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  1. Article ; Online: Monkeypox outbreak: after COVID-19, another challenge for the hemostatic system?

    Marietta, Marco / Coluccio, Valeria / Luppi, Mario

    Internal and emergency medicine

    2022  Volume 17, Issue 8, Page(s) 2179–2183

    MeSH term(s) Humans ; Mpox (monkeypox)/epidemiology ; COVID-19 ; Hemostatics ; Disease Outbreaks ; Antibodies, Viral
    Chemical Substances Hemostatics ; Antibodies, Viral
    Language English
    Publishing date 2022-10-04
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 2454173-4
    ISSN 1970-9366 ; 1828-0447
    ISSN (online) 1970-9366
    ISSN 1828-0447
    DOI 10.1007/s11739-022-03112-8
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    Zs.A 6673: Show issues Location:
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  2. Article ; Online: Vaccine-induced thrombotic thrombocytopenia: the elusive link between thrombosis and adenovirus-based SARS-CoV-2 vaccines.

    Marcucci, Rossella / Marietta, Marco

    Internal and emergency medicine

    2021  Volume 16, Issue 5, Page(s) 1113–1119

    Abstract: The amazing effort of vaccination against COVID-19, with more than 2 billion vaccine doses administered all around the world as of 16 June 2021, has changed the history of this pandemic, drastically reducing the number of severe cases or deaths in ... ...

    Abstract The amazing effort of vaccination against COVID-19, with more than 2 billion vaccine doses administered all around the world as of 16 June 2021, has changed the history of this pandemic, drastically reducing the number of severe cases or deaths in countries were mass vaccination campaign have been carried out. However, the people's rising enthusiasm has been blunted in late February 2021 by the report of several cases of unusual thrombotic events in combination with thrombocytopenia after vaccination with ChAdOx1 nCov-19 (Vaxzevria), and a few months later also after Ad26.COV2. S vaccines. Of note, both products used an Adenovirus-based (AdV) platform to deliver the mRNA molecule - coding for the spike protein of SARS-CoV-2. A clinical entity characterized by cerebral and/or splanchnic vein thrombosis, often associated with multiple thromboses, with thrombocytopenia and bleeding, and sometimes disseminated intravascular coagulation (DIC), was soon recognized as a new syndrome, named vaccine-induced immune thrombotic thrombocytopenia (VITT) or thrombosis with thrombocytopenia syndrome (TTS). VITT was mainly observed in females under 55 years of age, between 4 and 16 days after receiving only Adenovirus-based vaccine and displayed a seriously high fatality rate. This prompted the Medicine Regulatory Agencies of various countries to enforce the pharmacovigilance programs, and to provide some advices to restrict the use of AdV-based vaccines to some age groups. This point-of view is aimed at providing a comprehensive review of epidemiological issues, pathogenetic hypothesis and treatment strategies of this rare but compelling syndrome, thus helping physicians to offer an up-to dated and evidence-based counseling to their often alarmed patients.
    MeSH term(s) Biomarkers/analysis ; COVID-19 Vaccines/adverse effects ; COVID-19 Vaccines/pharmacokinetics ; COVID-19 Vaccines/therapeutic use ; Correlation of Data ; Expert Testimony ; Humans ; Thrombocytopenia/etiology ; Thrombocytopenia/physiopathology ; Vaccination/adverse effects ; Vaccination/methods ; Vaccination/statistics & numerical data
    Chemical Substances Biomarkers ; COVID-19 Vaccines
    Language English
    Publishing date 2021-06-30
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 2454173-4
    ISSN 1970-9366 ; 1828-0447
    ISSN (online) 1970-9366
    ISSN 1828-0447
    DOI 10.1007/s11739-021-02793-x
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  3. Article ; Online: Rebuttal to letter "Is thromboprophylaxis with high-dose enoxaparin really necessary for COVID-19 patients? A new "prudent" randomised clinical trial".

    Marietta, Marco / Tripodi, Armando

    Blood transfusion = Trasfusione del sangue

    2020  Volume 18, Issue 3, Page(s) 239–240

    MeSH term(s) Anticoagulants ; Betacoronavirus ; COVID-19 ; Coronavirus Infections ; Enoxaparin ; Humans ; Pandemics ; Pneumonia, Viral ; SARS-CoV-2 ; Venous Thromboembolism
    Chemical Substances Anticoagulants ; Enoxaparin
    Keywords covid19
    Language English
    Publishing date 2020-05-26
    Publishing country Italy
    Document type Letter ; Comment
    ZDB-ID 2135732-8
    ISSN 2385-2070 ; 0041-1787 ; 1723-2007
    ISSN (online) 2385-2070
    ISSN 0041-1787 ; 1723-2007
    DOI 10.2450/2020.0116-20
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    Zs.A 798: Show issues Location:
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  4. Article ; Online: Potential mechanisms of vaccine-induced thrombosis.

    Marietta, Marco / Coluccio, Valeria / Luppi, Mario

    European journal of internal medicine

    2022  Volume 105, Page(s) 1–7

    Abstract: Vaccine-induced immune thrombocytopenia and thrombosis (VITT) is a rare syndrome characterized by high-titer anti-platelet factor 4 (PF4) antibodies, thrombocytopenia and arterial and venous thrombosis in unusual sites, as cerebral venous sinuses and ... ...

    Abstract Vaccine-induced immune thrombocytopenia and thrombosis (VITT) is a rare syndrome characterized by high-titer anti-platelet factor 4 (PF4) antibodies, thrombocytopenia and arterial and venous thrombosis in unusual sites, as cerebral venous sinuses and splanchnic veins. VITT has been described to occur almost exclusively after administration of ChAdOx1 nCoV-19 and Ad26.COV2.S adenovirus vector- based COVID-19 vaccines. Clinical and laboratory features of VITT resemble those of heparin-induced thrombocytopenia (HIT). It has been hypothesized that negatively charged polyadenylated hexone proteins of the AdV vectors could act as heparin to induce the conformational changes of PF4 molecule that lead to the formation of anti-PF4/polyanion antibodies. The anti-PF4 immune response in VITT is fostered by the presence of a proinflammatory milieu, elicited by some impurities found in ChAdOx1 nCoV-19 vaccine, as well as by soluble spike protein resulting from alternative splice events. Anti-PF4 antibodies bind PF4, forming immune complexes which activate platelets, monocytes and granulocytes, resulting in the VITT's immunothrombosis. The reason why only a tiny minority of patents receiving AdV-based COVID-19 vaccines develop VITT is still unknown. It has been hypothesized that individual intrinsic factors, either acquired (i.e., pre-priming of B cells to produce anti-PF4 antibodies by previous contacts with bacteria or viruses) or inherited (i.e., differences in platelet T-cell ubiquitin ligand-2 [TULA-2] expression) can predispose a few subjects to develop VITT. A better knowledge of the mechanistic basis of VITT is essential to improve the safety and the effectiveness of future vaccines and gene therapies using adenovirus vectors.
    MeSH term(s) Humans ; Antigen-Antibody Complex ; COVID-19 Vaccines/adverse effects ; Ad26COVS1 ; ChAdOx1 nCoV-19 ; Ligands ; Spike Glycoprotein, Coronavirus ; COVID-19/prevention & control ; Platelet Factor 4/genetics ; Platelet Factor 4/metabolism ; Heparin/adverse effects ; Thrombocytopenia/chemically induced ; Thrombosis ; Vaccines/adverse effects ; Purpura, Thrombocytopenic, Idiopathic/chemically induced ; Ubiquitins
    Chemical Substances Antigen-Antibody Complex ; COVID-19 Vaccines ; Ad26COVS1 (JT2NS6183B) ; ChAdOx1 nCoV-19 (B5S3K2V0G8) ; Ligands ; Spike Glycoprotein, Coronavirus ; Platelet Factor 4 (37270-94-3) ; Heparin (9005-49-6) ; Vaccines ; Ubiquitins ; spike protein, SARS-CoV-2
    Language English
    Publishing date 2022-08-08
    Publishing country Netherlands
    Document type Journal Article ; Review
    ZDB-ID 1038679-8
    ISSN 1879-0828 ; 0953-6205
    ISSN (online) 1879-0828
    ISSN 0953-6205
    DOI 10.1016/j.ejim.2022.08.002
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 2608: Show issues Location:
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    Jg. 1995 - 2021: Lesesall (2.OG)
    ab Jg. 2022: Lesesaal (EG)

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  5. Article ; Online: Direct oral anticoagulants in atrial fibrillation: can data from randomized clinical trials be safely transferred to the general population? No.

    Marietta, Marco

    Internal and emergency medicine

    2015  Volume 10, Issue 6, Page(s) 647–650

    Abstract: Direct oral anticoagulants (DOAC) represent an innovative and relevant treatment for the prevention of cardiac embolism in patients with atrial fibrillation (AF). Their introduction has been followed by an ample debate on their appropriate use, ... ...

    Abstract Direct oral anticoagulants (DOAC) represent an innovative and relevant treatment for the prevention of cardiac embolism in patients with atrial fibrillation (AF). Their introduction has been followed by an ample debate on their appropriate use, considering that they can offer an effective treatment for the many patients with AF, which are not taking any effective anticoagulant treatment, even though they have a substantial thromboembolic risk (1). On the other hand, DOAC are much less tested in everyday clinical practice and much more expensive than anti-vitamin k anticoagulants (AVKs). Starting from the quite favorable results of the available randomized controlled trials (RCTs)--showing that DOAC are at least non-inferior to AVK and that may be even better for some outcomes--this article discusses their transferability to the majority of AF patients. In summary, the body of evidence supports the efficacy and safety of DOAC in patients carrying demographic and clinical characteristics similar to subjects included in RCT, but their use in less well-characterized subpopulations requires particular caution, while waiting for more reliable data from the real world.
    MeSH term(s) Administration, Oral ; Anticoagulants/adverse effects ; Anticoagulants/therapeutic use ; Atrial Fibrillation/complications ; Atrial Fibrillation/epidemiology ; Dabigatran/adverse effects ; Dabigatran/therapeutic use ; Embolism/prevention & control ; Female ; Humans ; Male ; Pyrazoles/adverse effects ; Pyrazoles/therapeutic use ; Pyridones/adverse effects ; Pyridones/therapeutic use ; Randomized Controlled Trials as Topic ; Rivaroxaban/adverse effects ; Rivaroxaban/therapeutic use ; Stroke/drug therapy ; Treatment Outcome ; Warfarin/adverse effects ; Warfarin/therapeutic use
    Chemical Substances Anticoagulants ; Pyrazoles ; Pyridones ; apixaban (3Z9Y7UWC1J) ; Warfarin (5Q7ZVV76EI) ; Rivaroxaban (9NDF7JZ4M3) ; Dabigatran (I0VM4M70GC)
    Language English
    Publishing date 2015-09
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 2454173-4
    ISSN 1970-9366 ; 1828-0447
    ISSN (online) 1970-9366
    ISSN 1828-0447
    DOI 10.1007/s11739-015-1278-5
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  6. Article: Non-replacement therapy for haemophilia treatment: fetching the east by the west.

    Marietta, Marco / Luppi, Mario

    Blood transfusion = Trasfusione del sangue

    2018  Volume 16, Issue 5

    MeSH term(s) Hemophilia A ; Hemophilia B ; Humans ; Medicine
    Language English
    Publishing date 2018-03-02
    Publishing country Italy
    Document type Editorial ; Comment
    ZDB-ID 2135732-8
    ISSN 1723-2007 ; 0041-1787
    ISSN 1723-2007 ; 0041-1787
    DOI 10.2450/2018.0032-18
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  7. Article ; Online: More on: 'COVID-19 coagulopathy in Caucasian patients'.

    Marietta, Marco / Coluccio, Valeria / Luppi, Mario

    British journal of haematology

    2020  Volume 189, Issue 6, Page(s) 1059–1060

    MeSH term(s) Betacoronavirus ; COVID-19 ; Coronavirus Infections ; Humans ; Pandemics ; Pneumonia, Viral ; SARS-CoV-2
    Keywords covid19
    Language English
    Publishing date 2020-05-22
    Publishing country England
    Document type Letter ; Comment
    ZDB-ID 80077-6
    ISSN 1365-2141 ; 0007-1048
    ISSN (online) 1365-2141
    ISSN 0007-1048
    DOI 10.1111/bjh.16772
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  8. Article: Rebuttal to letter "Is thromboprophylaxis with high-dose enoxaparin really necessary for COVID-19 patients? A new "prudent" randomised clinical trial"

    Marietta, Marco / Tripodi, Armando

    Blood Transfus

    Keywords covid19
    Publisher WHO
    Document type Article
    Note WHO #Covidence: #398701
    Database COVID19

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  9. Article ; Online: Effects of Anti-vitamin k oral anticoagulants on bone and cardiovascular health.

    Marietta, Marco / Coluccio, Valeria / Boriani, Giuseppe / Luppi, Mario

    European journal of internal medicine

    2020  Volume 79, Page(s) 1–11

    Abstract: Vitamin K antagonist oral anticoagulants (VKAs) have been proven over 50 years to be highly effective and acceptably safe in many settings and are still used by millions of people worldwide. The main concern about the safety of VKAs regards the risk of ... ...

    Abstract Vitamin K antagonist oral anticoagulants (VKAs) have been proven over 50 years to be highly effective and acceptably safe in many settings and are still used by millions of people worldwide. The main concern about the safety of VKAs regards the risk of bleeding, but there is accumulation evidence of their potentially negative effects beyond hemostasis. Indeed, VKAs impair the action of several Vitamin-K Dependent Proteins (VKDP), such as Bone Gla protein, Matrix Gla protein, Gas6 Protein, Periostin and Gla-Ric Protein, involved in bone and vascular metabolism, thus exerting a detrimental effect on bone and vascular health. Indeed, although the evidence regarding this issue is not compelling, it has been shown that VKAs use decreases bone mass density, increases the risk of bone fractures and accelerates the process of vascular and valvular calcification. Vascular calcification is a major concern in Chronic Kidney Disease (CKD) patients, also in absence of VKAs, because of mineral metabolism derangement, chronic inflammation and oxidative stress. Direct Oral AntiCoagulants (DOACs) do not affect VKDP involved in vascular and valvular calcification, and do not induce calcific valve degeneration in animal models, being a possible alternative to AVK for CKD patients. However, the efficacy and safety of DOACs in this population, suggested by some recent observations, requires confirmation by dedicated, randomized study. We reviewed here the effects of VKAs in bone and vascular health as compared to DOACs, in order to provide the physicians with some data useful to wisely choose the most suitable anticoagulant for every patient.
    MeSH term(s) Administration, Oral ; Animals ; Anticoagulants/adverse effects ; Atrial Fibrillation/drug therapy ; Hemorrhage ; Humans ; Vitamin K/therapeutic use ; Vitamins/therapeutic use
    Chemical Substances Anticoagulants ; Vitamins ; Vitamin K (12001-79-5)
    Language English
    Publishing date 2020-06-16
    Publishing country Netherlands
    Document type Journal Article ; Review
    ZDB-ID 1038679-8
    ISSN 1879-0828 ; 0953-6205
    ISSN (online) 1879-0828
    ISSN 0953-6205
    DOI 10.1016/j.ejim.2020.05.032
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    Zs.A 2608: Show issues Location:
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  10. Article ; Online: COVID-19, coagulopathy and venous thromboembolism: more questions than answers.

    Marietta, Marco / Coluccio, Valeria / Luppi, Mario

    Internal and emergency medicine

    2020  Volume 15, Issue 8, Page(s) 1375–1387

    Abstract: The acute respiratory illnesses caused by severe acquired respiratory syndrome corona Virus-2 (SARS-CoV-2) is a global health emergency, involving more than 8.6 million people worldwide with more than 450,000 deaths. Among the clinical manifestations of ... ...

    Abstract The acute respiratory illnesses caused by severe acquired respiratory syndrome corona Virus-2 (SARS-CoV-2) is a global health emergency, involving more than 8.6 million people worldwide with more than 450,000 deaths. Among the clinical manifestations of COVID-19, the disease that results from SARS-CoV-2 infection in humans, a prominent feature is a pro-thrombotic derangement of the hemostatic system, possibly representing a peculiar clinicopathologic manifestation of viral sepsis. The severity of the derangement of coagulation parameters in COVID-19 patients has been associated with a poor prognosis, and the use of low molecular weight heparin (LMWH) at doses registered for prevention of venous thromboembolism (VTE) has been endorsed by the World Health Organization and by Several Scientific societies. However, some relevant issues on the relationships between COVID-19, coagulopathy and VTE have yet to be fully elucidated. This review is particularly focused on four clinical questions: What is the incidence of VTE in COVID-19 patients? How do we frame the COVID-19 associated coagulopathy? Which role, if any, do antiphospolipid antibodies have? How do we tackle COVID-19 coagulopathy? In the complex scenario of an overwhelming pandemic, most everyday clinical decisions have to be taken without delay, although not yet supported by a sound scientific evidence. This review discusses the most recent findings of basic and clinical research about the COVID-associated coagulopathy, to foster a more thorough knowledge of the mechanisms underlying this compelling disease.
    MeSH term(s) Blood Coagulation/drug effects ; Blood Coagulation/physiology ; COVID-19 ; Coronavirus Infections/complications ; Coronavirus Infections/epidemiology ; Coronavirus Infections/physiopathology ; Disseminated Intravascular Coagulation/etiology ; Fibrinolytic Agents/therapeutic use ; Heparin, Low-Molecular-Weight/therapeutic use ; Humans ; Pandemics ; Pneumonia, Viral/complications ; Pneumonia, Viral/epidemiology ; Pneumonia, Viral/physiopathology ; Venous Thromboembolism/drug therapy ; Venous Thromboembolism/epidemiology ; Venous Thromboembolism/etiology
    Chemical Substances Fibrinolytic Agents ; Heparin, Low-Molecular-Weight
    Keywords covid19
    Language English
    Publishing date 2020-07-11
    Publishing country Italy
    Document type Journal Article ; Review
    ZDB-ID 2454173-4
    ISSN 1970-9366 ; 1828-0447
    ISSN (online) 1970-9366
    ISSN 1828-0447
    DOI 10.1007/s11739-020-02432-x
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