Matthias Erbe

Goethe-Universität Frankfurt am Main, Frankfurt am Main, Hesse, Germany

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Publications (9)28.14 Total impact

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    ABSTRACT: Thrombophilia is a well-established risk factor for a venous thromboembolic event (VTE), and it has been proposed that hereditary thrombophilia may substantially contribute to the development of VTE in young patients. We aimed to analyse the prevalence of thrombophilia with special regard to the age of VTE manifestation. The study cohort consisted of 1490 patients (58% females) with a median age 43 years at the time of their first VTE. At least one thrombophilic disorder was identified in 50·1% of patients. The probability of detecting a hereditary thrombophilia declined significantly with advancing age (from 49·3% in patients aged 20 years and younger to 21·9% in patients over the age of 70 years; P < 0·001). This may be primarily attributed to the decreasing frequencies of the F5 R506Q (factor V Leiden) mutation and deficiencies of protein C or protein S with older age at the time of the initial VTE event. Moreover, thrombophilia was more prevalent in unprovoked compared with risk-associated VTE (57·7% vs. 47·7%; P = 0·001). The decline in the prevalence of hereditary thrombophilia with older ages supports the use of a selected thrombophilia screening strategy dependent on age and the presence or absence of additional VTE risk factors.
    British Journal of Haematology 12/2013; 163(5):655-65. · 4.94 Impact Factor
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    ABSTRACT: Arterial blood sampling is necessary when drugs such as the fast-acting opioid analgesic remifentanil exhibit relevant differences between arterial and venous blood concentrations. Arterial cannulation is generally considered to be clinically safe and has thus become a standard procedure in pharmacokinetic-pharmacodynamic assessments. However, rare cases of arterial occlusions have to be considered in risk-benefit assessments of arterial sampling in pharmacokinetic studies, especially when including healthy volunteers. In an actual case, arterial occlusion requiring surgical repair was caused by a factor V Leiden thrombophilia associated genetic variant F5 1691G>A (rs6025) and aggravated by a hypoplastic radial artery. Neither risk factor had been identified prior to enrolment by routine laboratory tests such as the prothrombin time (international normalized ratio), partial thromboplastin time and the clinical Allen's test of arterial function. Re-assessment of the necessity of arterial sampling showed that none of the potential alternatives, target concentrations of computerized infusions or venous concentrations during non-steady-state and steady-state conditions could provide the arterial concentrations. Relying on venous concentrations may result in erroneous pharmacodynamic parameters. Accurate pharmacokinetic-pharmacodynamic studies relying on precisely measured blood concentrations require serial sampling techniques during both steady-state and non-steady-state conditions. However, as illustrated by the presented case, incidents involving the generally safe procedure of arterial sampling are possible, although rare. To further minimize the risks, screening of subjects for prothrombotic risks and careful assessment of the suitability of the artery should be considered in pharmacokinetic studies requiring arterial cannulation.
    Clinical Pharmacokinetics 10/2012; 51(10):629-38. · 5.49 Impact Factor
  • Clinical Pharmacokinetics 01/2012; · 5.49 Impact Factor
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    ABSTRACT: Inferior vena cava (IVC) thrombosis is a rare event and data detailing the underlying etiology are scarce. Therefore, we reviewed all available cases of IVC thrombosis consecutively registered in the MAISTHRO (MAin-ISar-THROmbosis) database and described the prevalence of VTE risk factors and other conditions contributing to IVC thrombosis development. 53 patients (35 F, 18 M) with IVC thrombosis aged 12 to 79 years were identified. 40 patients (75.5%) developed thrombosis under the age of 45. Local problems, such as IVC anomalies or external venous compression, contributed to the development of thrombosis in 12 cases (22.6%). Lupus anticoagulants (10.9 vs. 2.3%, p=0.013) and malignoma (17.0 vs. 6.4%, p=0.023) were more prevalent in IVC thrombosis patients compared to 265 age and sex matched controls with isolated lower extremity DVT. No difference was identified with regard to inherited thrombophilia or other known VTE risk factors. Symptomatic pulmonary embolism (PE) occurred in 32.1% of IVC thrombosis patients compared to 15.2% of controls (p=0.005). Local problems such as IVC anomalies and external venous compression, malignancy and the presence of lupus anticoagulants contribute to the risk of IVC thrombosis. The risk of symptomatic pulmonary embolism in the acute setting is high.
    Thrombosis Research 03/2008; 123(1):72-8. · 3.13 Impact Factor
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    ABSTRACT: Whether thrombophilic disorders, which are established risk factors for venous thromboembolism (VTE), also increase the risk of arterial thrombosis is still unknown. We analyzed data from 1081 consecutive patients (649 F/432 M, 16-93 years of age) with previous VTE registered in the MAISTHRO (MAin-ISar-THROmbosis) database with regard to arterial thrombotic events and contributing risk factors. Screening for thrombophilia included testing for factor V Leiden and prothrombin G20210A mutation, antiphospholipid antibodies and activities of factor VIII, protein C, protein S and antithrombin. Of the entire study cohort, 40 patients (3.7%) had a prior myocardial infarction (MI), and 41 (3.8%) suffered a stroke. Other arterial thrombotic events were rare. Elevated factor VIII levels were more prevalent in MI patients than in controls (44.4 vs. 25.9%, p=0.044), but after adjusting for the traditional cardiovascular risk factors, this relationship was no longer significant. We observed a higher rate of lupus anticoagulant in MI patients with an adjusted odds ratio of 3.3 (95%CI 0.84-12.8, p=0.090). No difference in any other tested thrombophilia was observed in patients with MI or stroke relative to those without. The cumulative incidence of arterial thrombotic events in VTE patients is low, and the inherited thrombophilias do not seem to substantially increase the risk of arterial thrombosis.
    Thrombosis Research 02/2008; 121(6):743-50. · 3.13 Impact Factor
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    ABSTRACT: It is still not clear whether native or platelet count adjusted platelet rich plasma (PRP) should be used for platelet aggregation measurements. To evaluate the necessity of using adjusted PRP in platelet function testing. Platelet aggregation with native PRP and adjusted PRP (platelet count: 250/nl, obtained by diluting native PRP with platelet poor plasma) was performed on the Behring Coagulation Timer (BCT(R)) using ADP, collagen, and arachidonic acid as agonists. Healthy subjects, patients on antiplatelet treatment, and patients with thrombocytosis (platelet counts in PRP > 1250/nl) were investigated. No significant differences in the maximum aggregation response were seen when using either native or adjusted PRP from healthy subjects and patients on antiplatelet treatment. Nevertheless, some patients taking aspirin or clopidogrel showed reduced inhibition of ADP and arachidonic acid induced aggregation in adjusted PRP but not in native PRP. The maximum velocity of healthy subjects and patients on antiplatelet treatment varied significantly as a result of the degree of dilution of the adjusted PRP. Surprisingly, the BCT provided good results when measuring platelet aggregation of native PRP from patients with thrombocytosis, whereas commonly used aggregometers could not analyse platelet aggregation of native PRP in these patients. The time consuming process of PRP adjustment may not be necessary for platelet aggregation measurements. Moreover, using adjusted PRP for monitoring aspirin or clopidogrel treatment may falsify results. Therefore, it may be better to use native PRP for platelet aggregation measurements, even in patients with thrombocytosis.
    Journal of Clinical Pathology 08/2005; 58(7):747-50. · 2.44 Impact Factor
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    ABSTRACT: Infection with human immunodeficiency virus (HIV) may lead to hemostatic imbalances. Forty-nine consecutive patients with acute opportunistic infections were screened for thrombophilic parameters. A follow-up investigation was performed after 10 +/- 8 weeks in 26 patients. In acutely ill patients, the incidence of protein S deficiency was 67% (33/49) and of protein C deficiency 25% (12/49), while at the follow-up visit the incidences were 54% (14/26) and 8% (2/26), respectively. Protein S and protein C levels increased significantly from initial to follow-up visit (p < 0.05). Lupus anticoagulants were not detected and anticardiolipin IgG antibodies were present in 11.4% (5/44). Three patients presented with deep venous thrombosis on admission; in two, protein S or protein C deficiency was observed. In conclusion, an acquired protein S and protein C deficiency often develop in patients with HIV and acute illness; this may be reversible after treatment for opportunistic infections.
    Clinical and Applied Thrombosis/Hemostasis 10/2003; 9(4):325-31. · 1.58 Impact Factor
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    ABSTRACT: Summary Patients with a mechanical heart valve prosthesis (MHVP) are usually anticoagulated with oral anticoagulants (OAC) to prevent thromboembolic complications. Considering the paucity of published data, the management of women with MHVP of childbearing age, who wish to become pregnant, still remains difficult and complicated. OAC may cause embryopathy during the first trimester, while neurologic complications, stillbirth and fetal death may appear during the second and third trimester. While the application of unfractionated heparin (UFH) in pregnant patients with MHVP may fail to prevent thromboembolic complications even with therapeutic dosage, only little is known about the application of body weight adjusted therapeutic dosages of low molecular weight heparin (LMWH). We report on 8 female patients, 7 with MHVP, one with atrial fibrillation, who were treated with LMWH during the whole pregnancy. No malformations or major bleeding complications were observed, no valve thrombosis or thromboembolic complications occurred. Three patients developed moderate heart failure during the third trimester, which resolved after treatment. In three patients, cesarean section was necessary, while the other five patients delivered spontaneously. Therefore, anticoagulation with body weight adjusted LMWH seems to be an alternative, safe and efficient treatment for pregnant women with MHVP. Prospective, randomized studies are needed to further evaluate this new therapeutic approach. The underlying heart disease represents a serious comorbid condition that requires continuous interdisciplinary monitoring.
    Zeitschrift für Kardiologie 11/2001; 90:125-130. · 0.97 Impact Factor
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    ABSTRACT: Patients with a mechanical heart valve prosthesis (MHVP) are usually anticoagulated with oral anticoagulants (OAC) to prevent thromboembolic complications. Considering the paucity of published data, the management of women with MHVP of childbearing age, who wish to become pregnant, still remains difficult and complicated. OAC may cause embryopathy during the first trimester, while neurologic complications, stillbirth and fetal death may appear during the second and third trimester. While the application of unfractionated heparin (UFH) in pregnant patients with MHVP may fail to prevent thromboembolic complications even with therapeutic dosage, only little is known about the application of body weight adjusted therapeutic dosages of low molecular weight heparin (LMWH). We report on 8 female patients, 7 with MHVP, one with atrial fibrillation, who were treated with LMWH during the whole pregnancy. No malformations or major bleeding complications were observed, no valve thrombosis or thromboembolic complications occurred. Three patients developed moderate heart failure during the third trimester, which resolved after treatment. In three patients, cesarean section was necessary, while the other five patients delivered spontaneously. Therefore, anticoagulation with body weight adjusted LMWH seems to be an alternative, safe and efficient treatment for pregnant women with MHVP. Prospective, randomized studies are needed to further evaluate this new therapeutic approach. The underlying heart disease represents a serious comorbid condition that requires continuous interdisciplinary monitoring.
    Zeitschrift für Kardiologie 02/2001; 90 Suppl 6:125-30. · 0.97 Impact Factor