Publications by authors named "Avi Leader"

Neutrophils and neutrophil extracellular traps (NETs) contribute to thrombosis and hyperinflammation in myeloproliferative neoplasms (MPN). High-density neutrophils (HDNs) and low-density neutrophils (LDNs) have recently been characterized as distinct neutrophil sub-populations with distinct morphological and functional properties. We aim to study the kinetics of NET formation and inhibition with interferon-α (IFNα) in neutrophils derived from patients with MPN as compared to matched healthy controls.

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Background: Postpartum hemorrhage is considered a risk factor for pregnancy-associated complement-mediated hemolytic uremic syndrome (CM-HUS; previously known as atypical hemolytic uremic syndrome) but has not been systematically studied.

Objectives: To systematically examine the role of postpartum hemorrhage in precipitating CM-HUS and to describe the characteristics of postpartum hemorrhage-associated CM-HUS, its prognosis and recommended management.

Methods: A systematic review of individual participant data from case series and reports in addition to a case series from our institution.

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Article Synopsis
  • Managing cancer-associated thrombosis (CAT) poses challenges due to factors like bleeding risk, patient frailty, and drug interactions, necessitating careful treatment decisions.
  • With the introduction of direct oral anticoagulants (DOACs), not all CAT patients benefit equally due to varied clinical and laboratory characteristics.
  • This review discusses four specific scenarios in CAT management—brain metastasis, gastrointestinal malignancies, drug interactions, and thrombocytopenia—suggesting tailored treatment approaches based on current literature.
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Venous thromboembolism (VTE) is a prevalent and serious complication among cancer patients, necessitating therapeutic anticoagulation for many individuals with brain metastases. Simultaneously, patients with brain metastases, particularly those with high-risk primary tumors, have an increased risk of intracranial hemorrhage (ICH). Managing anticoagulation in these patients presents a dual challenge: preventing thromboembolism while avoiding hemorrhagic events.

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Article Synopsis
  • The study investigates the occurrence of acute incidental cerebral microinfarcts (CMI) in patients with antiphospholipid syndrome (APS) and their link to future strokes (AIS) or transient ischemic attacks (TIA).
  • A cohort of 292 adults, including 207 with APS, was analyzed, revealing that 6.3% of APS patients had acute incidental CMI on MRI, while no control subjects did.
  • The findings show that APS is significantly associated with the presence of acute incidental CMI, which increases the risk of subsequent AIS or TIA over a median follow-up of four years.
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Venous thromboembolism (VTE) is a common complication in patients with brain tumors. The management of acute VTE is particularly challenging due to an elevated risk of intracranial hemorrhage (ICH). Risk of developing ICH on anticoagulation is influenced by a number of factors including tumor type, recent surgery, concomitant medications, platelet counts, and radiographic features.

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Chemotherapy-induced thrombocytopenia (CIT) is a common challenge of cancer therapy and can lead to chemotherapy dose reduction, delay, and/or discontinuation, affecting relative dose intensity, and possibly adversely impacting cancer care. Besides changing anticancer regimens, standard management of CIT has been limited to platelet transfusions and supportive care. Use of the thrombopoietin receptor agonist romiplostim, already approved for use in immune thrombocytopenia, has shown promising signs of efficacy in CIT.

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Background And Objectives: Incidental diffuse-weighted imaging (DWI)-positive subcortical and cortical lesions, or acute incidental cerebral microinfarcts (CMIs), are a common type of brain ischemia, which can be detected on magnetic resonance DWI for approximately 2 weeks after occurrence. Acute incidental CMI was found to be more common in patients with cancer. Whether acute incidental CMI predicts future ischemic stroke is still unknown.

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Chronic myeloid leukaemia (CML) management is complicated by treatment-emergent vascular adverse events seen with tyrosine kinase inhibitors (TKIs) such as nilotinib, dasatinib and ponatinib. Pleural effusion and pulmonary arterial hypertension (PAH) have been associated with dasatinib treatment. Endothelial dysfunction and impaired angiogenesis are hallmarks of PAH.

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A State of the Art lecture titled "Cancer and Arterial Thrombosis: Therapeutic Options" was presented at the International Society on Thrombosis and Haemostasis Congress in 2023. This State of the Art review delves into the complex relationship between cancer and arterial thromboembolism (ATE), encompassing acute coronary syndrome, ischemic strokes, and peripheral arterial disease. The burden of cancer-associated ATE is not well defined, but studies indicate elevated risks, particularly in the 6 months after a cancer diagnosis.

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Article Synopsis
  • Venous thromboembolism (VTE) significantly impacts cancer patients' health but education and awareness about it are severely lacking, with 63.5% of surveyed patients receiving inadequate information.
  • A study of 2262 cancer patients from 42 countries revealed that many felt unprepared to recognize VTE risks, with only 67.8% receiving guidance on seeking medical help when needed.
  • The research highlights critical gaps in VTE education and support, emphasizing the need for improved patient-centered care in managing cancer-associated VTE risks.
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Introduction: Atrial fibrillation or flutter (AF) is prevalent in cancer patients. Many of these patients have an indication for anticoagulation (AC) but are also at risk for developing chemotherapy-induced thrombocytopenia. There are scarce data regarding management of AC and risk of bleeding and thrombosis in cancer patients with AF and thrombocytopenia.

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Background: Glucagon-like peptide 1 receptor agonists (GLP1RAs) are used in the treatment of diabetes and obesity. Their slowing effect of gastric emptying might change oral drug absorption, potentially affecting pharmacokinetics, particularly in the case of medications with a narrow therapeutic index.

Purpose: The purpose of this systematic review is to summarize data on drug-drug interactions between GLP1RAs and oral drugs.

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Background: Young adult females are at risk of venous thromboembolism (VTE) due to various acquired and transient factors. In recent years, a growing number of females have engaged in strenuous physical activity, but its role as a risk factor for VTE is uncertain.

Objectives: To determine the incidence of VTE in young adult females engaged in strenuous physical activity.

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Background: Direct-acting oral anticoagulants (DOACs) including rivaroxaban and apixaban are preferred over vitamin K antagonists for the treatment of venous thromboembolism (VTE). We conducted a systematic review and a meta-analysis to compare the efficacy and safety of rivaroxaban versus apixaban in the treatment of VTE.

Methods: We conducted an electronic search for studies that directly compared treatment with rivaroxaban and apixaban in adult patients with VTE.

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Background And Objectives: Cerebral microinfarcts (CMIs) are the most common type of brain ischemia; however, they are extremely rare in the general population. CMIs can be detected by magnetic resonance diffusion-weighted imaging (MRI-DWI) only for a very short period of approximately 2 weeks after their formation and are associated with an increased stroke risk and cognitive impairment. We aimed to examine CMI detection rate in patients with lung cancer (LC), which is strongly associated with ischemic stroke risk relative to other cancer types.

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Background: The safety and efficacy of direct-acting oral anticoagulants (DOACs) for therapeutic anticoagulation in the setting of primary or metastatic brain cancer is not known.

Objectives: To conduct a meta-analysis and systematic review of studies that compare the risk of intracranial hemorrhage (ICH) in patients with brain cancer treated with DOACs vs low-molecular-weight heparin (LMWH).

Methods: A literature search was conducted using PubMed, EMBASE, and Cochrane databases.

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Thrombocytopenia is a common adverse effect of chemotherapy. The development of chemotherapy-induced thrombocytopenia (CIT) is influenced by cancer type and therapy, occurring in approximately one-third of patients with a solid tumor diagnosis and half of all patients with a hematologic malignancy. CIT may complicate the administration of chemotherapy, leading to therapeutic delays or dose reductions.

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This year's Congress of the International Society of Thrombosis and Haemostasis (ISTH) took place in person in Montréal, Canada, from June 24-28, 2023. The conference, held annually, highlighted cutting-edge advances in basic, translational, population and clinical sciences relevant to the Society. As for all ISTH congresses, we offered a special, congress-specific scientific theme; this year, the special theme was immunothrombosis.

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Background: It is unclear whether newly diagnosed cancer adds to the risk of arterial thromboembolism (ATE) in patients with atrial fibrillation/flutter (AF). This is especially relevant for AF patients with low to intermediate CHADS-VASc scores in whom the risk-benefit ratios between ATE and bleeding are delicately balanced.

Objectives: The objectives were to evaluate the ATE risk in AF patients with a CHADS-VASc score of 0 to 2 with and without cancer.

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Introduction: There is scarce data regarding the incidence of venous thromboembolism (VTE) and arterial thromboembolism (ATE) in the molecular subtypes of non-small cell lung cancer (NSCLC). We aimed to investigate the association between Anaplastic Lymphoma Kinase (ALK)-positive NSCLC and thromboembolic events.

Methods: A retrospective population-based cohort study of the Clalit Health Services database, included patients with NSCLC diagnosed between 2012 and 2019.

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Data are needed on direct oral anticoagulants (DOACs) for the treatment of venous thromboembolism (VTE) in hematological malignancies (HM). Retrospective studies to date lacked a control group and did not focus on patients with VTE. Out aim was to assess the incidence of VTE recurrence and bleeding in HM patients treated with low molecular weight heparin (LMWH) or DOACs for acute VTE.

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Article Synopsis
  • This paper explores the pathogenesis, clinical signs, diagnosis, and management of cancer-associated non-bacterial thrombotic endocarditis (NBTE), an often overlooked condition marked by sterile vegetations on heart valves.
  • Cancer is the primary cause of NBTE, particularly linked to mucin-releasing adenocarcinomas from various organs, and can lead to significant risks like embolic strokes.
  • Effective diagnosis involves transesophageal echocardiography and monitoring of D-dimer levels, while treatment often includes long-term anticoagulation with low molecular weight heparin and urgent cancer management if undiagnosed.
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Background: Cancer-associated venous thromboembolism (CAT) has detrimental impact on patients' clinical outcomes and quality of life. Data on CAT education, communication, and awareness among the general cancer population are scanty.

Methods: We present the preliminary results of an ongoing patient-centered survey including 27 items covering major spheres of CAT.

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Venous (VTE) and arterial (ATE) thromboemboli are a leading cause of morbidity and mortality in patients with cancer. Patients with hematological malignancies are at an exceptionally high risk of both VTE and ATE. This risk varies based on patient- and disease-specific risk factors and can be predicted using risk prediction models for some types of hematological malignancies.

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Synopsis of recent research by authors named "Avi Leader"

  • - Avi Leader's recent research focuses on the intersection of cancer and thromboembolic events, particularly examining the prevalence and implications of venous and arterial thrombosis in cancer patients, as evidenced by studies on cerebral microinfarcts and anticoagulation management.
  • - Leader's findings highlight the increased risks for thromboembolism in patients with antiphospholipid syndrome, brain tumors, and lung cancer, while exploring interventions such as direct oral anticoagulants and thrombopoietin receptor agonists to optimize patient outcomes.
  • - His work also addresses the critical gaps in education and awareness regarding venous thromboembolism among cancer patients, advocating for improved recognition and management of this preventable complication to enhance quality of life and clinical outcomes.