Role of caplacizumab in the treatment of acquired thrombotic thrombocytopenic purpura
JOURNAL OF ONCOLOGY PHARMACY PRACTICE
Authors: Reid, Justin H.; Durant, Karin M.; Chen, Sheh-Li; Perissinotti, Anthony J.; King, Richard; Khoriaty, Rami; Marini, Bernard L.
Acquired thrombotic thrombocytopenic purpura is a rare blood disorder with a high early mortality rate, if untreated. Standard of care plasma exchange and glucocorticoids have dramatically improved survival. However, additional advancements are necessary to further decrease mortality. Caplacizumab-yhdp (Cablivi (R)) is the first Food and Drug Administration-approved treatment indicated for adult patients with acquired thrombotic thrombocytopenic purpura, in combination with plasma exchange and immunosuppressive therapy. However, there are considerable risks associated with the use of caplacizumab and they must be weighed against the benefits of the medication.
Sensitive and specific assessment of recombinant von Willebrand factor in platelet function analyzer
Authors: Pekrul, Isabell; Kragh, Thorsten; Turecek, Peter L.; Novack, Aaron R.; Ott, Helmut W.; Spannagl, Michael
Background: Recombinant von Willebrand factor (rVWF), which was licensed in the United States in 2015, has the multimeric distribution of freshly secreted VWF with ultralarge (UL) and high molecular weight multimers (HMWM) from endothelial cells and megakaryocytes since it has never been exposed to ADAMTS13 or any other proteolytic enzyme. Measurement of closure time (CT) using the platelet function analyzer-200 (PFA-200) is highly sensitive to the presence of UL VWF multimers in added VWF concentrates. The PFA-200 is fully automated and can be used as a reliable point-of-care method to evaluate primary hemostasis. Although it is sensitive to presence of UL VWF multimers, there could be significant clinical utility when used to monitor rVWF replacement therapy. The ability to monitor and optimize the dosing of rVWF contributes to patient safety, especially in situations where the bleeding and thrombotic risk needs to be carefully balanced (e.g., cardiac assist device). Objective: The aim of this in-vitro study was to demonstrate the detectability of rVWF spiked in VWF-deficient blood from patients with severe von Willebrand disease (VWD) with quantitative and functional pathologies using a functional testing device. We hypothesized that (1) whole blood samples from VWD patients spiked with rVWF would show a normalization in PFA-CT and (2) that a dose-response relationship could be demonstrated. Methods and results: We selected 12 patients diagnosed with VWD from our database. A therapeutic dose of rVWF product (1 IU/ml) was spiked in VWD patients ' whole blood samples and PFA-CTs were measured. Furthermore, we investigated PFA-CTs under incremental doses of rVWF (0.1, 0.2, and 0.5 IU/ml). The PFA-CTs were normalized in VWD patients ' whole blood samples spiked with rVWF. Additionally, incremental doses of rVWF resulted in a progressive and dose-dependent PFA-CT correction. Conclusion: Our in-vitro data indicate that the PFA-200 is a useful tool to detect rVWF. As the PFA-CT correction is dose dependent, the rVWF might be reliably monitored with a point-of-care analytical method during replacement therapy.