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Valentino L.A.,Rush University | Holme P.A.,Research Institute of Internal Medicine | Holme P.A.,University of Oslo
Haemophilia | Year: 2015

Inhibitor development in haemophilia patients is challenging especially when undergoing surgical procedures. The development of an inhibitor precludes using factor VIII (FVIII) therapy thereby requiring a bypassing agent (BPA) for surgical bleeding prophylaxis if the FVIII inhibitor titre >5 BU. Concomitant use of anti-inhibitor coagulant complex (AICC) and tranexamic acid has been reported in the literature as a beneficial treatment for this population. Anti-inhibitor coagulant complex is known to cause an increase in thrombin generation and tranexamic acid inhibits fibrinolysis. Hence, the combined used of AICC and tranexamic acid has been limited due to safety concerns over possibilities of increased risk of thrombotic events and disseminated intravascular coagulation. However, the rationale for concomitant therapy is to obtain a potential synergistic effect and to increase clot stability. We conducted a literature review of past studies and individual case reports of concomitant use of AICC and tranexamic acid, which was extensively used during dental procedures. Evidence also exists for concomitant use of the combined therapy in orthopaedic procedures, control of gastrointestinal bleeding, epistaxis and cerebral haemorrhages. Some patients who received the combined therapy had failed monotherapy with a single BPA prior to combined therapy. There were no reports of thrombotic complications related to the concomitant therapy and haemostasis was achieved in all cases. Anti-inhibitor coagulant complex and tranexamic acid therapy was found to be safe, well-tolerated and effective therapy in haemophilia patients with inhibitors. Additional randomized controlled studies should be performed to confirm these findings. © 2015 John Wiley & Sons Ltd.

Grub C.,Innlandet Hospital Trust | Brunborg C.,University of Oslo | Hasseltvedt V.,Innlandet Hospital Trust | Aukrust P.,Research Institute of Internal Medicine | And 4 more authors.
Rheumatology | Year: 2012

Objectives. The mechanism linking inflammation to atherosclerosis is unknown. We have previously demonstrated a high occurrence of inflammation in the aortic adventitia of patients with coronary artery disease (CAD), which was more pronounced in patients with inflammatory rheumatic diseases (IRDs), and which might be involved in the pathogenesis of cardiovascular disease. In theory, infections might play a role in the pathogenesis of vascular inflammation or atherosclerosis, or both. This study compared seropositivity and the burden of several common infections in patients with CAD, both with and without IRD, and in healthy controls (HCs). Moreover, we looked for relationships between the examined antibodies and inflammatory infiltrates in the aortic adventitia.Methods. We examined sera for Chlamydophila pneumoniae, Mycoplasma pneumoniae, Helicobacter pylori, CMV, Streptococcus pyogenes, parvovirus B19, HBV and HCV with commercially available serological tests in 67 patients with IRD, 52 patients without IRD and 30 HCs.Results. We observed neither any statistically significant differences in the examined antibodies between the groups nor a difference in the burden of infection. Except for a protective effect of mycoplasma immunoglobulin A (IgA), we did not find any other associations between the examined antibodies and the occurrence of aortic adventitial mononuclear cell infiltrates. Conclusion. Our study does not support the notion that chronic infections or infectious burden contribute to accelerated occurrence of CAD in IRD. Mycoplasma IgA was related to a lower occurrence of aortic adventitial inflammation. © The Author 2011. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved.

Andreassen O.A.,University of Oslo | McEvoy L.K.,Multimodal Imaging Laboratory | McEvoy L.K.,University of California at San Diego | Wang Y.,University of Oslo | And 15 more authors.
Hypertension | Year: 2014

Blood pressure is a critical determinant of cardiovascular morbidity and mortality. It is affected by environmental factors, but has a strong heritable component. Despite recent large genome-wide association studies, few genetic risk factors for blood pressure have been identified. Epidemiological studies suggest associations between blood pressure and several diseases and traits, which may partly arise from a shared genetic basis (genetic pleiotropy). Using genome-wide association studies summary statistics and a genetic pleiotropy-informed conditional false discovery rate method, we systematically investigated genetic overlap between systolic blood pressure (SBP) and 12 comorbid traits and diseases. We found significant enrichment of single nucleotide polymorphisms associated with SBP as a function of their association with body mass index, low-density lipoprotein, waist/hip ratio, schizophrenia, bone mineral density, type 1 diabetes mellitus, and celiac disease. In contrast, the magnitude of enrichment due to shared polygenic effects was smaller with the other phenotypes (triglycerides, high-density lipoproteins, type 2 diabetes mellitus, rheumatoid arthritis, and height). Applying the conditional false discovery rate method to the enriched phenotypes, we identified 62 loci associated with SBP (false discovery rate <0.01), including 42 novel loci. The observed polygenic overlap between SBP and several related disorders indicates that the epidemiological associations are not mediated solely via lifestyle factors but also reflect an etiologic relation that warrants further investigation. The new gene loci identified implicate novel genetic mechanisms related to lipid biology and the immune system in SBP. © 2014 American Heart Association, Inc.

Askevold E.T.,University of Oslo | Nymo S.,Research Institute of Internal Medicine | Ueland T.,Section of Clinical Immunology and Infectious Diseases | Gravning J.,Institute for Surgical Research | And 6 more authors.
Circulation: Heart Failure | Year: 2013

Background-Glycoprotein 130 (gp130) is the common signal-transducing receptor subunit of the interleukin-6 (IL-6) family, which may be involved in the progression of heart failure (HF). We hypothesized that soluble gp130 would provide prognostic information beyond that of IL-6 in a population with HF from the Controlled Rosuvastatin Multinational Trial in Heart Failure (CORONA). Methods and Results-The associations of soluble gp130 and IL-6 with morbidity, mortality, and mode of death were assessed by immunoassays in a subset of 1452 patients enrolled in the CORONA trial, which included patients with HF, aged =60 years, in New York Heart Association classes II to IV, who had ischemic heart disease and a reduced left ventricular ejection fraction. In multivariable analyses, including C-reactive protein, IL-6, troponin T, and N-terminal pro-B-type natriuretic peptide, elevated soluble gp130 (fifth quintile versus all lower quintiles) was associated with all-cause mortality (hazard ratio, 1.47 [1.11-1.93]; P=0.006), cardiovascular mortality (hazard ratio, 1.38 [1.01-1.87]; P=0.042), and death from worsening HF (hazard ratio, 1.85 [1.09-3.14]; P=0.002), but not with the primary end point (composite of death from cardiovascular causes, nonfatal myocardial infarction, and nonfatal stroke; hazard ratio, 1.12 [0.84-1.50]; P=0.44). Plasma IL-6 was not associated with outcomes in multivariable analyses. Conclusions-Marked elevations in soluble gp130 are associated with total and cardiovascular mortality, as well as deaths from worsening HF, in elderly patients with HF of ischemic cause. © 2013 American Heart Association, Inc.

Tran H.T.T.,Research Institute of Internal Medicine | Tran H.T.T.,University of Oslo | Tjonnfjord G.E.,University of Oslo | Paus A.,University of Oslo | Holme P.A.,University of Oslo
Haemophilia | Year: 2011

The use of recombinant FVIIa (rFVIIa) to control bleed in individuals with FVII deficiency has been proven to be effective. The main problems associated with its use are that it requires frequent bolus injections to counteract its short half-life and high cost. Our study aimed to evaluate whether any advantage could be gained by providing rFVIIa by continuous infusion during surgery with regard to haemostatic efficacy, safety and cost. The prospective study included 10 patients with severe FVII deficiency, who underwent 25 surgical procedures (13 major and 12 minor procedures) and were treated with rFVIIa administered by continuous infusion. Tranexamic acid was given concomitantly every 8h. Prothrombin time, FVII:C assay and thrombin generation assay were used to monitor the treatment. The mean total dose given was 10mg during a major surgery and 4.4mg during a minor surgery for a mean treatment duration of 7.5 and 4.0days respectively. This corresponds to a reduction of 70-90% in drug usage and medication cost compared with bolus injections. Except for one major perioperative bleeding, excellent haemostasis was achieved in all procedures. One patient developed a transient inhibitory activity. None of these events affected the postoperative course or prolonged the hospital stay. Our study demonstrated that continuous infusion of rFVIIa during surgery is safe, effective and highly cost effective. © 2011 Blackwell Publishing Ltd.

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