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Absence of Effect of Emicizumab on D-Dimer Concentrations in Adult Patients with Severe Hemophilia A

BACKGROUND: The D-dimer (DD) assay is an essential biological test for the diagnosis and monitoring of thrombotic conditions. DD testing is usually not performed as part of the routine laboratory management of patients with hemophilia (PWH). There is an increasing concern about the risk of thromboti...

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Autores principales: Iarossi, Michael, Lambert, Catherine, Hermans, Cedric
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9732800/
https://www.ncbi.nlm.nih.gov/pubmed/36474347
http://dx.doi.org/10.1177/10760296221143382
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author Iarossi, Michael
Lambert, Catherine
Hermans, Cedric
author_facet Iarossi, Michael
Lambert, Catherine
Hermans, Cedric
author_sort Iarossi, Michael
collection PubMed
description BACKGROUND: The D-dimer (DD) assay is an essential biological test for the diagnosis and monitoring of thrombotic conditions. DD testing is usually not performed as part of the routine laboratory management of patients with hemophilia (PWH). There is an increasing concern about the risk of thrombotic complications in PWH, which is likely related to age, cardiovascular risk factors, invasive thrombogenic procedures, over-correction of Factor VIII (FVIII) or FIX, or administration of new therapeutic agents mimicking FVIII or rebalancing coagulation. OBJECTIVE: This retrospective study sought to assess the basal DD levels in PWH treated prophylactically with FVIII, and to evaluate potential changes after switching to emicizumab. METHOD: Patients over 18 years of age treated with emicizumab within a single center over the period 2017-2022 were included in the study. RESULT: DD levels were measured in 40 adult PWH (37 severe/ three moderate / two with FVIII inhibitor) with a median age of 46 years (range: 19-82; Q1-Q3: 30,25-56,5), before and at least 3 months after emicizumab initiation. No significant changes were revealed, with DD median values of 257 ng/mL (range: 250-2876; Q1-Q3: 250-493,5) before and 250 ng/mL (range: 50-6205; Q1-Q3: 250-380,25) after the switch (p  =  0.9). CONCLUSION: Most adult PWH on prophylaxis using FVIII display DD levels within the normal range, which remain unchanged after switching to emicizumab. In view of these reassuring results, monitoring of DDs at the start of emicizumab treatment does not appear necessary but could be considered when combined with other bypassing agents or high dose FVIII.
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spelling pubmed-97328002022-12-10 Absence of Effect of Emicizumab on D-Dimer Concentrations in Adult Patients with Severe Hemophilia A Iarossi, Michael Lambert, Catherine Hermans, Cedric Clin Appl Thromb Hemost Original Manuscript BACKGROUND: The D-dimer (DD) assay is an essential biological test for the diagnosis and monitoring of thrombotic conditions. DD testing is usually not performed as part of the routine laboratory management of patients with hemophilia (PWH). There is an increasing concern about the risk of thrombotic complications in PWH, which is likely related to age, cardiovascular risk factors, invasive thrombogenic procedures, over-correction of Factor VIII (FVIII) or FIX, or administration of new therapeutic agents mimicking FVIII or rebalancing coagulation. OBJECTIVE: This retrospective study sought to assess the basal DD levels in PWH treated prophylactically with FVIII, and to evaluate potential changes after switching to emicizumab. METHOD: Patients over 18 years of age treated with emicizumab within a single center over the period 2017-2022 were included in the study. RESULT: DD levels were measured in 40 adult PWH (37 severe/ three moderate / two with FVIII inhibitor) with a median age of 46 years (range: 19-82; Q1-Q3: 30,25-56,5), before and at least 3 months after emicizumab initiation. No significant changes were revealed, with DD median values of 257 ng/mL (range: 250-2876; Q1-Q3: 250-493,5) before and 250 ng/mL (range: 50-6205; Q1-Q3: 250-380,25) after the switch (p  =  0.9). CONCLUSION: Most adult PWH on prophylaxis using FVIII display DD levels within the normal range, which remain unchanged after switching to emicizumab. In view of these reassuring results, monitoring of DDs at the start of emicizumab treatment does not appear necessary but could be considered when combined with other bypassing agents or high dose FVIII. SAGE Publications 2022-12-06 /pmc/articles/PMC9732800/ /pubmed/36474347 http://dx.doi.org/10.1177/10760296221143382 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Original Manuscript
Iarossi, Michael
Lambert, Catherine
Hermans, Cedric
Absence of Effect of Emicizumab on D-Dimer Concentrations in Adult Patients with Severe Hemophilia A
title Absence of Effect of Emicizumab on D-Dimer Concentrations in Adult Patients with Severe Hemophilia A
title_full Absence of Effect of Emicizumab on D-Dimer Concentrations in Adult Patients with Severe Hemophilia A
title_fullStr Absence of Effect of Emicizumab on D-Dimer Concentrations in Adult Patients with Severe Hemophilia A
title_full_unstemmed Absence of Effect of Emicizumab on D-Dimer Concentrations in Adult Patients with Severe Hemophilia A
title_short Absence of Effect of Emicizumab on D-Dimer Concentrations in Adult Patients with Severe Hemophilia A
title_sort absence of effect of emicizumab on d-dimer concentrations in adult patients with severe hemophilia a
topic Original Manuscript
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9732800/
https://www.ncbi.nlm.nih.gov/pubmed/36474347
http://dx.doi.org/10.1177/10760296221143382
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