Monitoring of coagulation factor therapy in patients with von Willebrand disease type 3 using a microchip flow chamber system

Anna Ågren; Margareta Holmström; David E. Schmidt; Kazuya Hosokawa; Margareta Blombäck; Paul Hjemdahl

doi:10.1160/TH16-06-0430

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2017; 117(01): 75-85
DOI: 10.1160/TH16-06-0430

Coagulation and Fibrinolysis

Schattauer GmbH

Monitoring of coagulation factor therapy in patients with von Willebrand disease type 3 using a microchip flow chamber system

Anna Ågren

¹Department of Medicine, Division of Hematology, Coagulation Unit, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden

,

Margareta Holmström

¹Department of Medicine, Division of Hematology, Coagulation Unit, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden

,

David E. Schmidt

¹Department of Medicine, Division of Hematology, Coagulation Unit, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden

²University Medical Center Utrecht, Utrecht, The Netherlands

,

Kazuya Hosokawa

³Research Institute Fujimori Kogyo Co., Tokyo, Japan

,

Margareta Blombäck

⁴Department of Molecular Medicine and Surgery, Clinical Chemistry/Coagulation Research, Karolinska University Hospital, Stockholm, Sweden

⁵Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden

,

Paul Hjemdahl

⁶Department of Medicine Solna, Clinical Epidemiology/Clinical Pharmacology, Karolinska Institutet, Stockholm, Sweden

⁷Department of Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden

› Author Affiliations

Abstract

Summary

Patients with type 3 von Willebrand disease (VWD-3) have no measurable levels of VW factor (VWF) and usually require treatment with VWF-FVIII concentrate to prevent and/or stop bleeding. Even though the patients are treated prophylactically, they may experience bleeding symptoms. The aim of this study was to evaluate the effect of VWF-FVIII concentrate treatment in VWD-3 patients with the Total Thrombus Analysis System (T-TAS®), which measures thrombus formation under flow conditions. Coagulation profiles of 10 VWD-3 patients were analysed using T-TAS before and 30 minutes after VWF-FVIII concentrate (Haemate®) injection. Results were compared to VWF- and FVIII activity in plasma, and results with thromboelastometry and ris-tocetin-activated platelet impedance aggregometry (Multiplate®) in whole blood. For comparison, 10 healthy controls were also analysed with T-TAS. A median dose of 27 (range 15–35) IU/kg of VWF-FVIII concentrate increased VWF- and FVIII activity as expected. T-TAS thrombus formation was enhanced when a tissue factor/collagen-coated flow chamber was used at low shear, but treatment effects at high shear using a collagen-coated flow chamber were minimal. Whole blood coagulation assessed by thromboelastometry was normal and did not change (p > 0.05) but ristocetin-induced platelet aggregation improved (p < 0.001). In conclusion, T-TAS detects effects of VWF-FVIII concentrate treatment on coagulation-dependent thrombus formation at low shear, but minor effects are observed on platelet-dependent thrombus formation at high shear. The poor prediction of bleeding by conventional laboratory monitoring in VWD-3 patients might be related to insufficient restoration of platelet-dependent thrombus formation.

Keywords

Coagulation tests - flow chamber system - thromboelastography - von Willebrand disease - von Willebrand factor

Full Text

References

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