scholarly journals Von Willebrand factor in patients with peripheral artery disease who undergo invasive treatment

2021 ◽  
Vol 29 (3) ◽  
pp. 389-396
Author(s):  
Roman E. Kalinin ◽  
Igor A. Suchkov ◽  
Nina D. Mzhavanadze ◽  
Olga Zhurina ◽  
Emma A. Klimentova ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Lower Limb ◽  
Limb Ischemia ◽  
Peripheral Artery ◽  
Invasive Treatment ◽  
Artery Disease ◽  
One Year ◽  
Von Willebrand ◽  
Willebrand Factor

AIM: To evaluate the level and activity of von Willebrand factor (vWF) in patients with peripheral artery disease (PAD) who underwent endovascular or open bypass grafting. MATERIAL AND METHODS: The study included 115 patients with chronic lower limb ischemia due to PAD, stage IIb-IV according to A.V. PokrovskyFontaine. Fifty-five participants underwent endovascular treatment, while sixty underwent open bypass procedures using synthetic grafts. Peripheral blood samples were collected from all patients at baseline and three months after invasive treatment to determine the vWF antigen and activity. All patients were monitored every three months for a year to detect the development of unfavorable outcomes including disease progression, restenosis, graft thrombosis, oncology, myocardial infarction (MI), limb loss, stroke, and lethal outcomes. RESULTS: The highest values of vWF antigen in patients who underwent endovascular treatment were detected in patients with multilevel lesions1.25 g/mL (vs 0.2 g/mL, 95% confidence interval (CI) 0.723.21 mcg/mL p = 0.019); with a similar trend observed after a 3month follow-up. Baseline vWF antigen was higher in endovascular group patients who developed myocardial infarction (MI) within a year following the procedures as compared to those without MI: 1.15 mcg/mL (95% CI 1.051.175 mcg/mL) and 0.9 mcg/mL (95% CI 0.781.01 mcg/mL), respectively (p = 0.015). Moreover, vWF antigen was increased at the 3-month follow-up in patients with lethal outcomes1.06 mcg/mL (95% CI 0.961.18 mcg/mL, р = 0.031). vWF activity in endovascular group patients with developed MI was four times higher than those without MI (р = 0.022); a similar trend was detected in the development of lethal outcomes (р = 0.009). Those who underwent open bypass grafting presented with high activity of vWF with maximum values detected in participants with proximal iliofemoral lesions (1200%, 95% CI 640%1200%) and stage IV disease (770%, 95% CI 320%1200%, p 0.05). ROC analysis revealed that vWF activity at least 6.2 times higher in patients who underwent endovascular treatment associated with the development of lethal outcomes within one year after invasive treatments; sensitivity and specificity of the method were 83.3% and 75.5%, accordingly. CONCLUSION: Patients with PAD presented with increased vWF antigen and activity with maximum values detected in patients with multilevel lesions and critical lower limb ischemia. Increased vWF antigen and activity was associated with development of MI and lethal outcomes within one year following endovascular procedures on lower extremity arteries.

scholarly journals The role of ADAMTS13 testing in the diagnosis and management of thrombotic microangiopathies and thrombosis

Blood ◽  
2018 ◽  
Vol 132 (9) ◽  
pp. 903-910 ◽  
Author(s):  
Camila Masias ◽  
Spero R. Cataland
Keyword(s):  
Thrombotic Microangiopathies ◽  
Acute Setting ◽  
Artery Disease ◽  
A Disintegrin And Metalloproteinase ◽  
Von Willebrand ◽  
Willebrand Factor ◽  
Deficient Activity

Abstract ADAMTS13 (a disintegrin and metalloproteinase with thrombospondin type 1 motif, 13) is a metalloprotease responsible for cleavage of ultra-large von Willebrand factor (VWF) multimers. Severely deficient activity of the protease can trigger an acute episode of thrombotic thrombocytopenic purpura (TTP). Our understanding of the pathophysiology of TTP has allowed us to grasp the important role of ADAMTS13 in other thrombotic microangiopathies (TMAs) and thrombotic disorders, such as ischemic stroke and coronary artery disease. Through its action on VWF, ADAMTS13 can have prothrombotic and proinflammatory properties, not only when its activity is severely deficient, but also when it is only moderately low. Here, we will discuss the biology of ADAMTS13 and the different assays developed to evaluate its function in the context of TTP, in the acute setting and during follow-up. We will also discuss the latest evidence regarding the role of ADAMTS13 in other TMAs, stroke, and cardiovascular disease. This information will be useful for clinicians not only when evaluating patients who present with microangiopathic hemolytic anemia and thrombocytopenia, but also when making clinical decisions regarding the follow-up of patients with TTP.

scholarly journals P1280IMPACT OF HAEMODIALYSIS IN PATIENTS UNDERGOING BYPASS SURGERY FOR PERIPHERAL ARTERY DISEASE WITH CRITICAL LIMB ISCHEMIA - 10-YEAR FOLLOW-UP STUDY -

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Yoshitaka Kumada ◽  
Hideki Ishii ◽  
Norio Umemoto ◽  
Ryuta Ito ◽  
Hiroshi Takahashi
Keyword(s):  
Survival Rate ◽  
Limb Salvage ◽  
Bypass Surgery ◽  
Limb Ischemia ◽  
Major Amputation ◽  
Limb Salvage Rate ◽  
Peripheral Artery ◽  
Artery Disease ◽  
Salvage Rate

Abstract Background and Aims Although lower extremities bypass surgery has been commonly performed as the standard option to treat peripheral artery disease with critical limb ischemia (CLI) even in patients on haemodialysis (HD) as well as general population, higher amputation and/or mortality rates still remains major clinical problems after bypass surgery in this population. In this 10-year follow-up study, we investigated the impact of HD on outcomes after surgical revascularization in patients with CLI. Method A total of 464 patients undergoing successfully elective bypass surgery were enrolled. We compared 304 HD patients with 335 limbs and 160 non-HD (NHD) patients with 183 limbs during 10 years follow-up period. Primary outcome was amputation-free survival (AFS) rate defined as freedom rate from composited endpoint with major amputation (limb amputation above ankle level) or all-cause mortality. To minimize the differences of clinical characteristics between the two groups, propensity score-matching with all baseline variables was performed. Results Prevalence of diabetes (55.6% vs. 33.8%), ulcer/gangrene (99.1% vs. 63.5%) and infra-popliteal artery disease (58.9% vs. 32.5%) were significantly higher in HD group compared to NHD group (p<0.0001 in all). Pre-procedural C-reactive protein (CRP) levels was also higher in HD group [14.0 (4.0-51.5) mg/l vs. 7.0 (2.0-34.0) mg/l, p=0.0015]. Inversely, age was younger in HD group than in NHD group (67±9 years vs. 72±8 years, p<0.0001). The 30-day mortality rate was comparable (3.3% in HD group vs. 1.3% in NHD group, p=0.16). During follow-up period (median of 48 months), 53 amputation (17.4%) and 102 death (33.6%) in HD group, and 17 amputation (10.6%) and 23 death (14.4%) in NHD group occurred, respectively. The 10-year AFS rate was significantly lower in HD group compared to NHD group [41.3% vs. 71.3%, hazard ratio (HR) 2.33, 95% confidence interval (CI) 1.64-3.41, p<0.0001). Similarly, limb salvage rate and survival rate was also lower in HD group than in NHD group (72.1% vs. 87.5%, HR 1.90, 95%CI 1.12-3.39, p=0.016, and 51.8% vs. 80.4%, HR 2.78, 95%CI 1.80-4.48, p<0.0001, respectively). In the propensity score-matched cohort, having no significant differences of all baseline characteristics between HD and NHD group (n=125 in each), the 10-year AFS rate and survival rate was still lower in HD group compared to NHD group (53.1% vs. 72.8%, HR 2.11, 95% CI 1.34-3.39, p=0.0012 and 58.6% vs. 84.9%, HR 3.72, 95% CI 2.09-7.06, p<0.0001, respectively). However, the limb salvage rate was statistically comparable between the two group (81.9% vs. 84.2%, HR 1.13, 95%CI 0.55-2.38, p=0.74). In addition, pre-procedural CRP levels could predict major amputation in HD patients (HR 1.06, 95%CI 1.01-1.10, p=0.024) but not NHD patients (HR 1.09, 95%CI 0.93-1.25, p=0.27). Conclusion The long-term AFS rate and survival rate were markedly lower in HD patients compared to NHD patients. However, the limb salvage rate was even between HD and NHD after adjustment for clinical characteristics. These results suggest that detection at the early stage of PAD may potentially improve the poor outcome. Pre-procedural inflammation status may also specifically affects the poor outcome in HD group.

Pentoxifylline-Induced Thrombocytopenia

2015 ◽  
Vol 28 (6) ◽  
pp. 572-576 ◽  
Author(s):  
Michelle W. Tan ◽  
Grant E. Sklar
Keyword(s):  
Lower Limb ◽  
Surgical Intervention ◽  
Limb Ischemia ◽  
Blood Film ◽  
Probability Scale ◽  
Peripheral Artery ◽  
Lower Limb Ischemia ◽  
Peripheral Blood Film ◽  
Artery Disease ◽  
Chinese Male

Pentoxifylline-induced thrombocytopenia is rare, and information is lacking about its presentation. We describe a 72-year-old Chinese male who developed thrombocytopenia after initiation of pentoxifylline for the treatment of chronic lower limb ischemia due to peripheral artery disease. Venous thromboembolism had been ruled out with an ultrasound. Vascular surgeons had also determined there was no indication for surgical intervention. Four days after initiation of pentoxifylline, he developed thrombocytopenia, and his platelets were 68 × 103/μL. He was not in overt disseminated intravascular coagulation (DIC), based on his International Society for Thrombosis and Hemostasis (ISTH) DIC score of 4. Dengue fever, which is endemic in Singapore, was ruled out. Pseudothrombocytopenia was also excluded with a peripheral blood film. When his platelets continued to fall, pentoxifylline was discontinued on the fifth day of treatment, and platelets normalized 48 hours after discontinuation. Pentoxifylline was a probable cause of thrombocytopenia using the Naranjo Adverse Drug Reaction Probability Scale (score = 7). The patient did not receive further doses of pentoxifylline. Prescribers should be aware of the risk of thrombocytopenia with pentoxifylline therapy and discontinue its use promptly if it is suspected.

scholarly journals Major adverse cardiovascular and limb events in patients with diabetes and concomitant peripheral artery disease treated with sodium glucose cotransporter 2 inhibitor versus dipeptidyl peptidase-4 inhibitor

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Hsin-Fu Lee ◽  
Shao-Wei Chen ◽  
Jia-Rou Liu ◽  
Pei-Ru Li ◽  
Lung-Sheng Wu ◽  
...  
Keyword(s):  
Peripheral Artery Disease ◽  
Lower Limb ◽  
Limb Ischemia ◽  
Study Groups ◽  
Dipeptidyl Peptidase ◽  
Research Database ◽  
Peripheral Artery ◽  
Dipeptidyl Peptidase 4 ◽  
Dipeptidyl Peptidase 4 Inhibitors ◽  
Artery Disease

Abstract Background Whether sodium glucose co-transporter 2 inhibitors (SGLT2i) are associated with a lower risk of cardiovascular as well as adverse lower limb events in patients with type-2 diabetes mellitus (T2DM) and concomitant peripheral artery disease (PAD) is unclear. We aimed to evaluate the risk of cardiovascular and limb events, and death associated with the use of SGLT2i compared with dipeptidyl peptidase-4 inhibitors (DPP4i) among a longitudinal and national cohort of patients with T2DM. Methods In this nationwide retrospective cohort study based on the Taiwan National Health Insurance Research Database, we identified a total of 11,431 and 93,972 consecutive T2DM patients with PAD taking SGLT2i and DPP4i, respectively, from May 1, 2016, to December 31, 2017. We used 1:1 propensity score matching (PSM) to balance covariates across study groups. Patients were followed from the drug index date until the occurrence of clinical outcomes, death, discontinuation of the index drug, or the end of the study period, whichever occurred first. Results Overall, 56% and 44% of the patients were treated with dapagliflozin and empagliflozin, respectively. The use of SGLT2i had comparable risks of ischemic stroke and acute myocardial infarction, and was associated with lower risks of congestive heart failure (CHF) [hazard ratio (HR): 0.66; 95% confidence interval (CI) 0.49–0.89; p = 0.0062], lower limb ischemia requiring revascularization (HR: 0.73; 95% CI 0.54–0.98; p = 0.0367) or amputation (HR: 0.43; 95% CI 0.30–0.62; p < 0.0001), and cardiovascular death (HR: 0.67; 95% CI 0.49–0.90; p = 0.0089) when compared with the DDP4i group after PSM. The subgroup analysis revealed consistent results for CHF and major adverse limb outcomes for SGLT2i versus DPP4i among patients aged ≥ 75 years, the presence of chronic kidney disease and established cardiovascular disease was consistent with the main analysis. Conclusions SGLT2i were associated with lower risks of CHF and adverse lower limb events compared with DPP4i among patients with T2DM and PAD in real-world practice.

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