-reactive protein and E-selectin may be involved in regulating fibrinogen in PCOS.
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Affiliation(s)
- Louise Mannerås-Holm
- Department of Physiology, Institute of Neuroscience and Physiology, SahlgrenskaAcademy, University of Gothenburg, 405 30 Gothenburg, Sweden
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Lassila R, Antovic J, Armstrong E, Baghaei F, Dalsgaard-Nielsen J, Hillarp A, Holme P, Holmström M, Johnsson H, Joutsi-Korhonen L, Sandset P. Practical Viewpoints on the Diagnosis and Management of Heparin-Induced Thrombocytopenia. Semin Thromb Hemost 2011; 37:328-36. [DOI: 10.1055/s-0031-1274516] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
There has been increasing interest in the patient's perspective on outcome of treatment. The Haemophilia Activity List (HAL) has been developed as a disease-specific questionnaire for haemophilia patients and is a validated self-report measure of function developed according to WHO's International Classification of Functioning, Disability and Health. To validate HAL in Sweden. The Dutch and English versions of HAL were translated into Swedish using 'the forward-backward translation' method and merged into a final Swedish version. Validation was performed against the Swedish version of the questionnaires Arthritis Impact Measurement 2 (AIMS 2) and Impact on Participation and Autonomy (IPA). Two hundred and twenty-five patients with severe and moderate forms of haemophilia A and B from three centres were invited to participate in the study. Spearman's rank correlation test was used for validation, and internal consistency of the HAL was calculated with Cronbach's alpha. Eighty-four patients (39%) (18-80 years old) filled out the questionnaires. The internal consistency of the Swedish version of HAL was high, with Cronbach's alpha being 0.98-0.71. Function of the legs had the highest consistency and transportation had the lowest. The correlation was excellent between the HAL sum score and AIMS 2 physical (r = 0.84, P < 0.01), IPA autonomy indoors (r = 0.83, P < 0.01) and autonomy outdoors (r = 0.89, P < 0.01). The Swedish version of HAL has both internal consistency and convergent validity and may complement other functional tests to gather information on the patient's self-perceived ability.
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Affiliation(s)
- E Brodin
- Department of Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden.
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Hillarp A, Baghaei F, Fagerberg Blixter I, Gustafsson KM, Stigendal L, Sten-Linder M, Strandberg K, Lindahl TL. Effects of the oral, direct factor Xa inhibitor rivaroxaban on commonly used coagulation assays. J Thromb Haemost 2011; 9:133-9. [PMID: 20946166 DOI: 10.1111/j.1538-7836.2010.04098.x] [Citation(s) in RCA: 229] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Rivaroxaban is an oral direct factor Xa inhibitor developed for prophylaxis and treatment of thromboembolic disorders. Laboratory monitoring is not necessary but the dose-dependent effects on common reagents and assay procedures are largely unknown. OBJECTIVES To investigate the effect of rivaroxaban on commonly used coagulation assays. MATERIALS AND METHODS Rivaroxaban was added to plasma from healthy subjects in the concentration range 0-1000 μg L(-1) and analyzed using different reagents for activated partial thromboplastin time (APTT), prothrombin time (PT), antithrombin, fibrinogen and activated protein C (APC) resistance assays. RESULTS At an expected peak concentration of rivaroxaban in clinical use, the APTTs were almost invariably prolonged but at lower concentrations the effect was weak. The concentration needed to double the APTT varied between 389 ± 106 and 617 ± 149 μg L(-1) for different reagents. The PT assays showed a marked degree of difference. In general, the Quick PT type assays were more sensitive compared with the Owren type PT assays. The results from antithrombin assays were dependent on the type of reagent, with the Xa-based assay being sensitive for rivaroxaban with an estimated increase of 0.09 IU mL(-1) per 100 μg L(-1) rivaroxaban. There were only minor effects on fibrinogen assays based on thrombin reagents. The APTT-based assay for APC resistance is affected in a dose-dependent manner whereas an assay based on the activation of coagulation at the prothrombinase level was unaffected. CONCLUSIONS Different assays, and even different reagents within an assay group, display variable effects by therapeutic concentrations of rivaroxaban.
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Affiliation(s)
- A Hillarp
- University and Regional Laboratories Region Scania, Clinical Chemistry, Malmö, Sweden.
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