Thrombotic Storms - Are You Prepared?

Pathologic thrombosis im-pacts nearly every field of medicine. Whether the patient is surgical, obstetrical, or medical, it is almost always the hematologist who provides coagulation expertise in the diagnosis and management of complicated clotting cases. Investigations into the pathophysiology of thrombosis and recent advances in drug development are paying off not only with a better appreciation for the delicate hemostatic balance, but more diagnostic and therapeutic tools for the clinician – with more just around the corner. Are you up on your clotting?

This morning’s Scientific Sessions offer an encore performance of a key coagulation session: Scientific Committee on Hemostasis: Thrombin: From Structure to Clinic. If you missed this session yesterday, make room at 7:30 a.m. on today’s schedule to attend. Thrombin plays a crucial role in coagulation and has become a focus for the development of new anticoagulant drugs. This is your chance to have three experts explain thrombin function and the rationale for targeted thrombin inhibition. In a vivid demonstration of the key role thrombin plays in clotting, Dr. Barbara Furie will present her group’s amazing intravital microscopy images dissecting the dynamics of in vivo thrombus formation. Dr. James Huntington, who recently published interesting data on a thrombin variant that can no longer convert fibrinogen to fibrin (but maintains anticoagulant activity), will then correlate the structure and function of thrombin. The session will conclude with a translation of these insights into thrombin function to clinical applications. Dr. Kenneth Bauer, an expert in the management of thrombophilia who has contributed to the field on nearly every class of anticoagulants, will discuss the rationale and pharmacology of direct thrombin inhibition.

Yesterday, two complementary Education Sessions, Thrombophilia, and New Anticoagulant Drugs and Deep Venous Thrombosis (DVT), updated us on the latest in thrombophilia. The Thrombophilia program kicked off with an overview on the impact of thrombophilic risk factors on testing and therapeutic decision making by Dr. Middeldorp, then moved on to the hot topic of new anticoagulants. Dr. Geerts discussed parental and oral factor Xa inhibitors, followed by Dr. Heit who gave an update on direct thrombin inhibitors. If you’re short on time today and missed this session, a quick review of Dr. Heit’s talk in the Education Program Book will be useful for the Scientific Committee on Hemostasis session on thrombin.

In the DVT session, Dr. Lopez gave an overview of the physiology of thrombosis and updated his work on the hot topic of cell-derived microparticles. The session moved into the clinical realm with Dr. Kearon’s illuminating talk on the risks for recurrent venous thromboembolism, after which he offered guidance for the consideration of thrombophilic risk factors in therapeutic decision making. Dr. Lee completed the session with a discussion on malignancy-related thrombosis, touching on the clinical utility of low-molecular weight heparins and the remarkable potential for anti-neoplastic activity by these drugs.

If you missed these two sessions yesterday, the Education Progam Book is an excellent review, thought it lacks the ambiance, live performances, and cool visuals of the sessions. You still have time to make it to the Scientific Committee on Hemostasis today, and there are multiple relevant abstracts scheduled in the upcoming poster and simultaneous sessions.