Сhoice of lipoprotein apheresis method in a patient with a very high cardiovascular risk
Authors:
Company: Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation
For correspondence: Sign in or register.
Type: Clinical Cases
DOI:
For citation: Abramyan M.V., Afanasieva E.A., Esayan G.A., Yaroustovsky M.B., Nazarova E.I. Сhoice of lipoprotein apheresis method in a patient with a very high cardiovascular risk. Creative Cardiology. 2023; 17 (3): 433–42 (in Russ.). DOI: 10.24022/1997-3187-2023-17-3-433-442
Received / Accepted: 25.08.2023 / 26.09.2023
Keywords: extracorporeal therapy blood purification atherosclerosis hypercholesterolemia hyperLp(a)emia H.E.L.P.-apheresis lipidfiltration double filtration low-density lipoprotein apheresis antithrombin proteins C and S plasminogen plasmin inhibitor
Abstract
This article will briefly highlight some aspects of extracorporeal blood purification – lipid-double filtration and H.E.L.P.-apheresis in the complex therapy of cardiovascular diseases with concomitant dyslipidemia. This publication presents the experience of treating hypercholesterolemia, hyperlipoprotein(a)emia (hyperLp(a)emia) in a patient with a very high cardiovascular risk. In the presented clinical case, the high efficiency of LDL apheresis for elevated low-density lipoprotein (LDL) and lipoprotein(a) and a justified choice of method was shown. To date, there are no specific criteria for choosing an apheresis procedure. We have found that LDL apheresis techniques have different effects on the activity of the hemostasis system (activities of antithrombin, proteins C and S, plasminogen, plasmin inhibitor). The assessment of the effect of apheresis procedures on hematological and hemostatic parameters in our observation, on the one hand, showed safety and efficacy, and on the other hand, served as the basis for a personalized choice of a particular LDL apheresis technique.References
- Ezhov M.V., Kukharchuk V.V., Sergienko I.V., Alieva A.S., Antsiferov M.B., Ansheles A.A. et al. Disorders of lipid metabolism. Clinical Guidelines 2023. Russian Journal of Cardiology. 2023; 28 (5): 5471 (in Russ.). DOI: 10.15829/1560-4071-2023-5471
- Visseren F.L.J., Mach F., Smulders Y.M., Carballo D., Koskinas K.C., Bäck M. et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice: Developed by the Task Force for cardiovascular disease prevention in clinical practice with representatives of the European Society of Cardiology and 12 medical societies With the special contribution of the European Association of Preventive Cardiology (EAPC). Eur. Heart J. 2021; 42 (34): 3227–337. DOI: 10.1093/eurheartj/ehab484
- Kukharchuk V.V., Ezhov M.V., Sergienko I.V., Arabidze G.G., Balakhonova T.V., Gurevich V.S. et al. Eurasian Association of Cardiology (EAC) /Russian National Atherosclerosis Society (RNAS) Guidelines for the diagnosis and correction of dyslipidemia for the prevention and treatment of atherosclerosis (2020). Eurasian Heart Journal. 2020; 2: 6–29. DOI: 10.38109/2225-1685-2020-2-6-29
- Parhofer K.G. Apheresis: what should a clinician know? Curr. Atheroscler. Rep. 2023; 25 (3): 77–83. DOI: 10.1007/s11883-023-01081-7
- Raina R., Young C., Krishnappa V., Chanchlani R. Role of lipoprotein apheresis in cardiovascular disease risk reduction. Blood Purif. 2019; 47 (4): 301–16. DOI: 10.1159/000497447
- Julius U., Tselmin S., Schatz U., Fischer S., Bornstein S.R. Lipoprotein(a)–an interdisciplinary challenge. Clin. Res. Cardiol. Suppl. 2019; 14 (Suppl. 1): 20–7. DOI: 10.1007/s11789-019-00098-0
- Julius U. Current role of lipoprotein apheresis in the treatment of high-risk patients. J. Cardiovasc. Dev. Dis. 2018; 5 (2): 27. DOI: 10.3390/jcdd5020027 8. Makino H., Koezuka R., Tamanaha T., Ogura M., Matsuki K., Hosoda K. et al. Familial hypercholesterolemia and lipoprotein apheresis. J. Atheroscl. Thromb. 2019; 26: 8: 679–87. DOI: 10.5551/jat.RV17033
- Schatz U., Schettler V.J.J., Julius U. State of the art: lipoprotein apheresis. Dtsch. Med. Wochenschr. 2023; 148 (8): e44–54. DOI: 10.1055/a-1516-2761
- Yaroustovsky M.B., Abramyan M.V., Rogalskaya E.A., Komardina E.V., Nazarova E.I., Grigoryan D.A. et al. Possibilities of correction of elevated lipoprotein(a) levels. Creative Cardiology. 2019; 13 (2): 129–46 (in Russ.). DOI: 10.24022/1997-3187-2019-13-2-129-146
- Yaroustovsky M., Abramyan M., Rogalskaya E., Komardina E. The use of lipoprotein apheresis for the treatment of high-risk patients with elevated lipoprotein(a) and hypercholesterolemia. Vessel Plus. 2019; 3: 9. DOI: 10.20517/2574-1209.2019.02
- Julius U., Metzler W., Pietzsch J., Fassbender T., Klingel R. Intraindividual comparison of two extracorporeal LDL apheresis methods: lipidfiltration and HELP. Int. J. Artif. Organs. 2002; 25 (12): 1180–8. DOI: 10.1177/039139880202501210
- Cosentino F., Grant P.J., Aboyans V., Bailey C.J., Ceriello A., Delgado V. et al. 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur. Heart J. 2020; 41 (2): 255–323. DOI: 10.1093/eurheartj/ehz486
- Hara A., Wada T., Muso E., Maruyama S., Kato S., Furuichi K. et al. Effect of low-density lipoprotein apheresis on quality of life in patients with diabetes, proteinuria, and hypercholesterolemia. Blood Purif. 2023; 52 (4): 373–81. DOI: 10.1159/000527900
- Mellwig K.P., Pulawski E., Horstkotte D., van Buuren F. Lipid apheresis: oxidative stress, rheology, and vasodilatation. Clin. Res. Cardiol. Suppl. 2012; 7 (Suppl. 1): 45–9. DOI: 10.1007/s11789-012-0043-9
- Rhainds D., Brodeur M.R., Tardif J.C. Lipoprotein (a): when to measure and how to treat? Curr. Atheroscler. Rep. 2021; 23: 51. DOI: 10.1007/s11883-021-00951-2
- Schettler V.J.J., Neumann C.L., Peter C. et al. Lipoprotein apheresis is an optimal therapeutic option to reduce increased Lp(a) levels. Clin. Res.Cardiol. Suppl. 2019; 14 (1): 33–8. DOI: 10.1007/s11789-019-00094-4
- Pokrovsky S.N., Afanasieva O.I., Ezhov M.V. Therapeutic apheresis for management of Lp(a) hyperlipoproteinemia. Curr. Atheroscler. Rep. 2020; 22 (11): 68. DOI: 10.1007/s11883-020-00886-0 19. Kosmadakis G. Rheopheresis: a narrative review. Int. J. Artif. Organs. 2022; 45 (5): 445–54. DOI: 10.1177/03913988221086597
- Ramunni A., Burzo M., Vernò L., Brescia P. Pleiotropic effects of LDL apheresis. Atheroscler. Suppl. 2009; 10 (5): 53–5. DOI: 10.1016/S1567-5688(09)71811-2
- Samsonova N.N., Klimovich L.G. Interactive problems of cardiology: modern ideas about the hemostasis system. In the book: Bockeria L.A., Golukhova E.Z. (Eds.). Clinical cardiology: diagnosis and treatment. In 3 vols. Moscow; 2011. V. 3 (in Russ.).
- Nishimura Y., Takagi Y. Strategy for cardiovascular surgery in patients with antithrombin iii deficiency. Ann. Thorac. Cardiovasc. Surg. 2018; 24 (4): 187–92. DOI: 10.5761/atcs. oa.18-00030
- Sokol J., Timp J.F., Le Cessie S., van Hylckama‐Vlieg А., Rosendaal F.R., Kubisz P. et al. Mild antithrombin deficiency and risk of recurrent venous thromboembolism: results from the MEGA follow-up study. J. Thromb. Haemost. 2018; 16: 680–88. DOI: 10.1111/jth.13960
- Dinarvand P., Moser K.A. Protein C deficiency. Arch. Pathol. Lab. Med. 2019; 143 (10): 1281–85. DOI: 10.5858/arpa.2017-0403-RS
- Hovland A., Hardersen R., Nielsen E.W., Mollnes T.E., Lappegård K.T. Hematologic and hemostatic changes induced by different columns during LDL apheresis. J. Clin. Apher. 2010; 25 (5): 294–300. DOI: 10.1002/jca.20256
About Authors
- Marina V. Abramyan, Cand. Med. Sci., Leading Researcher, Transfusiologist; ORCID
- Ekaterina A. Afanasieva, Cand. Med. Sci., Head of Laboratory; ORCID
- Galina S. Esayan, Junior Researcher; ORCID
- Mikhail B. Yarustovskiy, Dr. Med. Sci., Professor, Corresponding Member of RAS, Deputy Director, Head of Department; ORCID
- Elena I. Nazarova, Transfusiologist; ORCID