By Anne McLeod, MD

2009-12-05

There will be no rest today for meeting attendees anxious for updates on the hottest topics in thrombosis. The 2009 Education Program includes three sessions with nine expert speakers, covering a cascade of topics from the pathobiology of venous and arterial thrombosis, to the risk of clotting in patients with disseminated intravascular coagulation (DIC), to the thrombotic challenges hematologists face working with special patient groups, such as pregnant women.

Today’s Venous Versus Arterial Thrombosis Session will take place at 7:30 a.m. in the La Nouvelle Ballroom AB at the Ernest N. Morial Convention Center. Dr. Bruce Furie of Beth Israel Deaconess Medical Center in Boston will examine why the pathogenesis of arterial and venous thrombosis, which have traditionally been considered distinct clinical entities, may need a little rethinking, based on results of confocal and intravital microscopy studies. Dr. David Green from Northwestern University in Chicago will then tackle the controversial hypothesis that patients with venous thrombosis carry a greater risk of arterial thrombosis. Completing the session, Dr. David Voran of Hadassah Medical Center in Jerusalem will focus on platelets, with a discussion of anti-platelet agents in the treatment of arterial thrombosis, anti-platelet drug resistance and how to test for it, and novel agents and approaches we need to know about. For those not “activated” in time for this session today, there will be a second chance to catch it tomorrow at 7:30 a.m. in the same location.

The second step in today’s coagulation education, Thrombotic Challenges Beyond Hematology, follows (after a short break for some stretching and clot prevention) at 9:30 a.m. in the same location, the La Nouvelle Ballroom AB. Dr. Andra James of Duke University will discuss approaches to the management of pregnant patients with venous thrombosis. She will review the epidemiology of VTE in pregnancy, indications for anticoagulation in pregnancy, and its management around delivery. Dr. William Geerts, author of the 8th Edition of the American College of Chest Physicians (ACCP) Guidelines on the Prevention of Venous Thromboembolism, will outline the peri-operative prevention of thromboembolism. Finally, Dr. Brett Cucchiara of the University of Pennsylvania will discuss antithrombotic, antiplatelet, and thrombolytic therapy for ischemic stroke and its hemorrhagic complications — issues which often lead to the involvement of the consulting hematologist. This session will be presented again later today, at 4:00 p.m. in the La Nouvelle Ballroom AB.

Between a Rock and a Hard Place: Thrombotic Risk in the Thrombocytopenic Patient will cover the difficult balance consulting hematologists struggle with in managing the thrombocytopenic patient at high risk for thrombosis. Today at 2:00 p.m. in E-3 in the Ernest N. Morial Convention Center, Dr. Thomas Ortel of Duke University will discuss a thrombocytopenic disorder that carries a high risk for thrombosis, heparin-induced thrombocytopenia. Dr. Wendy Lim from McMaster University in Toronto will review the management of antiphospholipid antibody syndrome in patients for whom anticoagulation is essential, but in whom thrombocytopenia is also part of their disorder. Dr. Craig Kitchens of the University of Florida will complete this session with a discussion of thrombotic risk in the acutely ill patient with DIC in the intensive care unit, stressing that the risk of thrombosis is not mitigated by thrombocytopenia — a paradox that makes thrombosis prophylaxis and management especially difficult. This session occurs again at 9:30 a.m. Sunday in the same location.

With nine hours of thrombosis sessions being offered as part of this year’s ASH Education Program, we’ll have a great opportunity to solidify our thinking on clots today.

Dr. McLeod indicated no relevant conflicts of interest.

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