scholarly journals Risk factors of thrombosis in chinese subjects with acute promyelocytic leukemia

2021 ◽  
Author(s):  
Xueya Zhang ◽  
Xizhe Guo
Keyword(s):  
Risk Factors ◽  
Acute Promyelocytic Leukemia ◽  
Detection Rate ◽  
Disease Risk ◽  
Laboratory Data ◽  
Female Gender ◽  
Promyelocytic Leukemia ◽  
Rare Manifestation ◽  
Chinese Subjects ◽  
Pai 1

Abstract Acute promyelocytic leukemia (APL) is a kind of malignant hematologic disease. Thrombosis is a rare manifestation of APL. However, the risk factors of thrombosis related to chinese APL patients are not fully understood. Clinical and laboratory data of 44 consecutively chinese APL patients were collected and analyzed. 1 arterial and 6 venous thrombosis occurred in 44 patients, including 22 males and 22 females, with a median age of 44 years (range 18–74 years). The ratio of male and female gender (P = 0.68), age (P = 0.823), white blood cell count (P = 0.077), hemoglobin (P = 0.409), platelets (P = 0.334), disease risk stratification (P = 0.475), CD2 (P = 0.737), khorana score (P = 0.52), differentiation syndrome (DS) (P = 0.562) and gene mutation related to prognosis of APL, including DNMT3A (P = 0.44), TET2 (P = 0.43), IDH1 (P = 0.6), IDH2 (P = 0.66), NRAS (P = 0.66), ASXL1(P = 0.9) in the two groups with and without thrombosis were not statistically significant. The detection rate of PAI-1 genotype 4G4G was 71.4% (5/7) in 7 patients with thrombosis, while the detection rate of PAI-1 genotype 4G4G in 37 patients without thrombosis was 8.1% (3/37). The differences between the two groups in WT-1 (P = 0.01), PAI-1 4G4G (P = 0.0009), bcr3 (P = 0.027), CD15 (P = 0.005), and FLT3-ITD mutation (P = 0.0008) were statistically significant. The results suggested the PAI-1 gene 4G4G type, PML/RARa (bcr3), CD15, WT-1 and FLT3-ITD mutations excluding DNMT3A, TET2, IDH1/2, NRAS and ASXL1 are risk factors of thrombotic events in chinese APL patients.

scholarly journals Risk factors of thrombosis in Chinese subjects with acute promyelocytic leukemia

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Xueya Zhang ◽  
Xizhe Guo
Keyword(s):  
Risk Factors ◽  
Venous Thrombosis ◽  
Acute Promyelocytic Leukemia ◽  
Detection Rate ◽  
Disease Risk ◽  
Laboratory Data ◽  
Female Gender ◽  
Promyelocytic Leukemia ◽  
Increased Risk ◽  
Pai 1

Abstract Background Acute promyelocytic leukemia (APL) is a special type of acute myeloid leukemia Thrombosis is at increased risk complication in patients with this disease. However, the risk factors of thrombosis related to Chinese APL patients are not fully understood. Methods In this study, clinical and laboratory data of 44 consecutively Chinese APL patients were collected and analyzed. Results One arterial and 6 venous thrombosis occurred in 44 patients, including 22 males and 22 females, with a median age of 44 years (range from 18 to 74 years). The ratio of male and female gender, age, white blood cell count, hemoglobin, platelets, disease risk stratification, CD2, Khorana score, differentiation syndrome (DS) and gene mutation related to prognosis of APL, including DNMT3A, TET2, IDH1, IDH2, NRAS and ASXL1 in the two groups with and without thrombosis were not statistically significant. The detection rate of PAI-1 genotype 4G4G was 71.4% (5/7) in 7 patients with thrombosis, while the detection rate of PAI-1 genotype 4G4G in 37 patients without thrombosis was 8.1% (3/37). The differences between the two groups in WT-1 (P = 0.01), PAI-1 4G4G (P = 0.0009), bcr3 (P = 0.027), CD15 (P = 0.005), and FLT3-ITD mutation (P = 0.0008) were statistically significant. Using multivariate analysis, the risk factors of venous thrombosis in APL were CD15 (P = 0.043), PAI-1 4G4G (P = 0.009), WT-1 (P = 0.043) and FLT3/ITD (P = 0.013), respectively. Conclusion Our results suggested the PAI-1 gene 4G4G type, CD15, WT-1 and FLT3-ITD mutations excluding DNMT3A, TET2, IDH1/2, NRAS and ASXL1 are risk factors of thrombotic events in Chinese APL patients.

scholarly journals Nonbacterial Thrombotic Endocarditis Associated with Acute Promyelocytic Leukemia: An Autopsy Case Report

Medicina ◽  
2021 ◽  
Vol 57 (11) ◽  
pp. 1264
Author(s):  
Tadayuki Hashimoto ◽  
Tatsuya Aoki ◽  
Yoshitaka Kawabata ◽  
Yoshihiro Owai ◽  
Yoshikazu Matsuda ◽  
...  
Keyword(s):  
Acute Promyelocytic Leukemia ◽  
Laboratory Data ◽  
Anticoagulation Therapy ◽  
Sudden Onset ◽  
Promyelocytic Leukemia ◽  
Intensity Change ◽  
High Signal ◽  
Left Brain ◽  
Wide Range ◽  
Nonbacterial Thrombotic Endocarditis

Valve vegetation is one of the most fearful findings for physicians. The first diagnosis that comes to their mind is infective endocarditis (IE), but it can also be noninfective; nonbacterial thrombotic endocarditis (NBTE). NBTE can be even more challenging than IE for physicians because of the wide range of differential diagnoses such as malignancies, autoimmune disorders and human immunodeficiency virus. A 45-year-old woman presented at the emergency room with a sudden onset of dysarthria and right-sided hemiplegia. Laboratory data showed her blood counts and coagulation test were mostly normal and the magnetic resonance imaging detected a high-signal-intensity change in her left brain. An echocardiogram found a vegetation-like structure on her atrial valve. We highly suspected IE leading to cerebral embolism. The clot was successfully removed by our neurosurgeons and anticoagulation therapy was started concurrently. Her state of consciousness improved, but then she suffered a brain hemorrhage and died. The autopsy revealed that the cause of her vegetation was acute promyelocytic leukemia (APL). Based on these findings, it is important to remember that APL can be the cause of NBTE even if the blood count and coagulation tests are almost normal.

A Risk Model for Early Intracranial Hemorrhage in Acute Leukemia.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 4473-4473
Author(s):  
Hawk Kim ◽  
Seong-Jun Choi ◽  
Je-Hwan Lee ◽  
Jung-Shin Lee ◽  
Kyoo Hyung Lee
Keyword(s):  
Acute Leukemia ◽  
Prothrombin Time ◽  
Acute Promyelocytic Leukemia ◽  
Induction Chemotherapy ◽  
Intracranial Hemorrhage ◽  
Risk Model ◽  
Female Gender ◽  
Promyelocytic Leukemia ◽  
Free Survival ◽  
Prolonged Prothrombin Time

Abstract Early intracranial hemorrhage (EICH), which is defined by noticeable ICH within 10 days of diagnosis, is a life-threatening hemorrhagic complication in patients with acute leukemia. To ascertain risk factors associated with EICH, we retrospectively analyzed 792 newly-diagnosed acute leukemia patients treated between July 1988 and March 2003. Thirty-one patients (3.9 %) had analyzable EICH. Multivariate analysis showed that female gender (OR = 3.064, P < 0.001), acute promyelocytic leukemia (OR = 8.797, P = 0.003), leukocytosis (OR = 6.056, P = 0.004), and prolonged prothrombin time (OR = 10.026, P = 0.016) were factors significantly associated with occurrence of EICH. Risk scores (RS) were calculated by a product of odds ratio and each risk factor (RF) and taking their sum, generating an RS ranging 0 to 27.943. The cutoff of RS 9 was of statistical significance to predict probability of EICH. Receiver-operating characteristics curve shows the sensitivity and 1 - specificity relative to risk score (AUC = 0.917; S.E. = 0.021; 95% CI, 0.876–0.958; Figure 1). In this regards, RF for EICH was classified as major (prolonged prothrombin time) and minor (female gender, acute promyelocytic leukemia, leukocytosis). Risk model demonstrated that EICH was low probable when no major RF and less than two minor RFs were present. Risk model for ICH in acute leukemia classified acute leukemia patients into two risk groups; low probable EICH group (LPG) and probable EICH group (PG). When applied to our patients, PG was positively correlated with more incidence of FICH than LPG (n = 27/173 vs. 4/619, P < 0.001). Induction chemotherapy could be undertook more frequently in LPG than in PG (p = 0.002, Table 1). Kaplan-Meier curves show the probability of EICH-free survival relative to probability of EICH. ICH-free survival was significantly longer in LPG than in PG (p < 0.0001, Figure 2). Our findings suggest that our risk model may predict the occurrence of EICH in patients with acute leukemia. Table 1. The relationship of risk model and frequency of early intracranial hemorrhage (EICH) or performance of induction chemotherapy. Figure Figure Figure Figure Low probable EICH group, n (%) Probable EICH group, n (%) P EICH (−) 615 (77.7 %) 146 (18.4 %) < 0.001 EICH (+) 4 (0.5 %) 27 (3.4 %) Induction chemotherapy (+) 563 (71.1 %) 143 (18.1 %) 0.002 Induction chemotherapy (−) 56 (7.1 %) 30 (3.8 %)

Vascular disease risk factors as determinants of incident depressive symptoms: a prospective community-based study

2004 ◽  
Vol 34 (4) ◽  
pp. 635-641 ◽  
Author(s):  
J. CERVILLA ◽  
M. PRINCE ◽  
S. RABE-HESKETH
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Depressive Symptoms ◽  
Vascular Disease ◽  
Disease Risk ◽  
Controlled Trial ◽  
A Priori ◽  
Executive Dysfunction ◽  
Female Gender ◽  
Psychiatric Research

Background. The potential association between vascular disease and depression have been the focus for much clinical psychiatric research, although few epidemiological prospective studies have looked into this association.Aims. This study explores the a priori hypothesis of a prospective association between cardiovascular disease or its risk factors and incident depressive symptoms.Method. A prospective primary care based study derived from a multi-centre randomized controlled trial of moderate hypertension. 2584 moderately-hypertensive volunteers were followed-up for 54 months when five assessments of depressive symptoms, vascular disease and its risk factors were made.Results. We found an association between the dependent variable (incident depressive symptoms measured with the Self-CARE-D) and baseline smoker status, low serum cholesterol levels, poorer cognitive function (particularly executive dysfunction), female gender and increasing age. These associations were independent of all other cardiovascular risk factors (ECG evidence of ischaemia or arrythmia, systolic or diastolic blood pressure, blood pressure decline along the trial and body mass index).Conclusions. Our results do not support the hypothesis of a specific association between vascular disease or its risk factors and incident depressive symptoms.

scholarly journals The specific activity of plasminogen activator inhibitor-1 in disseminated intravascular coagulation with acute promyelocytic leukemia

Blood ◽  
1991 ◽  
Vol 77 (9) ◽  
pp. 1949-1957 ◽  
Author(s):  
Y Sakata ◽  
T Murakami ◽  
A Noro ◽  
K Mori ◽  
M Matsuda
Keyword(s):  
Plasminogen Activator ◽  
Acute Promyelocytic Leukemia ◽  
Disseminated Intravascular Coagulation ◽  
Specific Activity ◽  
Plasminogen Activator Inhibitor ◽  
Promyelocytic Leukemia ◽  
Plasminogen Activator Inhibitor 1 ◽  
Intravascular Coagulation ◽  
Activator Inhibitor ◽  
Pai 1

In disseminated intravascular coagulation (DIC) with acute promyelocytic leukemia (APL) in the absence of severe infection, marked fibrinolysis was noted in comparison with normal levels of antithrombin III, which is a major inhibitor of the coagulation system. Increased plasminogen activator inhibitor-1 (PAI-1) antigen levels in plasma from patients with septicemia decreased the ratio of the plasma clot lysis rate induced by an anti-alpha 2-plasmin inhibitor monoclonal antibody to the tissue-type plasminogen activator (t-PA) concentration. This decrease was not as prominent in plasma from patients with DIC, especially those with APL. To explore the character of PAI-1 in these plasmas, we measured the specific activity of PAI-1 by determining the ratio of active PAI-1 antigen to t-PA-unbound PAI-1 antigen. To calculate the amount of active PAI-1 antigen, the amount of t-PA/PAI-1 complex before and after the addition of a fixed amount of t-PA to the sample was measured by a sandwich solid-phase enzyme-linked immunosorbent assay using anti-PAI-1 and anti-t-PA monoclonal antibodies. The assay to measure total PAI-1 antigen used three monoclonal anti-PAI-1 antibodies and had similar sensitivities to free active, latent, vitronectin-bound and t-PA-bound PAI-1. The specific activity of PAI-1 decreased in patients with DIC (43.7% +/- 30.6%) and in DIC cases with APL (10.3% +/- 6.0%) in comparison to patients with septicemia (83.7% +/- 20.2%) or normal controls (85.8% +/- 27.3%). In DIC associated with APL, degraded forms of PAI-1 were detected in plasma by immunoblotting. These results suggest that a decrease in the specific activity of PAI-1 and an increase in secondary fibrinolysis result in a hyperfibrinolytic state in DIC patients with APL.

scholarly journals Tools for Assessing Cardiovascular Disease Risk Factors in Underserved Young Adult Populations: A Systematic Review

2021 ◽  
Vol 18 (24) ◽  
pp. 13305
Author(s):  
Audrey A. Opoku-Acheampong ◽  
Richard R. Rosenkranz ◽  
Koushik Adhikari ◽  
Nancy Muturi ◽  
Cindy Logan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Risk Assessment ◽  
Heart Disease ◽  
Young Adult ◽  
Disease Risk ◽  
Laboratory Data ◽  
Assessment Tools ◽  
Cvd Risk ◽  
Risk Assessment Tools

Cardiovascular disease (CVD, i.e., disease of the heart and blood vessels) is a major cause of death globally. Current assessment tools use either clinical or non-clinical factors alone or in combination to assess CVD risk. The aim of this review was to critically appraise, compare, and summarize existing non-clinically based tools for assessing CVD risk factors in underserved young adult (18–34-year-old) populations. Two online electronic databases—PubMed and Scopus—were searched to identify existing risk assessment tools, using a combination of CVD-related keywords. The search was limited to articles available in English only and published between January 2008 and January 2019. Of the 10,383 studies initially identified, 67 were eligible. In total, 5 out of the 67 articles assessed CVD risk in underserved young adult populations. A total of 21 distinct CVD risk assessment tools were identified; six of these did not require clinical or laboratory data in their estimation (i.e., non-clinical). The main non-clinically based tools identified were the Heart Disease Fact Questionnaire, the Health Beliefs Related to CVD-Perception measure, the Healthy Eating Opinion Survey, the Perception of Risk of Heart Disease Scale, and the WHO STEPwise approach to chronic disease factor surveillance (i.e., the STEPS instrument).

Fibrinogen consumption and use of heparin are risk factors for delayed bleeding during acute promyelocytic leukemia induction

2019 ◽  
Vol 83 ◽  
pp. 106174 ◽  
Author(s):  
Bryan C. Hambley ◽  
Kelly J. Norsworthy ◽  
Jagar Jasem ◽  
Jacquelyn W. Zimmerman ◽  
Eugene Shenderov ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Promyelocytic Leukemia ◽  
Promyelocytic Leukemia ◽  
Delayed Bleeding

Incidence and Risk Factors for Thrombosis in Patients with Acute Promyelocytic Leukemia. Experience of the PETHEMA LPA96 and LPA99 Protocols.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 1503-1503 ◽  
Author(s):  
Pau Montesinos ◽  
Javier de la Serna ◽  
Edo Vellenga ◽  
Consuelo Rayon ◽  
Juan Bergua ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Tranexamic Acid ◽  
Acute Promyelocytic Leukemia ◽  
Univariate Analysis ◽  
Promyelocytic Leukemia ◽  
Cerebral Stroke ◽  
Flt3 Mutations ◽  
The Impact ◽  
Ischemic Events

Abstract Background: Thrombo-ischemic events can be a severe complication in patients with active acute promyelocytic leukemia (APL). In a recently published study, the incidence of thrombosis among 90 patients with APL was 9%, and it was related to CD2 surface antigen expression, FLT3 mutations and leukocytes >10×109/L. The introduction of coagulopathy prophylaxis with tranexamic acid has not shown a benefit on hemorrhagic mortality, but its impact on the incidence of thrombotic events is unclear. Objectives:Analyze the incidence and risk factors for the development of thrombosis in patients with APL undergoing induction chemotherapy.Analyze the impact of prophylaxis with tranexamic acid on development of thrombosis. Material and methods: Between 1996 and 2005 759 patients with newly diagnosed APL were registered in the multicenter PETHEMA LPA96 and LPA99 trials. Twenty-six patients (3.5%) died due to complications before start of chemotherapy (CT). Induction consisted of ATRA plus idarubicin. In the LPA99 trial prophylactic tranexamic acid 100 mg/kg/day was introduced in case of platelets <50×109/L. At the end of the LPA99 trial its use was not recommended, and overall, initiation of tranexamic acid was reported in 257 patients (35%) We performed a univariate analysis to assess clinico-biological factors associated with thrombosis. Significant variables (p<0.05) were included in a multivariate analysis. Results: 39/759 patients (5.1%) developed thrombosis. Among 26 patients who died before initiation of CT, 6 (23%) presented with thrombotic complications: 3 cerebral stroke (CNS), 2 pulmonary embolism (PE) and 1 acute myocardial infarction (AMI). Thirty-three (4.5%) of the 733 patients in whom CT was initiated experienced thrombosis: 3 at diagnosis (1 AMI, 1 CNS and 1 deep venous thrombosis (DVT)) and 30 after the start of CT (16 DVT, 6 CNS, 3 PE, 2 AMI and 2 others). Four thrombotic events were related with initiation of tranexamic acid: 2 DVT, 1 skin necrosis and 1 renal necrosis. The following factors were related to a higher incidence of thrombosis: leukocytes >10×109/L (9% vs 4%, p<0.01), M3-variant subtype (11% vs 4%, p=0.02), fibrinogen <170 mg/dl (7% vs 3%, p=0.02) and hemoglobin >10 g/dl (8% vs 4%, p=0.03). No significant relation was observed with CD2 or other surface antigens, as well as FLT3 mutations. Use of tranexamic acid showed a trend towards a higher incidence of thrombosis (6% vs 3%, p=0.08). In multivariate analysis hypofibrinogenemia and M3-v subtype remained as independent prognostic factors. Thrombosis was related with a higher induction mortality (including deaths before start of CT), 28% vs 11%, p<0.01. Conclusion: Thrombo-ischemic events are relatively frequent in active APL patients implying an elevated early mortality. Hypofibrinogenemia and M3-v are associated with a higher incidence of thrombosis. Treatment with tranexamic acid has not decreased hemorrhagic mortality and it could be related to increased thrombotic events. Therefore its prophylactic use should not be recommended.

C0321: Risk Factors for Thrombosis in Acute Promyelocytic Leukemia

2014 ◽  
Vol 133 ◽  
pp. S104-S105
Author(s):  
M. Mitrovic ◽  
N. Suvajdzic ◽  
I. Elezovic ◽  
A. Bogdanovic ◽  
V. Dordevic ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Promyelocytic Leukemia ◽  
Promyelocytic Leukemia
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