Anti-Clotting agent for alemtuzumab

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Alemtuzumab is a very good drug, but the problem is the side-effects issues that develop of which their are many and ever increasing it seems. However with the warnings about cardic risk, a change in label and alternatives, I suspect it would be putting a plaster on a sinking ship.

However, it can tell us some interesting biology as can the PD-1 inhibitors, which also have side-effect problems. I am not a Neuro and I am not going to comment on the soultion to the vascular problem, but for the neuros who read the blog this may or maynot be of interest.

D-dimer (or D dimer) is a fibrin degradation product (or FDP), a small protein fragment present in the blood after a blood clot is degraded by fibrinolysis. It is so named because it contains two D fragments of the fibrin protein joined by a cross-link.

D-dimer concentration may be determined by a blood test to help diagnose thrombosis. Since its introduction in the 1990s, it has become an important test performed in patients with suspected thrombotic disorders. While a negative result practically rules out thrombosis, a positive result can indicate thrombosis but does not rule out other potential causes. Its main use, therefore, is to exclude thromboembolic disease where the probability is low.

Heparin, is a medication used as an anticoagulant (blood thinner).Common side effects include bleeding, pain at the injection site, and low blood platelets.

Elevated D-dimer as an immediate response to alemtuzumab treatment. Libertinova J, Meluzinova E, Nema E, Rockova P, Elisak M, Petrzalka M, Mojzisova H, Hammer J, Tomek A, Marusic P. Mult Scler. 2020 20:1352458520904277. 

Alemtuzumab as a treatment of highly active multiple sclerosis causes a rapid decrease in inflammatory activity due the lysis of immune cells. Subsequent cytokine release determines the infusion-associated reaction that is a frequent adverse event of alemtuzumab treatment. Recently, serious cardiovascular and thrombotic adverse reactions following alemtuzumab infusion have been described. In our study, the dynamics of coagulation parameters were analyzed in 13 multiple sclerosis patients treated with alemtuzumab. An immediate, significant increase in the level of D-dimer was observed after the first administration of alemtuzumab. This observation provides evidence of coagulation activation and the potential risk of thrombotic complications with this therapy. Prophylactic low molecular weight heparin pretreatment maybe considered in patients receiving alemtuzumab.

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MouseDoctor

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  • My wife returned a Positive D-Dimer after developing plueritic pain mid cycle 1. Underwent pulmonary CT to rule out embolism. CT was clear but received clexane injection nonetheless as she was admitted for the night. This was only after I pushed for the work up. Also make sure you get your LFTs monitored pre and post treatment. This again was not looked at until I requested it after reading the updated EMA guidance issued mid last year. When tested, her ALT/AST were 5 x ULN. Stayed that way for 3 months.

    Be vigilant with this drug. The risks are very real. I just hope the benefit is worth the constant ongoing concern. Time will tell…..

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