ASH News Daily - Sunday, December 11, 2011 - (Page A-6)

Page A–6 ® THROMBOSIS Clinically Complex Clotting Questions By david gaRcia, Md, and ShaRi ghanny, Md most challenging consultations faced by hematologists. The stakes are high because the complications of either the disease (e.g., pulmonary embolism) or the treatment (e.g., anticoagulant-associated major bleeding) can be devastating. In recent years, important research has improved our understanding of how to care C linical questions about thrombosis or anticoagulation represent some of the for patients with thrombotic disorders. During yesterday’s Education Program session “Consultative Hematology I: Common Questions in Thrombosis Consults,” attendees heard the latest practice-changing evidence related to three important (and often confusing) topics: heparin-induced thrombocytopenia (HIT), thrombophilia testing, and the role of endovascular procedures in the management of deep-vein thrombosis (DVT). In the first presentation, Dr. Ted Dr. Theodore Warkentin discusses diagnosis and treatment during the “Consultative Hematology I: Common Questions in Thrombosis Consults” session. Warkentin of McMaster University, Hamilton, ON, discussed the diagnosis and treatment of HIT. This rare but highly feared complication of heparin-based anticoagulation has been the subject of much basic and clinical research in recent years. Dr. Warkentin provided attendees with important insights about how to interpret the often confusing diagnostic testing for HIT. For example, he showed convincing evidence that patients who are positive for anti-heparin/ PF4 antibodies (by ELISA) but have a negative serotonin release assay do not have HIT. Dr. Warkentin also described the advantages and disadvantages of various therapies (direct thrombin inhibitors versus indirect factor Xa inhibitors) for HIT. Next, Dr. Saskia Middeldorp of the Academic Medical Center, Amsterdam, The Netherlands, answered the question “Is Thrombophilia Testing Useful?” Although several inherited and acquired conditions that predispose to venous thrombosis have now been identified, many clinicians are uncertain about when to test for thrombophilias like protein C deficiency or how to interpret the results of such testing when it is done. Dr. Middeldorp’s presentation not only provided an overview of the latest epidemiology but also included the evidence pertinent to thrombophilia testing in specific groups: patients with a personal or family history of VTE, patients with a history of pregnancy loss, patients considering oral contraceptive use, and patients with arterial thrombosis. The final presentation, given by Dr. Suresh Vedantham of Washington University School of Medicine in St. Louis focused on the role of endovascular approaches for the acute management of DVT. We know that for patients with proximal DVT, anticoagulation alone is highly effective at preventing both clot extension and embolization to the lungs. Unfortunately, some patients with proximal DVT will go on to experience postthrombotic syndrome – an often irreversible condition associated with edema, pain, and other symptoms. Dr. Vedantham described the latest options for more aggressive, upfront treatment of proximal DVT, including systemic thrombolysis as well as endovascular (pharmacomechanical) interventions. He discussed existing evidence as well as ongoing research designed to determine whether more aggressive approaches to the management of proximal DVT can reduce the risk of long-term sequelae. Drs. Garcia and Ghanny indicated no relevant conflicts of interest. David G. Nathan Awarded Society’s Highest Honor RED CELLS D espite all that David G. Nathan, MD, of the DanaFarber Institute and Chil- dren’s Hospital Boston has contributed to the field, he will be the first to tell you that this career move was not quite of his own choosing. “Frankly, I was ordered into hematology,” he said. In 1957 when Dr. Nathan arrived in the lab of the late Dr. Nathaniel I. Berlin at the National Cancer Institute, Dr. Berlin asked his student what he wanted to study. “I told him I wanted to study ammonia metabolism in liver disease.” Dr. Berlin then told Dr. Nathan that he wanted him to study red cell lifespan in leukemia. Dr. Nathan once again reiterated his research interests. Then, Dr. Nathan remembers his mentor pulling rank. “He asked me to tell him how many stripes he would have on his sleeve if we were both in uniform. I said four. He asked me how many I would have, and I said two. ‘That,’ he said, ‘is why you are going to do hematology now and not ammonia metabolism in liver disease.’” Dr. Nathan has never regretted that order. This afternoon, the American So- ciety of Hematology will bestow its highest honor on Dr. Nathan with the Wallace H. Coulter Award for Lifetime Achievement in Hematology. The award commemorates the innovative spirit, visionary leadership, and entrepreneurship of Mr. Coulter, who was best known for his development of the Coulter Principle — a proven theory that provided a methodology for counting, measuring, and evaluating cells and microscopic particles suspended in fluid. Further, his invention of the Coulter Counter made possible today’s most common medical diagnostic test: the complete blood count. The award in his name is conferred upon an individual who has exhibited a lifetime commitment to hematology, making outstanding contributions and leaving a significant impact on education, research, and/or practice. Dr. Nathan has made outstand- ing contributions throughout the course of his more than 50-year career. He and his team developed the first prenatal diagnostic test for thalassemia and sickle cell anemia, were the first to introduce hydroxyurea to prevent certain sickle cell complica- tions, and were the first to develop a successful treatment for patients who produce an excessive amount of iron, subcutaneous deferoxamine, while undergoing chronic transfusion therapy. These accomplishments have had a profound impact on the field of hematology, especially as it relates to inherited red cell disorders. Having mentored more than 100 hematologists during his career, Dr. Nathan surely understands the mutual benefits of tutelage. His most cherished work-related memories have been witnessing the development of his many trainees and some of his younger colleagues into highly distinguished hematologists, “several of whom,” he says, “are or will be Coulter candidates.” Over the last 50-plus years one can imagine the profound nuggets of wisdom Dr. Nathan has obtained and dispensed. As for the best advice he has received, Dr. Nathan David G. Nathan, MD recalls the words of the late clinical cardiologist Dr. Samuel A. Levine of the then Peter Brent Brigham Hospital: “Worry about your patients. Think about the complex ones all the time. A great idea will come to you if you worry about them.” Dr. Nathan says he has tried to follow that advice and admits that many of his ideas have seemingly come out of nowhere. Despite all of his success, Dr. Na- than recognizes the need to achieve a healthy balance between professional and family life and credits his wife Jean for making it possible for him to enjoy his career and his family. When away from the office, he enjoys sailing and swimming with his family in Nantucket, and while striking this balance has been his biggest challenge, time spent with them brings him his greatest joy. Dr. Nathan will receive his award today at 1:30 p.m. in Hall AB. ASH NEWS DAILY Sunday, December 11, 2011

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ASH News Daily - Sunday, December 11, 2011

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