Antithrombotic therapy is one of the cornerstones of cardiovascular medicine, and
numerous patients with or at risk for myocardial infarction or stroke rely on it.
Much has changed within recent years, and direct-acting oral anticoagulants are now
the first choice for many patients requiring potent antithrombotic therapy.[1]
[2] Combining antiplatelet drugs with anticoagulants remains a major challenge in the
management of patients with several comorbidities (e.g. atrial fibrillation and acute
coronary syndrome).[3]
During the 3rd Thrombosis Meeting in Freiburg in February 2018, several invited expert
speakers and a lively audience took a close look at the state-of-the-art inhibition
of platelets and coagulation factors—just 1 day after the exciting 62nd Annual Meeting
of the Society of Thrombosis and Haemostasis Research (GTH) was successfully wrapped
up in Vienna. Going beyond current concepts, recent discoveries in thrombus biology
were discussed not only in Vienna, but now also in Freiburg, like the interplay between
known thrombus components and the complement system[4]
[5]—and, of course, neutrophil extracellular traps (NETs).[6] How external influences change haemostasis dramatically became evident when haemostasis
testing in critically ill patients requiring extracorporeal membrane oxygenation (ECMO)
was presented.[7] Finally, looking at a collage of novel antithrombotic targets motivated the participants
of this meeting to continue working toward further improvement of patient care.
With this theme issue in your hands, selected speakers of the Third Freiburg Thrombosis
Meeting present the results of these discussions in concise review articles. As the
organizer of the Freiburg Thrombosis Meeting, I hope very much that our readers will
enjoy this overview of thrombus formation and inhibition. With this theme issue, I
also want to thank all speakers, who came to Freiburg on that day: Christoph Bode, former president of the GTH and chairman of our department (and my mentor), moderated
the meeting. Harald Langer from Tübingen presented very novel data suggesting an important role of complement
receptors in platelet biology.[5] In this issue, he summarizes this novel and previous knowledge.[8] Tom Eirik Mollnes from Oslo as second speaker added recent data linking the complement and coagulation
systems, when he showed how Staphylococcus aureus induces coagulation by complement activation.[4] Both are intriguing novel aspects of immunothrombosis.[9]
Rüdiger Scharf, Editor-in-Chief of Hämostaseologie – Progress in Haemostasis, past GTH congress president and renowned expert of platelet biology and pathology,
invited the audience to take a fascinating look at complex platelet mechanisms. In
this issue, he summarizes, weighs, reviews and critically discusses platelet signalling
in a two-part overview.[10]
[11] I find his ideas and illustrations very stimulating and highly valuable.
Tobias Fuchs from Hamburg discovered NETs in thrombi together with Denisa Wagner from Boston in
2009.[12] He related to his initial experiments and also showed very exciting new findings,
suggesting that NETs may indeed become an interesting antithrombotic target.[6] Christoph Reinhardt from Mainz then disclosed how gut microbiota influence thrombus initiation and formation—a
novel aspect that some clinicians had been anticipating for a long time.[13] His findings are also presented in this issue.[14]
Carlos Silvestre-Roig from Munich examined and illustrated the contribution of neutrophils to atherosclerosis
and atherothrombosis.[15] Jolanta Siller-Matula from Vienna is an expert in platelet function testing and made an important point,
when she advocated for personalized medicine with the state-of-the art phenotyping
of patients treated with antiplatelet drugs.[16] Barbara Zieger from Freiburg thrilled us with her troubling description of the altered haemostatic
system with acquired von Willebrand syndrome in patients under ECMO support.[7]
Meinrad Gawaz from Tübingen provided pragmatic suggestions for optimal antiplatelet therapy—which
he shares in this issue.[17] Ingo Hilgendorf from Freiburg nicely compiled the most promising novel antithrombotic targets that
he delineates and discusses in this issue.[18] Dietmar Trenk from Bad Krozingen showed surprising features—and clinical consequences—of reticulated
platelets, a very reactive, RNA-rich platelet subpopulation.[19] He will further discuss this aspect in an upcoming issue of Hämostaseologie. Martin Moser from Freiburg finally presented the novel concept of adding low-dose rivaroxaban
to long-term antiplatelet therapy in high-risk patients with vascular disease.[20] This dual-antithrombotic concept is reviewed by Samer Al Said et al in this issue.[21] Gerd Heusch from Essen was a highly appreciated discussant, enthusiastically chairing and moderating
interesting sessions.
As organizer of this year's Freiburg Thrombosis Meeting and guest editor of this theme
issue of Hämostaseologie – Progress in Haemostasis, I am inviting you to share our enthusiasm for improving antithrombotic therapy.
Please deal with the review articles of this edition in detail, discuss them with
your co-workers, relate to them whenever you wish and get back to us with any questions
or comments you may have.
