The recent ISTH 2020 meeting that was supposed to be held in Milan, Italy was still a success even in a virtual setting. As always, the topics were extremely informative. The addition of ISTH TV was an innovative way of presenting new information in a roundtable format with top members of the coagulation community. The topics ranged from Key Findings /Learnings from the 2020 Meeting Related to Anticoagulation: The speakers were Dr. Saskia Middeldorp, MD, PhD, and Dr. Jeffrey Weitz MD.
They discussed the use of aspirin as a primary and secondary medication for thrombosis, issues of using DOACs and the use of reversal agents, and how these meds have taken over in the treatment of VTE. The role of renal function in the use of DOACs was brought up as well. One of the more interesting parts of their presentation was the use of the DOACs in extended thromboprophylaxis, and which subjects benefit the most.
Of course, no one could get away without discussing COVID-19 and Anticoagulation at the ISTH 2020 meeting. The same experts had a brisk discussion on the thrombosis risk issues in subjects affected by the SARS-CoV-2 virus. They also found that the risk factors were much higher with more variables than those who had been infected with viral influenza. They discussed the thromboprophylaxis on patients when first admitted using heparinoids, stages in hospitalization, and the weight-based adjustments with the low molecular weight heparins (LMWH). They admitted that with this new virus, trial and error using information from a number of clinical trials and early studies were incorporated into their treatment plans. Again, the extended therapy upon discharge was taken into consideration.
One topic that got my attention was the presentation on advancements the have been made in anticoagulation management in special populations. This presentation was moderated by Dr. Beverly Hunt, Dr. Alexander Cohen, and again Dr. Middeldorp. Too often, pediatric patients, elderly persons, patients who are morbidly obese or severely underweight, and those with renal insufficiency are excluded from clinical trials. The FXa inhibitor DOACs have largely taken over this segment in need of anticoagulation unless in patients who are only able to use Vitamin-K antagonists. Dr. Cohen stated that the DOACs have virtually taken over even in patients with renal insufficiency.
Another topic was Advancing Care for Hemophilia: Insight from the 2020 Meeting. This session was hosted by John Pasi, MB, Dh.B, Ph.D., Robert Klamroth, MD, and Magaret Ozelo MD. The main topic dealt with hemophilia therapies, particularly gene therapies and monoclonal antibodies, and factor concentrates. I was surprised at this meeting that none of the short sessions discussed testing required for measuring and monitoring the new treatments.
In the September topic of CLOT CLUB, we will be discussing a South Texas Family who we have traced 5 generations of male members who have Factor V Leiden. It hits close to home because they are my in-laws. We will discuss this heterozygous mutation, its physical effects, and the laboratory testing for its detection.
Remember the first rule of CLOT CLUB is we do talk about CLOT CLUB.