Post-thrombotic syndrome (PTS) is the most frequent complication of deep vein thrombosis, and it can be detrimental to the quality of life of affected patients. Once affected by this chronic condition, treatment options are very limited, so preventive therapies are paramount.Currently, the prevention of PTS is hampered by the lack of unequivocally effective therapies.However, increased pathogenic insight acquired in recent years, including the central role of residual venous obstruction, could lead to better application of existing therapies and identification of novel therapeutic targets. Plausible therapeutic agents include flavonoids and statins, while promising future agents include those that target leukocyte-endothelial interaction. Moreover, differences in PTS risk were found to be partly explained by a tendency of patients to form clots which are less susceptible to lysis. Finally, identifying patients that are expected to benefit most from certain therapies is equally valuable for the success of future preventive strategies. This requires exploration of better risk stratification through machine learning techniques.
The 4th Maastricht Consensus Conference on Thrombosis (MCCT), included the following themes:
Theme 1: The “coagulome” as a critical driver of cardiovascular disease
Blood coagulation proteins also play divergent roles in biology and pathophysiology, related to specific organs, including brain, heart, bone marrow and kidney. Four investigators shared their views on these organ-specific topics.
Theme 2: Novel mechanisms of thrombosis
Mechanisms linking factor XII to fibrin, including their structural and physical properties, contribute to thrombosis, which is also affected by variation in microbiome status. Virus infections associated-coagulopathies perturb the hemostatic balance resulting in thrombosis and/or bleeding.
Theme 3: How to limit bleeding risks: insights from translational studies
This theme included state of the art methodology for exploring the contribution of genetic determinants of a bleeding diathesis; determination of polymorphisms in genes that control the rate of metabolism by the liver of P2Y12 inhibitors, to improve safety of antithrombotic therapy. Novel reversal agents for direct oral anticoagulants are discussed.
Theme 4: Hemostasis in extracorporeal systems: how to utilize ex vivo models?
Perfusion flow chamber and nanotechnology developments are developed for studying bleeding and thrombosis tendencies. Vascularised organoids are utilized for disease modeling and drug development studies. Strategies for tackling extracorporeal membrane oxygenation (ECMO) associated coagulopathy are discussed.
Theme 5: Clinical dilemmas in thrombosis and antithrombotic management
Plenary presentations addressed controversial areas, ie thrombophilia testing, thrombosis risk assessment in hemophilia, novel antiplatelet strategies and clinically tested factor XI(a) inhibitors,both possibly with reduced bleeding risk. Finally, Covid-19 associated coagulopathy is revisited.
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