Ana Boban

The value and impact of anti-xa activity monitoring for prophylactic dose adjustment of low-molecular-weight heparin during pregnancy: a retrospective study.

&NA; Low-molecular-weight heparin (LMWH) is the anticoagulant drug class of choice for the prevention of thrombosis during pregnancy and often used for prevention of severe obstetrical complications, yet the optimal dosage is still a matter of debate. Although several studies have evaluated LMWH dose adjustment methods based on anti-Xa levels, no definitive conclusion as yet exists. This extensive retrospective study sought to address the rationale of regular anti-Xa activity monitoring in pregnant patients given LMWH prophylaxis. We evaluated pregnant patients receiving LMWH prophylaxis with three or more anti-Xa measurements. The initial LMWH dose was fixed and adjusted for obesity. The desired anti-Xa activity was 0.2–0.6 IU/ml and LMWH dose was increased for anti-Xa levels less than 0.3 IU/ml. Of the 173 enrolled women, 79% required LMWH dose adjustment (56%: one dose increase; 20%: two; 3%: three). In the vast majority of patients, LMWH dose was increased before substantial body weight gain. The number of dose adjustments positively correlated with BMI, though not with body weight gain. Based on our study findings, we recommend conducting LMWH dose adjustments based on anti-Xa levels, monitored regularly during pregnancy to keep the anti-Xa activity within the desired range.

Is the cardiovascular toxicity of NSAIDS and COX-2 selective inhibitors underestimated in patients with haemophilia?

Joint pain secondary to chronic arthropathy represents one of the most common and debilitating complications of haemophilia, often requiring analgesic care. When compared with nonselective non-steroidal anti-inflammatory drugs (ns-NSAIDs), selective COX-2 inhibitors (coxibs) offer the major advantage of not increasing the bleeding risk, thus being a better choice of analgesics for haemophilia patients. However, several studies have highlighted the cardiovascular risks posed by coxibs and NSAIDs. Given the assumed protection against thrombosis conferred by the deficiency in coagulation factors VIII or IX, these precautions regarding the use of coxibs and NSAIDs have never really been taken into account in haemophilia management. However, contrary to what has long been suspected, haemophilia patients are indeed affected by the same cardiovascular risk factors as nonhaemophiliac patients. Further studies should be conducted to evaluate the impact of NSAIDs on cardiovascular risks and the prevalence of hypertension in haemophilia patients.

Successful Treatment and Secondary Prevention of Venous Thrombosis Secondary to Behçet Disease with Rivaroxaban

We here present the successful initial treatment and secondary prophylaxis of superficial venous thrombosis secondary to Behçets disease by a novel anticoagulant drug, rivaroxaban (Xarelto®). To our knowledge, this is the first case of using an oral direct inhibitor of FXa in this setting. Our findings are promising; the outcome was favourable without any adverse effect noted. We propose that the patients with Behçets disease and venous thrombosis might benefit from the advantages of the new anticoagulant drug.

Acute promyelocytic leukemia after whole brain irradiation of primary brain lymphomainan HIV-infected patient

The occurrence of acute promyelocytic leukemia (APL) in HIV-infected patients has been reported in only five cases. Due to a very small number of reported HIV/APL patients who have been treated with different therapies with the variable outcome, the prognosis of APL in the setting of the HIV-infection is unclear. Here, we report a case of an HIV-patient who developed APL and upon treatment entered a complete remission. A 25-years old male patient was diagnosed with HIV-infection in 1996, but remained untreated. In 2004, the patient was diagnosed with primary central nervous system lymphoma. We treated the patient with antiretroviral therapy and whole-brain irradiation, resulting in complete remission of the lymphoma. In 2006, prompted by a sudden neutropenia, we carried out a set of diagnostic procedures, revealing APL. Induction therapy consisted of standard treatment with all-trans-retinoic-acid (ATRA) and idarubicin. Subsequent cytological and molecular analysis of bone marrow demonstrated complete hematological and molecular remission. Due to the poor general condition, consolidation treatment with ATRA was given in March and April 2007. The last follow-up 14 months later, showed sustained molecular APL remission. In conclusion, we demonstrated that a complete molecular APL remission in an HIV-patient was achieved by using reduced-intensity treatment.

Characteristics of Older Patient with Haemophilia

1.1 Life expectancy in patients with haemophilia Until 1960 haemophilia was a life-threatening disease with limited treatment options as splints, icepacks and bed rest. With the discovery of factor concentrates the life of haemophilia patients changed dramatically better. They improved quality of life and prolong life expectancy (Mejia-Carvajal, 2006). Median life expectancy in males with severe haemophilia was 11 years in the early 20th century, increased to the range of 55 to 63 years in the 1970s (Plug, 2006; Darby, 2007). By the early 1980s life expectancy was almost 68 years (Chorba, 2001; Oldenburg, 2009). By 1990s the life expectancy in US haemophiliacs dropped to 49 years because of HIV infections. The decline in HIV-related mortality in HIV-infected persons with haemophilia reflected improvements in highly active anti-retroviral therapy (HAART). In 2001, haemophiliac life expectancy in The Netherlands reached 67 years (74 years for those without blood borne virus infections) and by 2007, the overall haemophilic life expectancy was reported to be 71 years in Italy (Plug, 2006; Tagliaferri, 2010) that is approaching the general male population. About 2% of haemophilia A and B patients surveyed in US comprehensive haemophilia treatment centres are 65 years of age or older and 15% are 45 years or older (Philipp, 2010).