Four-year follow-up of two patients on maintenance therapy with fondaparinux and mycophenolate mofetil for microthrombotic antiphospholipid syndrome

Lupus ◽  
2019 ◽  
Vol 28 (8) ◽  
pp. 1003-1006 ◽  
Author(s):  
B W Baron ◽  
J M Baron
Keyword(s):  
Mycophenolate Mofetil ◽  
Maintenance Therapy ◽  
Antiphospholipid Syndrome ◽  
Warfarin Therapy ◽  
Lower Extremities ◽  
Arterial Disease ◽  
Critical Ischemia ◽  
Intravenous Heparin ◽  
Small Cohort

Objectives We discuss two patients with antiphospholipid syndrome (APS) who presented with critical ischemia of both lower extremities due to arterial microthrombi. They received multimodality therapy emergently: anticoagulation, immunosuppression, and therapeutic plasma exchange (TPE). Then they were maintained on anticoagulation with fondaparinux and immunosuppression with mycophenolate mofetil (MMF), and were followed for 4 years. Methods Two patients with APS with ischemia and necrosis of their distal lower extremities were treated emergently with anticoagulation (intravenous heparin), immunosuppression (prednisone), and TPE. They were maintained on anticoagulation with fondaparinux and immunosuppression with MMF. Results Neither patient had recurrent microthrombotic disease during a 4-year follow-up. Conclusions As described in our small cohort, patients with APS who suffer from microthrombotic arterial disease may benefit from maintenance therapy of anticoagulation with fondaparinux and immunosuppression with MMF, an approach which may be worthy of further trial. Fondaparinux does not require attention to diet, monitoring, and cumbersome bridging that is typical of warfarin therapy. MMF provides immunosuppression while sparing the side effects of steroid treatment.

scholarly journals Long-term follow-up of the MAINTAIN Nephritis Trial, comparing azathioprine and mycophenolate mofetil as maintenance therapy of lupus nephritis

2015 ◽  
Vol 75 (3) ◽  
pp. 526-531 ◽  
Author(s):  
Farah Tamirou ◽  
David D'Cruz ◽  
Shirish Sangle ◽  
Philippe Remy ◽  
Carlos Vasconcelos ◽  
...  
Keyword(s):  
Mycophenolate Mofetil ◽  
Lupus Nephritis ◽  
Positive Predictive Value ◽  
Maintenance Therapy ◽  
Early Response ◽  
Renal Outcome ◽  
Proliferative Lupus Nephritis ◽  
Long Term Follow Up

ObjectiveTo report the 10-year follow-up of the MAINTAIN Nephritis Trial comparing azathioprine (AZA) and mycophenolate mofetil (MMF) as maintenance therapy of proliferative lupus nephritis, and to test different definitions of early response as predictors of long-term renal outcome.MethodsIn 2014, data on survival, kidney function, 24 h proteinuria, renal flares and other outcomes were collected for the 105 patients randomised between 2002 and 2006, except in 13 lost to follow-up.ResultsDeath (2 and 3 in the AZA and MMF groups, respectively) and end-stage renal disease (1 and 3, respectively) were rare events. Time to renal flare (22 and 19 flares in AZA and MMF groups, respectively) did not differ between AZA and MMF patients. Patients with good long-term renal outcome had a much more stringent early decrease of 24 h proteinuria compared with patients with poor outcome. The positive predictive value of a 24 h proteinuria <0.5 g/day at 3 months, 6 months and 12 months for a good long-term renal outcome was excellent (between 89% and 92%). Inclusion of renal function and urinalysis in the early response criteria did not impact the value of early proteinuria decrease as long-term prognostic marker.ConclusionsThe long-term follow-up data of the MAINTAIN Nephritis Trial do not indicate that MMF is superior to AZA as maintenance therapy in a Caucasian population suffering from proliferative lupus nephritis. Moreover, we confirm the excellent positive predictive value of an early proteinuria decrease for long-term renal outcome.Trial registration numberNCT00204022.

scholarly journals NEXT AND LONG-TERM RESULTS OF X-RAY ENDOVASCULAR INTERVENTIONS IN TREATMENT OF CHRONIC CRITICAL ATHERODIABETIC ISCHEMIA OF LOWER EXTREMITIES

2020 ◽  
Vol 18 (6) ◽  
pp. 710-715
Author(s):  
N. N. Ioskevich ◽  
◽  
L. F. Vasilchuk ◽  
P. E. Vankovich ◽  
S. P. Antonenko ◽  
...  
Keyword(s):  
Lower Limb ◽  
Type I Diabetes ◽  
Lower Extremities ◽  
Limb Ischemia ◽  
Type I ◽  
Critical Ischemia ◽  
Lower Limb Ischemia ◽  
X Ray ◽  
Endovascular Interventions

Background. The treatment of chronic critical ischemia of the lower extremities with their combined atherodiabetic lesion is one of the far from the resolved problems of modern surgery. Aim of the study. Analysis of the results of X-ray endovascular interventions in patients with critical lower limb ischemia due to atherodiabetic lesions of the femoral-popliteal-tibial segment. Material and methods. We analyzed the results of REVS in 60 patients with diabetes mellitus with critical ischemia of the lower extremities due to infra-anginal atherosclerotic occlusions with a follow-up period of up to 5 years from the moment of the manipulation. Results. The total shelf life of the lower limb after REVV was 492.4 ± 10.1 days. Out of 26 amputations performed, balloon angioplasty was performed in 18 cases and stenting in 8 cases. In individuals with type I diabetes, the duration of painless period was 415.4 ± 5.1 days, and the total shelf life of the leg was 465.4 ± 4.3 days. In type II diabetes, these indicators were, respectively, 181.4 ± 4.4 days and 317.8 ± 6.7 days. In the group of patients with type I diabetes, the lower limb was saved in 55.6% of cases (in 20 out of 36 patients), and in type II diabetes - in 58.3% (in 14 out of 24 people). Conclusions. The presence of simultaneously obliterating atherosclerosis and diabetes mellitus in patients leads to a combined atherodiabetic lesion of the arterial bed, including infra-anginal arteries. X-ray endovascular interventions (balloon angioplasty and stenting) on the arterial femoral-popliteal-tibial segment are a rather effective method of eliminating chronic critical lower limb ischemia, which allows preserving the lower limb in 56.7% patients with a follow-up period of up to 5 years from the date of surgery. Improving the results of X-ray endovascular interventions in case of chronic critical atherodiabetic lower limb ischemia requires a comprehensive study of the possible causes of occlusions of reconstructed arterial segments (blood coagulation potential, non-optimal processes in the intervention zone).

Multicentric study comparing cyclosporine, mycophenolate mofetil and azathioprine in the maintenance therapy of lupus nephritis: 8 years follow up

2020 ◽  
Author(s):  
Lorenza Maria Argolini ◽  
Giulia Frontini ◽  
Elena Elefante ◽  
Francesca Saccon ◽  
Valentina Binda ◽  
...  
Keyword(s):  
Mycophenolate Mofetil ◽  
Lupus Nephritis ◽  
Maintenance Therapy ◽  
Multicentric Study

scholarly journals The use of rotational thrombectomy in the treatment of arterial thrombosis

2018 ◽  
Vol 22 (3) ◽  
pp. 464-467
Author(s):  
V.V. Petrushenko ◽  
Ya.V. Khrebtii ◽  
O.M. Skupyi ◽  
O.I. Mitiuk ◽  
S.A. Cheshenchuk
Keyword(s):  
Lupus Erythematosus ◽  
Arterial Thrombosis ◽  
Clinical Signs ◽  
Lower Extremities ◽  
Arterial Disease ◽  
Modern Method ◽  
Acute Onset ◽  
Critical Ischemia ◽  
Rotational Thrombectomy ◽  
Peripheral Arterial

Rotation thrombectomy is a modern method of treating peripheral arterial disease. To date, there are no randomized studies regarding rotational thrombectomy. We want to share our own results in the treatment of patients with arterial thrombosis in the treatment of 8 patients with arteriosclerosis of the lower extremities, complicated by thrombosis using Rotarex. Patients noted the acute onset of the disease, but were referred to the clinic after 2 weeks since the onset of clinical signs of the disease. All patients underwent ultrasound examination, arteriography of the affected arterial segment. After treatment, all patients underwent control angiography. During the procedure, heparin and clopidogrel were administered. One patient had systemic lupus erythematosus. Patients had thrombosis of the femoro-popliteal arterial segments. All patients had a critical ischemia of the lower extremities. Men were 6, women — 2. 2 (25%) of patients had thrombosis of the stent of the superficial femoral artery. In 8 (100%) cases, rotational thrombectomy with rotary catheter was used. For the procedure, catheters with a diameter of 6F and a length of 110–135 cm were used. During the procedure, a catheter was performed from 3 to 5 passages in the affected segment. Duration of the procedure was 1.5–2 hours. In 6 (75%) cases, after the thrombectomy, ballooning of the affected segment was used with a balloon covered with polytaxel. In 8 (100%) patients, there was a clinical improvement. In 8 (100%) patients, control arteriography showed complete patency of the affected segments of the femoral and popliteal arteries. In 8 patients, ischemia was regressed. Cases of rethrombosis were not observed. Thus, rotation thrombectomy is a modern and effective method of treatment of arterial thrombosis of the femoral and popliteal segment.

Absolute Immature Platelet Counts Suggest Platelet Production Suppression during Complicated Relapsing Thrombotic Thrombocytopenic Purpura

2020 ◽  
pp. 1-5 ◽  
Author(s):  
Sirisha Kundrapu ◽  
Hollie M. Reeves ◽  
Robert W. Maitta
Keyword(s):  
Mycophenolate Mofetil ◽  
Maintenance Therapy ◽  
Thrombotic Thrombocytopenic Purpura ◽  
Adamts13 Activity ◽  
Thrombocytopenic Purpura ◽  
Early Therapy ◽  
Platelet Production ◽  
Platelet Counts ◽  
Initial Improvement

Absolute immature platelet counts (A-IPC) aid in diagnosis and treatment follow-up in thrombotic thrombocytopenic purpura (TTP). A-IPC was used to follow a patient on mycophenolate mofetil (MMF) maintenance therapy treated with a prolonged therapeutic plasma exchange (TPE) regimen for relapsing TTP. On admission, the platelet (PLT) count was 95 × 10<sup>9</sup>/L declining to 14 × 10<sup>9</sup>/L in 5 days. Daily TPE was initiated for suspected TTP, and MMF was discontinued. A-IPC and PLT count were 1 × 10<sup>9</sup>/L and 14 × 10<sup>9</sup>/L, respectively, prior to first TPE. A-IPC improved to 3.2 × 10<sup>9</sup>/L with 1 TPE, and on day 5, A-IPC and PLT count were 7.5 × 10<sup>9</sup>/L and 218 × 10<sup>9</sup>/L, respectively. On day 6, A-IPC and PLT count decreased to 4.8 × 10<sup>9</sup>/L and 132 × 10<sup>9</sup>/L further worsening to 0.4 × 10<sup>9</sup>/L and 13 × 10<sup>9</sup>/L, respectively. ADAMTS13 activity remained &#x3c;5% with an inhibitor; counts did not recover. Initial improvement followed by rapidly declining A-IPC despite therapy suggested production suppression. In TTP, A-IPC may aid in establishing early therapy effects over PLT production.

Experience of endovascular treatment of patients with chronic ischemia threatening the loss of a limb

2021 ◽  
Vol 88 (2) ◽  
pp. 38-43
Author(s):  
V.Ya. Rudman ◽  
◽  
K.A. Kalashnikov ◽  
G.A. Burov ◽  
◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Lower Extremities ◽  
Limb Loss ◽  
Diabetic Foot Syndrome ◽  
Correct Selection ◽  
Chronic Ischemia ◽  
Critical Ischemia ◽  
Endovascular Revascularization ◽  
Global Trend

The aim of the study was to assess the technical feasibility of endovascular revascularization of the arteries of the lower extremities in the development of critical ischemia of the lower extremities (chronic ischemia with threatening limb loss), including diabetic foot syndrome. Two clinical cases of endovascular revascularization of lower limb arteries with the development of chronic ischemia with threatening limb loss and diabetic foot syndrome were analyzed. Median age was 61 (60–62) years; there was 1 male (50 %). Upon hospitalization, the risk of limb loss according to the WIfI classification was assessed in one case as high, in the other as medium. The efficiency of revascularization was 100 %. In 1 case (50 %), a second intervention was required. High amputation after surgery during the next year of follow-up was 100 % not necessary. The duration of the operation was 120–150 minutes. The survival rate during the year of follow-up after surgery was 100 %. Clinical observation demonstrates that even with the correct selection of patients, stratification of risk factors for both possible loss of a limb and the risk of surgery, as well as the correctness of the chosen tactics for revascularization of the CPR, only with an increase in the number of procedures performed, routing training and the creation of specialized centers is it possible to achieve satisfactory results in treatment of this problem, which, as the global trend shows, will worsen as the incidence of diabetes increases and the population ages

scholarly journals A Score of Run-Off (Outflow) Resistance in Lesions Femoropopliteal Arteries Using MSCT Angiography

2017 ◽  
pp. 90-102
Author(s):  
A. L. Maslov ◽  
A. E. Zotikov
Keyword(s):  
Blood Flow ◽  
Arteriovenous Fistula ◽  
Venous Blood ◽  
Lower Extremities ◽  
Arterial Disease ◽  
Lower Limbs ◽  
Venous Blood Flow ◽  
Critical Ischemia ◽  
Type D ◽  
Msct Angiography

Despite the ongoing treatment, in 10–20% of patients with obliterating diseases of the arteries of the lower limbs, the progression of the disease leads to amputation, with mortality rates being up to 50%.The aim: to determine the effectiveness of MSCT angiography in patients with type-D femoral-popliteal arteries according to TASC II with critical ischemia of the lower extremities and poor condition of outflow tracts for performing arterialization of venous blood flow and / or superimposition of arteriovenous fistula.Material and methods. 145 MSCT angiographic studies were performed for patients with arterial diseases of the lower extremities performed in “RAMSAY Diagnostics Rus”Moscow. For the analysis, 53 (37% of the total) of the patient with lesions of the femoropopliteal segment of Type D according to TASC II were selected. The analysis of the state of the arterial outflow pathways was carried out according to the modified Rutherford classification, where each artery of the shin was maximally assigned 3 points depending on the degree of stenosis, the blood flow resistance was estimated as 0 points – the absence of stenosis or stenosis less than 20%, 1 point stenosis 20–49% 2 points stenosis 50–99%, 3 points – occlusion.Results. The degree of resistance of arteries of outflow tracts of 39 limbs (16 right and 23 left) was calculated in 53 patients: 10 points in 23.7% of cases; 9 points in 5.1%; 8 points – 2.5%; 7 points 18%, 6 points in 5%; 5 points 2.5%; 4 points 15.4%; 3 points 7.7%; 2 points 0; 1 point 20.5%. In patients with poor arterial outflow, with a score greater than 7, there is a high risk of early thrombosis of the prosthesis, so such patients undergo an operation with the formation of an unloading arteriovenous fistula.Conclusion. MSCT angiography of the arteries of the lower extremities is an effective method for determining the severity of arterial damage with an accurate definition of the level, extent, prevalence with the possibility of using different classifications, including TASC II and theRutherford classification. It can be used as a screening, expert method in patients with arterial diseases of the lower extremities, may be an alternative to direct angiography, used to assess patients in the postoperative period.Key words: peripheral arterial disease, outflow score, ball classification of outflow tracts, runoff score, computed tomography, angiography. 

scholarly journals FP141MULTICENTRIC STUDY COMPARING CYCLOSPORINE, MYCOPHENOLATE MOFETIL AND AZATHIOPRINE IN THE MAINTENANCE THERAPY OF LUPUS NEPHRITIS: 10 YEARS FOLLOW UP

2019 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Gabriella Moroni ◽  
Lorenza Argolini ◽  
Elena Elefante ◽  
Francesca Saccon ◽  
Valentina Binda ◽  
...  
Keyword(s):  
Mycophenolate Mofetil ◽  
Lupus Nephritis ◽  
Maintenance Therapy

scholarly journals Тransplantation of autologous stem cells, obtained from adipose tissue, in complex treatment of chronic ischemia of the lower extremities

2018 ◽  
Vol 85 (12) ◽  
pp. 30-34
Author(s):  
V. G. Mishalov ◽  
N. Yu. Litvinova ◽  
O. I. Kefeli-Yanovska ◽  
V. A. Chernyak ◽  
D. E. Dubenko ◽  
...  
Keyword(s):  
Stem Cells ◽  
Lower Extremities ◽  
Walking Distance ◽  
Complex Treatment ◽  
Critical Ischemia ◽  
Simultaneous Application ◽  
Group I ◽  
Autologous Mesenchymal Stem Cells ◽  
One Year

Objective. To investigate the efficacy of application of autologous mesenchymal stem cells (AMSC) in treatment of patients, suffering critical ischemia of the lower extremities (CILE). Маterials and methods. In 2012 - 2015 yrs there was conducted the treatment of 41 patients, suffering CILE: 22 (53.7%) - men, and 19 (46.3%) - women. In the Group I (the main) 21 (51.2%) patients have had obtained a standard course of treatment, using AMSC. In the Group II (the control one) 20 (49.8%) patients have obtained a standard course of conservative treatment, using prostaglandins of group Е1 (PGЕ1). The results were investigated, measuring ankle-brachial pressure index, and the indices of a laser duplex flowmetry and a walking distance. Results. During a one-year follow-up a trustworthy enhancement of microcirculation index was registered in the patients, who were treated, using AMSC, comparing with the patients, who obtained a course of therapy of PGЕ1 (р=0.037). Positive dynamics of the microcirculation index while a PGЕ1application was observed during (1.8 ± 0.3) mo, аnd while application of AMSC the microcirculation index have been enhanced trustworthily in (2.7 ± 0.4) mo and persisted during one-year of follow-up. Conclusion. Development of therapeutic effect in groups of patients, who were treated with AMSC and PGЕ1, did not occur simultaneously, thus , a complex treatment with simultaneous application of both methods and conduction of a dosed physical training may be considered a rational option.

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