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Blood Coagulation and Beyond: Position Paper from the Fourth Maastricht Consensus Conference on Thrombosis.

ABSTRACT: The Fourth Maastricht Consensus Conference on Thrombosis included the following themes. Theme 1: The "coagulome" as a critical driver of cardiovascular disease. Blood coagulation proteins also play divergent roles in biology and pathophysiology, related to specific organs, including brain, heart, bone marrow, and kidney. Four investigators shared their views on these organ-specific topics. Theme 2: Novel mechanisms of thrombosis. Mechanisms linking factor XII to fibrin, including their structural and physical properties, contribute to thrombosis, which is also affected by variation in microbiome status. Virus infection-associated coagulopathies perturb the hemostatic balance resulting in thrombosis and/or bleeding. Theme 3: How to limit bleeding risks: insights from translational studies. This theme included state-of-the-art methodology for exploring the contribution of genetic determinants of a bleeding diathesis; determination of polymorphisms in genes that control the rate of metabolism by the liver of P2Y12 inhibitors, to improve safety of antithrombotic therapy. Novel reversal agents for direct oral anticoagulants are discussed. Theme 4: Hemostasis in extracorporeal systems: the value and limitations of ex vivo models. Perfusion flow chamber and nanotechnology developments are developed for studying bleeding and thrombosis tendencies. Vascularized organoids are utilized for disease modeling and drug development studies. Strategies for tackling extracorporeal membrane oxygenation-associated coagulopathy are discussed. Theme 5: Clinical dilemmas in thrombosis and antithrombotic management. Plenary presentations addressed controversial areas, i.e., thrombophilia testing, thrombosis risk assessment in hemophilia, novel antiplatelet strategies, and clinically tested factor XI(a) inhibitors, both possibly with reduced bleeding risk. Finally, COVID-19-associated coagulopathy is revisited.

SUBMITTER: Akbulut AC

PROVIDER: S-EPMC10365887 | biostudies-literature | 2023 Aug

REPOSITORIES: biostudies-literature

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Blood Coagulation and Beyond: Position Paper from the Fourth Maastricht Consensus Conference on Thrombosis.

Akbulut Asim Cengiz AC Arisz Ryanne A RA Baaten Constance C F M J CCFMJ Baidildinova Gaukhar G Barakzie Aarazo A Bauersachs Rupert R Ten Berg Jur J van den Broek Wout W A WWA de Boer H C HC Bonifay Amandine A Bröker Vanessa V Buka Richard J RJ Ten Cate Hugo H Ten Cate-Hoek Arina J AJ Cointe S S De Luca Ciro C De Simone Ilaria I Diaz Rocio Vacik RV Dignat-George Françoise F Freson Kathleen K Gazzaniga Giulia G van Gorp Eric C M ECM Habibi Anxhela A Henskens Yvonne M C YMC Iding Aaron F J AFJ Khan Abdullah A Koenderink Gijsje H GH Konkoth Akhil A Lacroix Romaric R Lacroix Romaric R Lahiri Trisha T Lam Wilbur W Lamerton Rachel E RE Lorusso Roberto R Luo Qi Q Maas Coen C McCarty Owen J T OJT van der Meijden Paola E J PEJ Meijers Joost C M JCM Mohapatra Adarsh K AK Nevo Neta N Robles Alejandro Pallares AP Poncelet Philippe P Reinhardt Christoph C Ruf Wolfram W Saraswat Ronald R Schönichen Claudia C Schutgens Roger R Simioni Paolo P Spada Stefano S Spronk Henri M H HMH Tazhibayeva Karlygash K Thachil Jecko J Diaz Rocio Vacik RV Vallier L L Veninga Alicia A Verhamme Peter P Visser Chantal C Watson Steve P SP Wenzel Philip P Willems Ruth A L RAL Willers Anne A Zhang Pengyu P Zifkos Konstantinos K van Zonneveld Anton Jan AJ

Thrombosis and haemostasis 20230313 8

The Fourth Maastricht Consensus Conference on Thrombosis included the following themes. Theme 1: The "coagulome" as a critical driver of cardiovascular disease. Blood coagulation proteins also play divergent roles in biology and pathophysiology, related to specific organs, including brain, heart, bone marrow, and kidney. Four investigators shared their views on these organ-specific topics. Theme 2: Novel mechanisms of thrombosis. Mechanisms linking factor XII to fibrin, including their structura ...[more]

PMID: 36913975

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Project description:BackgroundDecision-making in emergency settings is inherently complex, requiring surgeons to rapidly evaluate various clinical, diagnostic, and environmental factors. The primary objective is to assess a patient's risk for adverse outcomes while balancing diagnoses, management strategies, and available resources. Recently, indocyanine green (ICG) fluorescence imaging has emerged as a valuable tool to enhance surgical vision, demonstrating proven benefits in elective surgeries.AimThis consensus paper provides evidence-based and expert opinion-based recommendations for the standardized use of ICG fluorescence imaging in emergency settings.MethodsUsing the PICO framework, the consensus coordinator identified key research areas, topics, and questions regarding the implementation of ICG fluorescence-guided surgery in emergencies. A systematic literature review was conducted, and evidence was evaluated using the GRADE criteria. A panel of expert surgeons reviewed and refined statements and recommendations through a Delphi consensus process, culminating in final approval.ResultsICG fluorescence imaging, including angiography and cholangiography, improves intraoperative decision-making in emergency surgeries, potentially reducing procedure duration, complications, and hospital stays. Optimal use requires careful consideration of dosage and timing due to limited tissue penetration (5-10 mm) and variable performance in patients with significant inflammation, scarring, or obesity. ICG is contraindicated in patients with known allergies to iodine or iodine-based contrast agents. Successful implementation depends on appropriate training, availability of equipment, and careful patient selection.ConclusionsAdvanced technologies and intraoperative navigation techniques, such as ICG fluorescence-guided surgery, should be prioritized in emergency surgery to improve outcomes. This technology exemplifies precision surgery by enhancing minimally invasive approaches and providing superior real-time evaluation of bowel viability and biliary structures-areas traditionally reliant on the surgeon's visual assessment. Its adoption in emergency settings requires proper training, equipment availability, and standardized protocols. Further research is needed to evaluate cost-effectiveness and expand its applications in urgent surgical procedures.

Dataset Information

Blood Coagulation and Beyond: Position Paper from the Fourth Maastricht Consensus Conference on Thrombosis.

Publications

Blood Coagulation and Beyond: Position Paper from the Fourth Maastricht Consensus Conference on Thrombosis.

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