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Semin Thromb Hemost 2013; 39(02): 113-116
DOI: 10.1055/s-0033-1336408
Preface
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Expert Approaches to Common Bleeding and Thrombotic Problems, Part II

Catherine P. M. Hayward
1   Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
,
Kathryn E. Webert
2   Canadian Blood Services, Hamilton Centre, Ontario, Canada
› Author Affiliations
Further Information

Publication History

Publication Date:
20 February 2013 (online)

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Welcome to this second special issue of Seminars in Thrombosis & Hemostasis that is devoted to expert approaches to common bleeding and thrombotic problems. Like the first issue on expert approaches,[1] the current issue features evidence and opinions on the diagnosis and management of common disorders, with discussion of many practical considerations for optimal management of common thrombotic and bleeding problems that are relevant to the field of hematology.[2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] The expert contributors have shared their thoughts and advice, with appraisal of the current evidence.[2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] All of the articles in this issue discuss clinical management and related laboratory testing.[2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] Taken together, the articles provide up-to-date, helpful diagnostic and management reviews, with in-depth discussions of key issues. This issue of Seminars in Thrombosis & Hemostasis is anticipated to be highly valued by individuals engaged in clinical, laboratory, educational, and research practices.

In the first article of the issue, Rojas-Hernandez and Garcia discuss the novel, oral anticoagulants that are now available in many countries as alternatives for thromboprophylaxis and long-term oral anticoagulation treatment.[2] Rojas-Hernandez and Garcia review the basic pharmacology, advantages, and limitations of these agents, and they provide helpful perspectives on the current and potential indications for these new drugs, which range from thromboprophylaxis for surgery and atrial fibrillation to the treatment of acute venous thromboembolism.[2] Importantly, the authors discuss the current information on the risks for thrombosis and bleeding for patients treated with the new oral anticoagulants, relative to other established therapies.[2] They also address several of the current challenges related to measuring and reversing these agents.[2]

In the second article by Tagalakis et al, the topic of preventing and treating venous thromboembolism in patients with cancer is discussed—an important issue as patients with malignancies are at significantly increased risk for venous thromboembolism.[3] The authors provide a thoughtful review of the factors that contribute to the increased thrombotic risks for cancer patients.[3] They also review and discuss the current evidence on risk assessment and therapies that are appropriate for preventing and treating cancer-associated venous thromboembolism.[3]

The third article of the issue, by Schulman, provides a contemporary, expert perspective on the optimal duration of anticoagulant therapy to balance the benefits of antithrombotic therapy with the risks for serious bleeding.[4] Schulman reviews how the balance is impacted by patient factors and disease factors that influence the risks and consequences for bleeding and recurrent thrombosis.[4] He discusses the current guideline recommendations, risk prediction tools, and where evidence is lacking to guide decisions on therapy duration for individual patients.[4] The article provides valued guidance to practitioners that manage patients on anticoagulant therapy.[4]

The fourth article by Hylek discusses the important topic of anticoagulation therapy for atrial fibrillation, a very common cardiac arrhythmia that is associated with significant risks for thromboembolic stroke.[5] She discusses the risk reduction associated with warfarin as anticoagulation therapy for atrial fibrillation, including the challenges of this therapy.[5] Hylek also discusses the new and emerging roles for the novel anticoagulants dabigatran, rivaroxaban, and apixaban for preventing strokes associated with atrial fibrillation, including the current information on their effectiveness and risks for hemorrhage relative to warfarin, which has been the mainstay of therapy.[5] The article provides an up-to-date review on the important issues to consider in managing anticoagulation therapy for atrial fibrillation,[5] which could change as more information emerges on the benefits and risks associated with using the new oral anticoagulants in patients with atrial fibrillation and other prothrombotic conditions.

In the fifth article of this issue, George and Charania provide expert perspectives on the evaluation of patients with thrombocytopenia and microangiopathic hemolytic anemia.[6] They discuss the differential diagnosis of microangiopathic hemolytic anemias and when to consider thrombotic thrombocytopenic purpura as the cause.[6] George and Charania discuss when to consider plasma exchange therapy, which remains the most effective established therapy for thrombotic thrombocytopenic purpura.[6]

The sixth article, by Balduini et al, presents an expert approach to the diagnosis and management of inherited, thrombocytopenic platelet disorders[7]—a topic that has been the focus of several articles recently published in Seminars in Thrombosis & Hemostasis.[13] [14] [15] [16] [17] [18] [19] [20] [21] [22] In their contribution, Balduini et al provide an update on the characterized disorders associated with congenital thrombocytopenic with discussion of their pathogenesis, diagnosis, management, and prognosis.[7] They provide a helpful framework for exploring when a low platelet count might be due to an inherited cause and the tests that may be helpful in establishing a specific diagnosis, which is not always possible.[7]

In the seventh article of the issue, De Simone and Sarode provide their expert approach to the diagnosis and management of common acquired bleeding disorders, which have diverse causes and presentations.[8] They review the role of the medical history in establishing the potential etiologies, with many practical tips on how to use laboratory investigations to guide diagnosis and management.[8] De Simone and Sarode also discuss current treatment indications and options for managing common acquired bleeding problems.[8]

In the eighth article of the issue, Shander and Javidroozi present an insightful, expert approach to patients with bleeding problems that cannot be treated with blood-derived products.[9] They discuss the evidence-based concepts, principles, and strategies of so-called “Bloodless Medicine and Surgery” and strategies to improve patient outcomes when blood-derived products cannot be used.[9] This article provides helpful guidance on how to manage patients who do not accept blood-derived products, which is also helpful to consider the optimizing therapy to reduce blood product exposures for other patients.[9]

In the ninth article, Federici et al provide an update on the diagnosis and management of acquired von Willebrand syndrome, which is one of the more serious acquired bleeding disorders.[10] The article details the current evidence on acquired von Willebrand syndrome, with an overview on its diverse pathogeneses. It also provides a helpful update on the laboratory diagnosis of this disorder and the options for therapy that should be considered when managing the bleeding complications.[10] This valued update will be useful to both clinical and laboratory practitioners who evaluate patients with acquired von Willebrand syndrome.

In the tenth article of the issue, Lippi et al discuss the diagnosis and management of ischemic heart disease, the leading cause of death and morbidity worldwide.[11] They review the laboratory strategies to diagnose ischemic heart disease, including the use of highly sensitive troponin immunoassays and other biomarkers.[11] Lippi et al also provide an overview of the evidence for reperfusion and pharmacological therapies, including the use of anticoagulants and drugs that inhibit platelet function and potential future therapies, such as stem cell–based treatments.[11]

In the eleventh article of the issue, Targher and Byrne discuss the diagnosis and management of nonalcoholic fatty liver disease, a common cause of chronic liver disease that has important hemostatic/thrombotic and vascular complications.[12] The authors provide a helpful and concise overview on the spectrum of nonalcoholic fatty liver disease and its associations with atherothrombotic events. They also discuss the pathogenic, proinflammatory and prothrombotic mechanisms that cause this disorder and treatment options that may influence the vascular complications.[12]

This collection of interesting expert opinion articles, which comprise this second expert approaches issue of Seminars in Thrombosis & Hemostasis, provide valued and helpful guidance on diagnosing, managing, and treating common bleeding and thrombotic problems. The collection highlights current evidence and questions that need to be addressed to guide clinical and laboratory practice. The Guest Editors of this issue of Seminars in Thrombosis & Hemostasis extend their sincere gratitude to all the authors for their thoughtful, interesting, and timely contributions. We anticipate that this issue be highly valued by clinicians, laboratories, researchers, educators, and learners worldwide. We hope that readers enjoy this new collation of expert articles on common bleeding and thrombotic problems.