Blood Coagulation and Beyond: Position Paper from the Fourth Maastricht Consensus Conference on Thrombosis

Abstract

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.

A Happy New Year 2024 from Thrombosis and Haemostasis!

“…For this year, we plan to include additional State-of-the-Art Review articles, Clinical Perspectives, and Executive Summaries of Guidelines and Position papers, following the well-received examples from the previous years. 2 3 4 5 6…”

Editorial: The integrated synapse: the (dys)functional role of neurovascular unit, resident glia and extracellular matrix during synaptic development and plasticity

“…The pleiotropy of coagulation signaling and the existence of the glymphatic during sleep/wake cycles are novel and emergent fields of interest to understand the CNS without cutting out the arteriovenous and cerebrospinal circulation (Akbalut et al, 2023 ). The neural network is harmonically interplaying with non-neuronal cells to generate electromagnetic fields, using the functional scaffold of ECM for paracrine and autocrine signaling, while the neurovascular unit in both physiology and pathology carries out the metabolic, hormonal, electrolytic- and waste-clearing functions (Virtuoso et al, 2021 ).…”