Science Meets Clinical Practice

Dear Colleagues,

It is a great pleasure for us to serve as guest editors of the congress issue of Hämostaseologie – Progress in Haemostasis on the occasion of the 63rd Annual Meeting of the Society of Thrombosis and Hemostasis Research (GTH) taking place in Berlin.

In the field of haemostasis and thrombosis, we are witnessing a relevant growth of groundbreaking knowledge both in basic and preclinical science and also in the development of innovative treatment options.

Our aim with this congress edition is to transfer science into clinical practice. The physiology and pathophysiology of haemostasis are often perceived as very complex by clinicians from different disciplines. Platelets and coagulation play a critical role in surgery and intensive care medicine and also have a major impact on cardiovascular diseases and thrombosis in general practice.

In this issue, we have selected several topics in the wide field of haemostasis and thrombosis that have direct implications on the daily treatment of our patients. In a narrative review, Warkentin describes the pathology of microvascular thrombosis and limb loss in severely ill patients.[1] Acquired haemostatic disorders are being further addressed by Petros in his article on trauma-induced coagulopathy.[2] In recent years, we have learnt relevant details about the pathophysiology and treatment options of both entities.

Parents of children with hereditary bleeding disorders are often facing questions about possible child abuse. Indeed, violence against children is more common than expected, and the clinician should carefully evaluate both possibilities in children with unusual bleeding symptoms. The article by Knöfler et al offers a practical approach and a useful diagnostic pathway.[3]

The contribution by Ferrière and Lenting explains the possibility of mimicking factor VIII cofactor activity by a bispecific monoclonal antibody.[4] This is an outstanding example of the stringent way from basic science to clinical practice and results in a new option for the treatment of patients suffering from congenital haemophilia A and inhibitors.

There are several risk factors for the development of venous thromboembolism. Hormonal contraception is a relevant risk factor in women, even when the absolute risk is low. Rott reviews the thromboembolic risk of different birth control pills and discusses implications in women with a high risk for or a history of venous thromboembolism.[5]

In this context, physicians often want to quantify the individual risk for venous thromboembolism and recommend laboratory diagnostics for thrombophilia. There is a huge variety of potential risk factors, some with more and some with less or even no relevance. Linnemann and Hart provide a recommendation for a rationale diagnostic evaluation of thrombophilia.[6]

Preventing venous thromboembolism is of major importance, and medical patients have more or less the same risk like surgical patients. In the last few years, there have been relevant developments leading to new drugs for thromboembolic prophylaxis. In her article, Haas reviews these novel agents and their impact on improving thromboprophylaxis.[7]

Deep vein thrombosis in patients with cancer is always challenging. Voigtlaender and Langer discuss the evidence of low-molecular-weight heparin in this patient group.[8] Specifically, the authors provide an update on the role of direct oral anticoagulants in cancer patients.

We are grateful to the authors who are sharing their expert knowledge in these selected topics of thrombosis and haemostasis. We trust that you as readers will take advantage of this series of reviews and that the conclusions drawn will be helpful for your daily clinical practice.

R. Klamroth, Vivantes Klinikum im Friedrichshain

J. Koscielny, Charité Berlin

• References

• 1 Warkentin TE. Microvascular thrombosis and ischaemic limb losses in critically ill patients. Hämostaseologie 2019; 39 (01) 6-19
• 2 Petros S. Trauma-induced coagulopathy. Hämostaseologie 2019; 39 (01) 20-27
• 3 Knöfler R, Streif W, Watzer-Herberth I, Hahn G, Schmidt U. Child abuse or bleeding disorder - an interdisciplinary approach. Hämostaseologie 2019; 39 (01) 28-35
• 4 Ferrière S, Lenting PJ. Antibodies in the treatment of haemophilia A, a biochemical perspective. Hämostaseologie 2019; 39 (01) 36-41
• 5 Rott H. Birth control pills and thrombotic risks. Differences of contraception methods with and without estrogen. Hämostaseologie 2019; 39 (01) 42-48
• 6 Linnemann B, Hart C. Laboratory diagnostics in thrombophilia. Hämostaseologie 2019; 39 (01) 49-61
• 7 Haas S. The role of LMWH for VTE prevention in medical patients - What is new in 2019?. Hämostaseologie 2019; 39 (01) 62-66
• 8 Voigtlaender M, Langer F. Low-molecular-weight heparin in cancer patients: overview and indications. Hämostaseologie 2019; 39 (01) 67-75