PNH and Thrombosis - Aplastic Anemia & MDS International ...

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Prevention of thrombosis in <strong>PNH</strong> • Warfarin as primary prophylaxis (Hall et al 2003) • Eculizumab (anti C5 monoclonal antibody, Hillmen et al 2007) - 7 events per 100 patient years (untreated) -1 event per 100 patient years (on treatment) - 1 infectious complication (meninogoccemia) per 100 patient years of treatment
Fewer Thrombotic Events With SOLIRIS Pre-Treatment SOLIRIS Treatment Patients, n 195* 195* Thrombotic Events Cumulative 3 Observation Period (patient-years) 272 281 † 39 • On an individual patient basis, pre-treatment <strong>and</strong> SOLIRIStreatment periods were matched – Duration of SOLIRIS treatment was used to define the duration of the pre-treatment period • Thrombotic events were defined by MAVE criteria based on an intent-to-treat analysis • Majority of patients (63%) received concomitant anticoagulant therapy • The effect of anticoagulant withdrawal was not studied *N = 195 Soliris-treated patients: 11 Pilot; 43 TRIUMPH (SOLIRIS group); 44 TRIUMPH (placebo patients who crossed over to SOLIRIS treatment upon entering the extension); 97 SHEPHERD. † P < 0.001. MAVE = Major adverse vascular event. 77
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PNH and Thrombosis David J. Araten,
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Tendency to clot inappropriately
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Red cells moving in a blood vessel
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Platelets Tissue factor fibrin
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Abnormal blood clotting • Starts
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Coagulation cascade Tissue factor
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We do not know which of these prote
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Anticoagulants* work to prevent the
Page 28 and 29: clot
Page 30 and 31: clot Clot in artery: Tissue does no
Page 32 and 33: clot Clot in a vein. Blood can not
Page 38 and 39: Blood Clots in PNH Patients (Hillme
Page 40 and 41: Sonogram of the Abdomen
Page 42 and 43: Watt BJ Haematol 2007 Dermal thromb
Page 44 and 45: Superior & Inferior Sinus Thrombosi
Page 46 and 47: Deep Vein thrombosis (DVT)
Page 48 and 49: Symptoms of Blood Clots DVT: leg sw
Page 50 and 51: Symptoms of Blood Clots Veins of Br
Page 52 and 53: Low threshold for radiologic tests
Page 54 and 55: marked worldwide differences • hi
Page 56 and 57: Risk of Thrombosis: Small PNH versu
Page 58 and 59: Management of Blood Clots An ounce
Page 60 and 61: Coumadin • No one dose of Coumadi
Page 62 and 63: Coumadin Doses Typically require ad
Page 64 and 65: Initial hypercoagulability when cou
Page 66 and 67: Why take Coumadin at all? • Tried
Page 68 and 69: In 3 years, all of these drugs may
Page 70 and 71: Additional Risk Factors for Blood C
Page 72 and 73: Reversal of blood clots Clot bustin
Page 74 and 75: Sonogram : Portal Vein Before TPA A
Page 78 and 79: Fewer Thrombotic Events With SOLIRI
Page 80 and 81: Recommendations regarding Eculizuma
Page 82 and 83: Recent Improvement in Survival of P
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PNH and Thrombosis - Aplastic Anemia & MDS International ...

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