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Article ; Online: An alternative COVID-19 checklist.

Thomas, Mari

The British journal of general practice : the journal of the Royal College of General Practitioners

2020 Volume 70, Issue 694, Page(s) 230

MeSH term(s)	Anesthesia, General ; Betacoronavirus ; COVID-19 ; Checklist ; Coronavirus Infections/epidemiology ; Coronavirus Infections/therapy ; General Practitioners ; Humans ; Interprofessional Relations ; Pandemics ; Patient Care Team ; Pneumonia, Viral/epidemiology ; Pneumonia, Viral/therapy ; Professional-Patient Relations ; SARS-CoV-2
Keywords	covid19
Language	English
Publishing date	2020-04-30
Publishing country	England
Document type	Letter
ZDB-ID	1043148-2
ISSN	1478-5242 ; 0035-8797 ; 0960-1643
ISSN (online)	1478-5242
ISSN	0035-8797 ; 0960-1643
DOI	10.3399/bjgp20X709541
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Article ; Online: Clinical features of thrombosis and bleeding in COVID-19.

Thomas, Mari R / Scully, Marie

Blood

2022 Volume 140, Issue 3, Page(s) 184–195

Abstract: Infection with the SARS-CoV-2 virus, resulting in COVID-19 disease, has presented a unique scenario associated with high rates of thrombosis. The risk of venous thrombosis is some three- to sixfold higher than for patients admitted to a hospital for ... ...

Abstract	Infection with the SARS-CoV-2 virus, resulting in COVID-19 disease, has presented a unique scenario associated with high rates of thrombosis. The risk of venous thrombosis is some three- to sixfold higher than for patients admitted to a hospital for other indications, and for patients who have thrombosis, mortality appears to increase. Thrombosis may be a presenting feature of COVID-19. Pulmonary thrombi are the most frequent events, some related to deep vein thrombosis, but also to in situ microvascular and macrovascular thrombosis. Other venous thromboses include catheter- and circuit-associated in patients requiring hemofiltration and extracorporeal membrane oxygenation. Arterial thrombosis is less commonly documented, with 3% of patients in intensive care units having major arterial strokes and up to 9% having myocardial infarction, both of which are most likely multifactorial. Risk factors for thrombosis above those already documented in hospital settings include duration of COVID-19 symptoms before admission to the hospital. Laboratory parameters associated with higher risk of thrombosis include higher D-dimer, low fibrinogen, and low lymphocyte count, with higher factor VIII and von Willebrand factor levels indicative of more severe COVID-19 infection. All patients should receive thromboprophylaxis when admitted with COVID-19 infection, but the dose and length of treatment are still debated. Thrombosis continues to be treated according to standard VTE guidelines, but adjustments may be needed depending on other factors relevant to the patient's admission.
MeSH term(s)	Anticoagulants/therapeutic use ; COVID-19/complications ; Hemorrhage/chemically induced ; Humans ; SARS-CoV-2 ; Thrombosis/complications ; Venous Thromboembolism/etiology ; Venous Thrombosis/complications
Chemical Substances	Anticoagulants
Language	English
Publishing date	2022-04-19
Publishing country	United States
Document type	Journal Article
ZDB-ID	80069-7
ISSN	1528-0020 ; 0006-4971
ISSN (online)	1528-0020
ISSN	0006-4971
DOI	10.1182/blood.2021012247
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Article: An alternative COVID-19 checklist

Thomas, Mari

Br J Gen Pract

Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #155029
Database	COVID19

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Article ; Online: Cancer-associated venous thrombosis in adults (second edition): A British Society for Haematology Guideline.

Alikhan, Raza / Gomez, Keith / Maraveyas, Anthony / Noble, Simon / Young, Annie / Thomas, Mari

British journal of haematology

2024

Abstract: A shared decision on the most appropriate agent for the treatment of cancer-associated thrombosis should consider the following factors, which should be reassessed as patients continue along their cancer care pathway: risk of bleeding; tumour site; ... ...

Abstract	A shared decision on the most appropriate agent for the treatment of cancer-associated thrombosis should consider the following factors, which should be reassessed as patients continue along their cancer care pathway: risk of bleeding; tumour site; suitability of oral medications; potential for drug-drug interactions; and patient preference and values regarding choice of drug. Continuing anticoagulation beyond 6 months in patients with cancer-associated venous thromboembolism and active cancer is recommended.
Language	English
Publishing date	2024-04-25
Publishing country	England
Document type	Journal Article
ZDB-ID	80077-6
ISSN	1365-2141 ; 0007-1048
ISSN (online)	1365-2141
ISSN	0007-1048
DOI	10.1111/bjh.19414
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Article: Microangiopathy in Cancer: Causes, Consequences, and Management.

Thomas, Mari R / Scully, Marie

Cancer treatment and research

2019 Volume 179, Page(s) 151–158

Abstract: Thrombotic microangiopathy (TMA) is a syndrome involving fragmentation haemolysis, thrombocytopenia, and thrombosis. A range of disorders including cancer may have TMA as a clinical manifestation. TMA in cancer may be caused by several mechanisms, ... ...

Abstract	Thrombotic microangiopathy (TMA) is a syndrome involving fragmentation haemolysis, thrombocytopenia, and thrombosis. A range of disorders including cancer may have TMA as a clinical manifestation. TMA in cancer may be caused by several mechanisms, including systemic microvascular metastases, but may also be due to extensive bone marrow involvement with cancer or secondary necrosis. Chemotherapeutic agents may also cause associated TMA through a range of different mechanisms. Gemcitabine, platinum-based drugs, mitomycin C, and proteasome inhibitors are known to cause TMA in cancer patients. Transplant-associated TMA (TA-TMA) may affect either solid organ or HSCT patients. TA-TMA remains a difficult complication to address due to its high mortality rate, lack of standard diagnostic criteria, and limited therapeutic options. The challenge of cancer-associated TMA is furthered by the fact that plasma exchange is ineffective in its management.
MeSH term(s)	Antineoplastic Agents/adverse effects ; Antineoplastic Agents/therapeutic use ; Humans ; Neoplasms/complications ; Neoplasms/drug therapy ; Thrombotic Microangiopathies/etiology ; Thrombotic Microangiopathies/therapy
Chemical Substances	Antineoplastic Agents
Language	English
Publishing date	2019-07-17
Publishing country	United States
Document type	Journal Article
ISSN	0927-3042
ISSN	0927-3042
DOI	10.1007/978-3-030-20315-3_10
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Article ; Online: Use of anti-factor Xa levels in cancer patients taking direct oral anticoagulants.

Sayar, Zara / Weatherill, Anna / Gates, Carolyn / Thomas, Mari

Thrombosis research

2021 Volume 200, Page(s) 81–82

MeSH term(s)	Administration, Oral ; Anticoagulants/therapeutic use ; Blood Coagulation Tests ; Factor Xa Inhibitors/therapeutic use ; Humans ; Neoplasms/drug therapy
Chemical Substances	Anticoagulants ; Factor Xa Inhibitors
Language	English
Publishing date	2021-01-26
Publishing country	United States
Document type	Letter
ZDB-ID	121852-9
ISSN	1879-2472 ; 0049-3848
ISSN (online)	1879-2472
ISSN	0049-3848
DOI	10.1016/j.thromres.2021.01.017
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Article ; Online: Peak ADAMTS13 activity to assess ADAMTS13 conformation and risk of relapse in immune-mediated Thrombotic Thrombocytopenic Purpura.

Prasannan, Nithya / Dragunaite, Bertina / Subhan, Maryam Owais / Thomas, Mari / de Groot, Rens / Singh, Deepak / Vanhoorelbeke, Karen / Scully, Marie

Blood

2024

Abstract: Previous studies have demonstrated that more than 38% of immune-mediated thrombotic thrombocytopenic purpura (TTP) patients in remission with activity >50% had an open ADAMTS13 conformation. We assessed ADAMTS13 conformation in remission (ADAMTS13 ... ...

Abstract	Previous studies have demonstrated that more than 38% of immune-mediated thrombotic thrombocytopenic purpura (TTP) patients in remission with activity >50% had an open ADAMTS13 conformation. We assessed ADAMTS13 conformation in remission (ADAMTS13 activity >60%), focussing on peak ADAMTS13 activity levels and longitudinal assessment in 420 samples across 157 patients. Fewer cases had open conformation at peak ADAMTS13 activity compared to unselected remission samples with ADAMTS13 activity>60% (23% vs 43%). Patients with a closed ADAMTS13 conformation at peak ADAMTS13 activity had an 8-fold lower relapse rate in the subsequent year (9% vs 46%; OR 8.4, p=0.007) and a 5-fold lower relapse rate within 2 years (23% vs 62%; OR 5.3, p=0.02) compared to cases with an open conformation. Patients with an open conformation at peak ADAMTS13 activity required pre-emptive anti-CD20 treatment earlier than patients with a closed conformation (median 10 vs 25 months, p=0.02). Longitudinally, an open conformation was evident at, and often preceded relapse. Where the conformation was already open prior to relapse, an increase in conformation index at relapse was seen despite undetectable anti-ADAMTS13 IgG antibody. In cases with detectable anti-ADAMTS13 IgG antibody, these became undetectable prior to achieving closed conformation, highlighting the relapse risk even with undetectable anti-ADAMTS13 IgG antibody and the clinical utility of open/closed during monitoring. This is the first study to show an association between relapse risk and ADAMTS13 conformation when activity levels are at a peak. Open conformation identifies antibody mediated subclinical disease which is not detectable through current ADAMTS13 testing.
Language	English
Publishing date	2024-03-19
Publishing country	United States
Document type	Journal Article
ZDB-ID	80069-7
ISSN	1528-0020 ; 0006-4971
ISSN (online)	1528-0020
ISSN	0006-4971
DOI	10.1182/blood.2023023269
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Article ; Online: Autoantibodies enhance ADAMTS-13 clearance in patients with immune thrombotic thrombocytopenic purpura.

Underwood, Mary I / Alwan, Ferras / Thomas, Mari R / Scully, Marie A / Crawley, James T B

Journal of thrombosis and haemostasis : JTH

2023 Volume 21, Issue 6, Page(s) 1544–1552

Abstract: Background: Severe deficiency in ADAMTS-13 (<10%) and the loss of von Willebrand factor-cleaving function can precipitate microvascular thrombosis associated with thrombotic thrombocytopenic purpura (TTP). Patients with immune-mediated TTP (iTTP) have ... ...

Abstract	Background: Severe deficiency in ADAMTS-13 (<10%) and the loss of von Willebrand factor-cleaving function can precipitate microvascular thrombosis associated with thrombotic thrombocytopenic purpura (TTP). Patients with immune-mediated TTP (iTTP) have anti-ADAMTS-13 immunoglobulin G antibodies that inhibit ADAMTS-13 function and/or increase ADAMTS-13 clearance. Patients with iTTP are treated primarily by plasma exchange (PEX), often in combination with adjunct therapies that target either the von Willebrand factor-dependent microvascular thrombotic processes (caplacizumab) or the autoimmune components (steroids or rituximab) of the disease. Objectives: To investigate the contributions of autoantibody-mediated ADAMTS-13 clearance and inhibition in patients with iTTP at presentation and through the course of the PEX therapy. Patients/methods: Anti-ADAMTS-13 immunoglobulin G antibodies, ADAMTS-13 antigen, and activity were measured before and after each PEX in 17 patients with iTTP and 20 acute TTP episodes. Results: At presentation, 14 out of 15 patients with iTTP had ADAMTS-13 antigen levels of <10%, suggesting a major contribution of ADAMTS-13 clearance to the deficiency state. After the first PEX, both ADAMTS-13 antigen and activity levels increased similarly, and the anti-ADAMTS-13 autoantibody titer decreased in all patients, revealing ADAMTS-13 inhibition to be a modest modifier of the ADAMTS-13 function in iTTP. Analysis of ADAMTS-13 antigen levels between consecutive PEX treatments revealed that the rate of ADAMTS-13 clearance in 9 out of 14 patients analyzed was 4- to 10-fold faster than the estimated normal rate of clearance. Conclusion: These data reveal, both at presentation and during PEX treatment, that antibody-mediated clearance of ADAMTS-13 is the major pathogenic mechanism that causes ADAMTS-13 deficiency in iTTP. Understanding the kinetics of ADAMTS-13 clearance in iTTP may now enable further optimization of treatment of patients with iTTP.
MeSH term(s)	Humans ; Autoantibodies ; Purpura, Thrombotic Thrombocytopenic ; von Willebrand Factor ; Purpura, Thrombocytopenic, Idiopathic ; Thrombosis ; ADAMTS13 Protein ; Immunoglobulin G
Chemical Substances	Autoantibodies ; von Willebrand Factor ; ADAMTS13 Protein (EC 3.4.24.87) ; Immunoglobulin G
Language	English
Publishing date	2023-02-20
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2112661-6
ISSN	1538-7836 ; 1538-7933
ISSN (online)	1538-7836
ISSN	1538-7933
DOI	10.1016/j.jtha.2023.02.011
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Article ; Online: ADAMTS-13 conformation influences autoimmune recognition in immune thrombotic thrombocytopenic purpura.

Underwood, Mary I / Thomas, Mari R / Scully, Marie A / Crawley, James T B

Journal of thrombosis and haemostasis : JTH

2023 Volume 22, Issue 4, Page(s) 1069–1079

Abstract: Background: Patients with immune-mediated thrombotic thrombocytopenic purpura (iTTP) have anti-ADAMTS-13 immunoglobulin G (IgG) autoantibodies that enhance ADAMTS-13 clearance and/or inhibit its function. ADAMTS-13 normally circulates in a closed ... ...

Abstract	Background: Patients with immune-mediated thrombotic thrombocytopenic purpura (iTTP) have anti-ADAMTS-13 immunoglobulin G (IgG) autoantibodies that enhance ADAMTS-13 clearance and/or inhibit its function. ADAMTS-13 normally circulates in a closed conformation, which is manifested by the interaction of the CUB domains with the central spacer domain. Disruption of the spacer-CUB interaction opens ADAMTS-13, which augments its proteolytic function but may also expose cryptic autoimmune epitopes that promote further autoantibody recognition. Objectives: To explore differences in autoantibody binding to ADAMTS-13 in its closed or open conformations in patients with iTTP and to correlate these differences with disease-related parameters. Methods: We developed a novel assay to measure autoantibodies binding to closed and open ADAMTS-13. Autoantibody titer and IgG subclass binding to open or closed ADAMTS-13 were measured in 70 iTTP first presentation samples and correlated with clinical data, remission, and relapse. Results: In 70 patients with iTTP, the mean autoantibody titer against open ADAMTS-13 was, on average, approximately 2-fold greater than that against closed ADAMTS-13, suggesting that ADAMTS-13 opening increases epitope exposure and immune complex formation. Autoantibody titer against closed/open ADAMTS-13 and IgG subclass did not correlate with ADAMTS-13 antigen at presentation. Two patients with iTTP and persistent autoantibodies lost specificity for closed ADAMTS-13 in remission. Recognition of closed/open ADAMTS-13 and autoantibody IgG subclass between the first and second iTTP episodes were very similar. Conclusion: ADAMTS-13 autoantibody binding is highly influenced by ADAMTS-13 conformation. Although this does not appear to modify the pathogenicity of autoantibodies, the autoantibody signature at relapse suggests that relapse represents re-emergence of the original autoimmune response rather than de novo presentation.
MeSH term(s)	Humans ; ADAMTS13 Protein/chemistry ; ADAMTS13 Protein/immunology ; Autoantibodies ; Epitopes ; Immunoglobulin G ; Purpura, Thrombocytopenic, Idiopathic ; Purpura, Thrombotic Thrombocytopenic/diagnosis ; Recurrence ; Thrombosis
Chemical Substances	ADAMTS13 Protein (EC 3.4.24.87) ; Autoantibodies ; Epitopes ; Immunoglobulin G ; ADAMTS13 protein, human (EC 3.4.24.87)
Language	English
Publishing date	2023-12-30
Publishing country	England
Document type	Journal Article
ZDB-ID	2112661-6
ISSN	1538-7836 ; 1538-7933
ISSN (online)	1538-7836
ISSN	1538-7933
DOI	10.1016/j.jtha.2023.12.028
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Article ; Online: Monsters do exist: an unusual case of chest pain.

Thomas, Mari Lluon

BMJ case reports

2014 Volume 2014

Abstract: A 19-year-old man presented to the emergency department with a 3-week history of chest pain. Despite normal examination, bloods and observations of his chest X-ray revealed a large opacity in the middle and lower right zone. Further imaging revealed a ... ...

Abstract	A 19-year-old man presented to the emergency department with a 3-week history of chest pain. Despite normal examination, bloods and observations of his chest X-ray revealed a large opacity in the middle and lower right zone. Further imaging revealed a multicystic mediastinal teratoma. He was admitted under the respiratory physicians who arranged further investigations and discussed his case with the lung and testicular multidisciplinary team. He was started on neoadjuvant chemotherapy with a plan for future definitive surgical resection. Four months later he suddenly deteriorated due to airway compression from the tumour. He underwent an emergency thoracotomy and tumour resection. He is currently doing well and is thought to have a good prognosis following complete resection of his tumour. This case report summarises this rare diagnosis and emphasises the need for careful evaluation of patients despite their initial well appearance, especially in patients who are reattending.
MeSH term(s)	Chest Pain/diagnosis ; Chest Pain/etiology ; Chest Pain/therapy ; Combined Modality Therapy ; Diagnosis, Differential ; Humans ; Male ; Mediastinal Neoplasms/complications ; Mediastinal Neoplasms/diagnosis ; Mediastinal Neoplasms/therapy ; Neoplasms, Germ Cell and Embryonal/complications ; Neoplasms, Germ Cell and Embryonal/diagnosis ; Neoplasms, Germ Cell and Embryonal/therapy ; Radiography, Thoracic ; Tomography, X-Ray Computed ; Young Adult
Language	English
Publishing date	2014-01-21
Publishing country	England
Document type	Case Reports ; Journal Article
ISSN	1757-790X
ISSN (online)	1757-790X
DOI	10.1136/bcr-2013-202406
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