Scholars@Duke
Ara Dickran Metjian

Ara Dickran Metjian

Associate Professor of Medicine
Medicine, Hematology
ara.metjian@duke.edu
Duke Box 3422, Duke University Medical Center, Durham, NC 27710
0547 Stead Building, 100 Trent Drive, Durham, NC 27710

Selected Publications

Proteomics of arterial thrombi in acute limb ischemia.

Journal Article J Thromb Thrombolysis · October 2025 Acute limb ischemia (ALI) is characterized by a sudden decrease in limb perfusion due to arterial occlusion. Without urgent revascularization, patients are at risk of ischemic damage and amputation. This study uses novel proteomic techniques to investigate ... Full text Link to item Cite

Relapse-free survival is progressively shortened in a subset of Black patients with immune-mediated TTP treated in the rituximab era.

Journal Article Blood Adv · January 28, 2025 Immune thrombotic thrombocytopenic purpura (iTTP) is a chronically relapsing disorder caused by autoantibody-mediated deficiency of ADAMTS13. Rituximab is frequently administered to prevent relapses, but whether the durability of rituximab effect is mainta ... Full text Link to item Cite

Thrombotic thrombocytopenic purpura: 100 years of research on Moschcowitz syndrome.

Journal Article Blood · September 12, 2024 In the 100 years since Eli Moschcowitz reported the first case of thrombotic thrombocytopenic purpura (TTP), there has been remarkable awareness and progress in the diagnosis and management of this rare blood disorder. This progress initially was the resul ... Full text Link to item Cite

A machine learning approach to predict mortality due to immune-mediated thrombotic thrombocytopenic purpura

Journal Article Research and Practice in Thrombosis and Haemostasis · March 1, 2024 Background: Mortality due to immune-mediated thrombotic thrombocytopenic purpura (iTTP) remains significant. Predicting mortality risk may potentially help individualize treatment. The French Thrombotic Microangiopathy (TMA) Reference Score has not been ex ... Full text Cite

Real-world safety and effectiveness of recombinant porcine sequence factor VIII in acquired haemophilia A: A non-interventional, post-authorization safety study.

Journal Article Haemophilia · September 2023 INTRODUCTION: Recombinant porcine factor VIII (rpFVIII, susoctocog alfa) is indicated for the treatment of bleeding episodes in adults with acquired haemophilia A (AHA). AIM: To provide long-term real-world safety and effectiveness data for rpFVIII in the ... Full text Link to item Cite

iTTP: more long-term consequences.

Journal Article Blood · January 19, 2023 Full text Link to item Cite

Long-term follow-up of patients treated with caplacizumab and safety and efficacy of repeat caplacizumab use: Post-HERCULES study.

Journal Article J Thromb Haemost · December 2022 INTRODUCTION: Caplacizumab demonstrated efficacy and safety in patients with immune-mediated thrombotic thrombocytopenic purpura (iTTP) in the phase 3 HERCULES trial. However, data on long-term outcomes following caplacizumab treatment are limited. OBJECTI ... Full text Link to item Cite

Race, rituximab, and relapse in TTP.

Journal Article Blood · September 22, 2022 Immune-mediated thrombotic thrombocytopenic purpura (iTTP) is characterized by recurring episodes of thrombotic microangiopathy, causing ischemic organ impairment. Black patients are overrepresented in iTTP cohorts in the United States, but racial disparit ... Full text Link to item Cite

Safety and tolerability of solvent/detergent-treated plasma for pediatric patients requiring therapeutic plasma exchange: An open-label, multicenter, postmarketing study.

Journal Article Transfusion · February 2022 BACKGROUND: This study investigated the real-world safety and tolerability of solvent/detergent-treated (S/D) plasma for pediatric patients requiring therapeutic plasma exchange (TPE). STUDY DESIGN AND METHODS: LAS-213 was a multicenter, open-label, interv ... Full text Link to item Cite

Caplacizumab prevents refractoriness and mortality in acquired thrombotic thrombocytopenic purpura: integrated analysis.

Journal Article Blood Adv · April 27, 2021 The efficacy and safety of caplacizumab in individuals with acquired thrombotic thrombocytopenic purpura (aTTP) have been established in the phase 2 TITAN and phase 3 HERCULES trials. Integrated analysis of data from both trials was conducted to increase s ... Full text Link to item Cite

Ex vivo assays to detect complement activation in complementopathies.

Journal Article Clin Immunol · December 2020 In complement-driven thrombotic microangiopathies, failure to regulate complement activation leads to end-organ damage. The modified Ham (mHam) test measures complement-mediated killing of a nucleated cell in vitro but lacks a confirmatory assay and reliab ... Full text Link to item Cite

Efficacy and safety of open-label caplacizumab in patients with exacerbations of acquired thrombotic thrombocytopenic purpura in the HERCULES study.

Journal Article J Thromb Haemost · February 2020 BACKGROUND: Acquired thrombotic thrombocytopenic purpura (aTTP) is a rare, life-threatening autoimmune thrombotic microangiopathy. Caplacizumab, an anti-von Willebrand Factor Nanobody® , is effective for treating aTTP episodes and is well tolerated. OBJECT ... Full text Link to item Cite

Caplacizumab Treatment for Acquired Thrombotic Thrombocytopenic Purpura.

Journal Article N Engl J Med · January 24, 2019 BACKGROUND: In acquired thrombotic thrombocytopenic purpura (TTP), an immune-mediated deficiency of the von Willebrand factor-cleaving protease ADAMTS13 allows unrestrained adhesion of von Willebrand factor multimers to platelets and microthrombosis, which ... Full text Link to item Cite

Indications for and outcomes of therapeutic plasma exchange after cardiac transplantation: A single center retrospective study.

Journal Article J Clin Apher · August 2018 INTRODUCTION: Limited data are available describing indications for and outcomes of therapeutic plasma exchange (TPE) in cardiac transplantation. METHODS: In a retrospective study of patients who underwent cardiac transplantation at Duke University Medical ... Full text Open Access Link to item Cite

A rare CALR variant mutation and a review of CALR in essential thrombocythemia.

Journal Article J Thromb Thrombolysis · April 2018 Essential thrombocythemia (ET) is an indolent myeloproliferative neoplasm characterized by megakaryocyte hyperplasia, thrombocytosis, thrombotic and hemorrhagic complications, and potential transformation into myelofibrosis and acute myeloid leukemia. The ... Full text Link to item Cite

Novel therapeutic approaches for thrombotic thrombocytopenic purpura.

Journal Article Curr Opin Hematol · November 2017 PURPOSE OF REVIEW: Acquired thrombotic thrombocytopenic purpura is an immune-mediated thrombotic microangiopathy caused by antibodies to ADAMTS13 (A Disintegrin And Metalloproteinase with a ThromboSpondin type 1 motif, member 13). Standard treatment with t ... Full text Link to item Cite

Human Leukocyte Antigen Sensitization in Solid Organ Transplantation: A Primer on Terminology, Testing, and Clinical Significance for the Apheresis Practitioner.

Journal Article Ther Apher Dial · October 2017 The human leukocyte antigen (HLA) system is an important immunologic barrier that must be considered for successful solid organ transplantation. Formation of donor-specific HLA antibodies in solid organ transplantation is an important cause of allograft in ... Full text Open Access Link to item Cite

The thrombotic microangiopathy Registry of North America: A United States multi-institutional TMA network.

Journal Article J Clin Apher · October 2016 The thrombotic microangiopathy (TMA) Registry Network of North America (TRNA) is a collaborative network organized for the purpose of developing a multi-institutional registry and network to conduct clinical studies in a rare patient population. The TRNA w ... Full text Link to item Cite

rVWF: treatment finally reaches the modern age.

Journal Article Blood · October 22, 2015 In this issue of Blood, Gill et al describe the results of the first phase 3 clinical trial evaluating recombinant von Willebrand factor (rVWF) for the treatment of hemorrhagic events in all patients with von Willebrand disease (VWD). ... Full text Link to item Cite

Waldenström macroglobulinemia in hepatitis C: case report and review of the current literature.

Journal Article Case Rep Oncol Med · 2014 Background. Recent literature has associated hepatitis C virus with the development of non-Hodgkin lymphoma. Hepatitis C virus infection appears to promote lymphoproliferation, providing a plausible mechanism for a causative association; however, despite p ... Full text Link to item Cite

Use of a thrombopoietin mimetic for chronic immune thrombocytopenic purpura in pregnancy.

Journal Article Obstet Gynecol · August 2013 BACKGROUND: Romiplostim, a thrombopoietin mimetic, is a novel therapeutic option for patients with chronic immune thrombocytopenic purpura. We report on the effects of romiplostim use throughout pregnancy. CASE: A 28-year-old primigravid woman with chronic ... Full text Link to item Cite

Similarity in joint function limitation in Type 3 von Willebrand's disease and moderate haemophilia A.

Journal Article Haemophilia · July 2013 Type 3 von Willebrand's disease (VWD) is a rare bleeding diathesis with complete or near complete deficiency of von Willebrand factor (VWF) and low factor VIII (FVIII) levels. In contrast, only FVIII is decreased in haemophilia A (HA). Both disorders are c ... Full text Link to item Cite

Hematology

Journal Article · December 1, 2012 Full text Cite

Hematology

Chapter · January 1, 2011 Full text Cite

Validation of the high-dose heparin confirmatory step for the diagnosis of heparin-induced thrombocytopenia.

Journal Article Blood · September 9, 2010 The diagnosis of heparin-induced thrombocytopenia (HIT) requires detection of antibodies to the heparin/platelet factor 4 (PF4) complexes via enzyme-linked immunosorbent assay. Addition of excess heparin to the sample decreases the optical density by 50% o ... Full text Link to item Cite

Bleeding symptoms and laboratory correlation in patients with severe von Willebrand disease.

Journal Article Haemophilia · July 2009 Type 3 von Willebrand disease (VWD) is a rare bleeding disorder with markedly decreased or absent von Willebrand factor (VWF) protein, accompanied by a parallel decrease in VWF function and factor VIII (FVIII) activity. The goal of this study was to descri ... Full text Link to item Cite

New advances in the treatment of adult chronic immune thrombocytopenic purpura: role of thrombopoietin receptor-stimulating agents.

Journal Article Biologics · 2009 Featured Publication Decades of basic science and clinical research have led to an increased understanding of the pathophysiology of immune thrombocytopenic purpura (ITP), the processes underlying thrombopoiesis, and the treatment of chronic ITP. Now, new agents are available ... Link to item Cite

ASH evidence-based guidelines: should asymptomatic patients with antiphospholipid antibodies receive primary prophylaxis to prevent thrombosis?

Journal Article Hematology Am Soc Hematol Educ Program · 2009 Featured Publication A 35-year-old female presents with a prolonged activated partial thromboplastin time (aPTT) on routine testing, which is found to be due to a lupus anticoagulant. She has no medical issues, no personal or family history of thrombosis, no history of pregnan ... Full text Link to item Cite

New insights and therapeutics for immune-mediated thrombocytopenia.

Journal Article Expert Rev Cardiovasc Ther · January 2008 Featured Publication In recent years, great advances have been made in elucidating the pathogenesis of thrombocytopenia and the mechanisms of thrombopoiesis. Drawing upon decades of basic science and clinical research, the pathways behind the immune-mediated destruction of pla ... Full text Link to item Cite

Agonists cause nuclear translocation of phosphatidylinositol 3-kinase gamma. A Gbetagamma-dependent pathway that requires the p110gamma amino terminus.

Journal Article J Biol Chem · September 24, 1999 Featured Publication In hematopoietic cells, the signals initiated by activation of the phosphoinositide 3-kinase (PI3K) family have been implicated in cell proliferation and survival, membrane and cytoskeletal reorganization, chemotaxis, and the neutrophil respiratory burst. ... Full text Link to item Cite

Cytoskeletal reorganization by G protein-coupled receptors is dependent on phosphoinositide 3-kinase gamma, a Rac guanosine exchange factor, and Rac.

Journal Article Mol Cell Biol · August 1998 Featured Publication Reorganization of the actin cytoskeleton is an early cellular response to a variety of extracellular signals. Dissection of pathways leading to actin rearrangement has focused largely on those initiated by growth factor receptors or integrins, although sti ... Full text Link to item Cite