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dc.contributor.authorKhan, Tina Z.
dc.contributor.authorGorog, Diana A.
dc.contributor.authorArachchillage, Deepa J.
dc.contributor.authorAhnström, Josefin
dc.contributor.authorRhodes, Samantha
dc.contributor.authorDonovan, Jacqueline
dc.contributor.authorBanya, Winston
dc.contributor.authorPottle, Alison
dc.contributor.authorBarbir, Mahmoud
dc.contributor.authorPennell, Dudley J.
dc.date.accessioned2019-09-10T15:31:37Z
dc.date.available2019-09-10T15:31:37Z
dc.date.issued2019-07-02
dc.identifier.citationKhan , T Z , Gorog , D A , Arachchillage , D J , Ahnström , J , Rhodes , S , Donovan , J , Banya , W , Pottle , A , Barbir , M & Pennell , D J 2019 , ' Impact of lipoprotein apheresis on thrombotic parameters in patients with refractory angina and raised lipoprotein(a) : Findings from a randomized controlled cross-over trial ' , Journal of Clinical Lipidology . https://doi.org/10.1016/j.jacl.2019.06.009
dc.identifier.issn1933-2874
dc.identifier.otherPURE: 17359903
dc.identifier.otherPURE UUID: 0c7081b3-4930-419b-b051-42dc7a6cb782
dc.identifier.otherScopus: 85071362681
dc.identifier.otherPubMed: 31353231
dc.identifier.urihttp://hdl.handle.net/2299/21668
dc.descriptionCopyright © 2019 National Lipid Association. Published by Elsevier Inc. All rights reserved.
dc.description.abstractBackground: Raised lipoprotein(a) [Lp(a)] is a cardiovascular risk factor common in patients with refractory angina. The apolipoprotein(a) component of Lp(a) exhibits structural homology with plasminogen and can enhance thrombosis and impair fibrinolysis. Objectives: The objective of the study was to assess the effect of lipoprotein apheresis on markers of thrombosis and fibrinolysis in patients with high Lp(a). Methods: In a prospective, single-blind, crossover trial, 20 patients with refractory angina and raised Lp(a) > 50 mg/dL were randomized to three months of weekly lipoprotein apheresis or sham. Blood taken before and after apheresis/sham was assessed using the Global Thrombosis Test, to assess time taken for in vitro thrombus formation (occlusion time) and endogenous fibrinolysis (lysis time), as well as von Willebrand Factor, fibrinogen, D-dimer, thrombin/anti-thrombin III complex, prothrombin fragments 1 + 2, and thrombin generation assays. Results: Lp(a) was significantly reduced by apheresis (100.2 [interquartile range {IQR}, 69.6143.0] vs 24.8 [17.2,34.0] mg/dL, P =.0001) but not by sham (P =.0001 between treatment arms). Apheresis prolonged occlusion time (576 ± 116 s vs 723 ± 142 s, P <.0001) reflecting reduced platelet reactivity and reduced lysis time (1340 [1128, 1682] s vs 847 [685,1302] s, P =.0006) reflecting enhanced fibrinolysis, without corresponding changes with sham. Apheresis, but not sham, reduced von Willebrand Factor (149 [89.0, 164] vs 64.2 [48.5, 89.8] IU/dL, P =.0001), and fibrinogen (3.12 ± 0.68 vs 2.20 ± 0.53 g/L, P <.0001), and increased prothrombin fragments 1 + 2 (158.16 [128.77, 232.09] vs 795.12 [272.55, 1201.00] pmol/L, P =.0006). There was no change in D-dimer, thrombin/anti-thrombin III complex, or thrombin generation assay with apheresis or sham. Conclusion: Lipoprotein apheresis reduces Lp(a) and improves some thrombotic and fibrinolytic parameters in patients with refractory angina.en
dc.language.isoeng
dc.relation.ispartofJournal of Clinical Lipidology
dc.rightsEmbargoed
dc.subjectAngina
dc.subjectApheresis
dc.subjectFibrinolysis
dc.subjectLipoprotein(a)
dc.subjectThrombosis
dc.subjectInternal Medicine
dc.subjectEndocrinology, Diabetes and Metabolism
dc.subjectNutrition and Dietetics
dc.subjectCardiology and Cardiovascular Medicine
dc.titleImpact of lipoprotein apheresis on thrombotic parameters in patients with refractory angina and raised lipoprotein(a) : Findings from a randomized controlled cross-over trialen
dc.contributor.institutionDepartment of Clinical and Pharmaceutical Sciences
dc.contributor.institutionBasic and Clinical Science Unit
dc.contributor.institutionCentre for Health Services and Clinical Research
dc.contributor.institutionSchool of Life and Medical Sciences
dc.description.statusPeer reviewed
dc.date.embargoedUntil2020-07-02
dc.identifier.urlhttp://www.scopus.com/inward/record.url?scp=85071362681&partnerID=8YFLogxK
dc.relation.schoolSchool of Life and Medical Sciences
dc.description.versiontypeFinal Accepted Version
dcterms.dateAccepted2019-07-02
rioxxterms.versionAM
rioxxterms.versionofrecordhttps://doi.org/10.1016/j.jacl.2019.06.009
rioxxterms.licenseref.uriOther
rioxxterms.licenseref.startdate2020-07-02
rioxxterms.typeJournal Article/Review
herts.preservation.rarelyaccessedtrue
herts.date.embargo2020-07-02
herts.rights.accesstypeEmbargoed


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