Limits...
LDL apheresis in a woman with severe heterozygous familial hypercholesterolemia. Late, but not too late.

Mickiewicz A, Fijałkowski M, Rynkiewicz A, Raczak G, Gruchała M - Arch Med Sci (2015)

View Article: PubMed Central - PubMed

Affiliation: First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Familial hypercholesterolemia (FH) is an under-recognized and undertreated common lipid metabolism disorder... Early and intensive treatment reduces consequent mortality from coronary heart disease... The diagnosis was established as “definite” FH equal to premature coronary artery disease (CAD) and high LDL cholesterol concentrations before lipid-lowering treatment (417 mg/dl)... Systematic weekly/biweekly cascade lipoprotein filtration was started... The treatment was well tolerated and the only side effects observed were hypocalcemia and mild hypotension... The mean acute LDL-C reduction of all apheresis sessions was 58.73 ±8.71%... Cascade filtration also decreases the level of the clotting factor fibrinogen resulting in a reduction of thrombosis risk... The most important factors determining the clinical course of FH are early initiation of treatment and a low interval mean LDL cholesterol concentration... Fortunately it was not too late for this patient, because acute coronary syndrome was no longer observed after initiation of LDL apheresis treatment... We conclude that it was due to reduction of the clotting factor fibrinogen and thrombosis risk... Only selected methods of apheresis, such as the described cascade filtration, are able to remove fibrinogen... In conclusion, our report supports the view that long-term reductions of LDL cholesterol and fibrinogen concentrations together with the pleiotropic effects significantly reduce cardiovascular risk and improve the quality of life of those with FH... LDL apheresis remains an underutilized option for FH patients with an uncontrolled high LDL-C level.

No MeSH data available.


Related in: MedlinePlus

Coronary angiography: left main coronary artery occluded by stent thrombosis
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4697067&req=5

Figure 0001: Coronary angiography: left main coronary artery occluded by stent thrombosis

Mentions: The coronary angiography at admission revealed a stent thrombosis in the left main coronary artery and a successful thrombectomy and balloon angioplasty was performed (Figure 1 A–B). Nevertheless, the patient developed cardiogenic shock followed by chronic heart failure with low left ventricular ejection fraction (23%). Based on additional laboratory tests, resistance to aspirin was diagnosed. A treatment using acetylsalicylic acid in high doses (300 mg daily), ticlopidine, bisoprolol, ramipril, spironolactone, furosemide, ezetimibe and rosuvastatin was prescribed. Despite maximal doses of rosuvastatin 40 mg/day and ezetimibe 10 mg/day, the lowest observed LDL-C level was 181 mg/dl. Systematic weekly/biweekly cascade lipoprotein filtration was started. The treatment was well tolerated and the only side effects observed were hypocalcemia and mild hypotension.


LDL apheresis in a woman with severe heterozygous familial hypercholesterolemia. Late, but not too late.

Mickiewicz A, Fijałkowski M, Rynkiewicz A, Raczak G, Gruchała M - Arch Med Sci (2015)

Coronary angiography: left main coronary artery occluded by stent thrombosis
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4697067&req=5

Figure 0001: Coronary angiography: left main coronary artery occluded by stent thrombosis
Mentions: The coronary angiography at admission revealed a stent thrombosis in the left main coronary artery and a successful thrombectomy and balloon angioplasty was performed (Figure 1 A–B). Nevertheless, the patient developed cardiogenic shock followed by chronic heart failure with low left ventricular ejection fraction (23%). Based on additional laboratory tests, resistance to aspirin was diagnosed. A treatment using acetylsalicylic acid in high doses (300 mg daily), ticlopidine, bisoprolol, ramipril, spironolactone, furosemide, ezetimibe and rosuvastatin was prescribed. Despite maximal doses of rosuvastatin 40 mg/day and ezetimibe 10 mg/day, the lowest observed LDL-C level was 181 mg/dl. Systematic weekly/biweekly cascade lipoprotein filtration was started. The treatment was well tolerated and the only side effects observed were hypocalcemia and mild hypotension.

View Article: PubMed Central - PubMed

Affiliation: First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Familial hypercholesterolemia (FH) is an under-recognized and undertreated common lipid metabolism disorder... Early and intensive treatment reduces consequent mortality from coronary heart disease... The diagnosis was established as “definite” FH equal to premature coronary artery disease (CAD) and high LDL cholesterol concentrations before lipid-lowering treatment (417 mg/dl)... Systematic weekly/biweekly cascade lipoprotein filtration was started... The treatment was well tolerated and the only side effects observed were hypocalcemia and mild hypotension... The mean acute LDL-C reduction of all apheresis sessions was 58.73 ±8.71%... Cascade filtration also decreases the level of the clotting factor fibrinogen resulting in a reduction of thrombosis risk... The most important factors determining the clinical course of FH are early initiation of treatment and a low interval mean LDL cholesterol concentration... Fortunately it was not too late for this patient, because acute coronary syndrome was no longer observed after initiation of LDL apheresis treatment... We conclude that it was due to reduction of the clotting factor fibrinogen and thrombosis risk... Only selected methods of apheresis, such as the described cascade filtration, are able to remove fibrinogen... In conclusion, our report supports the view that long-term reductions of LDL cholesterol and fibrinogen concentrations together with the pleiotropic effects significantly reduce cardiovascular risk and improve the quality of life of those with FH... LDL apheresis remains an underutilized option for FH patients with an uncontrolled high LDL-C level.

No MeSH data available.


Related in: MedlinePlus