Published 10 July 2019 | 4 min read
My three keys learnings from this year’s ISTH have been:
After the poster session on Monday night, I attended a pre-arranged dinner with my international colleagues from the Haemophilia Academy Alumini. I was excited to strengthen the bond I have with these colleagues, and this demonstrated the benefits of ISTH with regard to bringing us together to collaborate and discuss haemostasis and beyond!
I started my day on Tuesday learning about the microbiome and cardiovascular risk. I have been curious about this topic over the last few years, and increasingly we are using probiotics in the field of paediatrics. Australian gastroenterologist, Dr Emad El-Omar, introduced himself jovially as being ‘just above orthopaedics in the hierarchy of knowledge’, but demonstrated his specialised knowledge in this area. I was interested to learn about environment vs genetics in the make-up of the microbiome, and the effects of various medications and diet. Microbiome regulation appears to have a huge influence on other factors such as weight gain, auto-immunity and inflammation.
"I am sure the next 20 years will see an explosion of research and knowledge in this field, affecting all aspects of medicine including haematology."
The final plenary was nothing but fascinating. Thomas Renne from Germany presented work on a new concept in anticoagulation — targeting the contact pathway including Factor XII. Should this be successful, we would be able to reduce thrombosis risk without increasing the risk of bleeding. This would certainly revolutionise anticoagulation, and dramatically reduce complications! I look forward with anticipation to the future of this work, and particularly the potential effect on paediatric patients.
I also attended the oral presentations on evidence-based antithrombotic use in paediatrics and enjoyed learning about anticoagulation trials in children. So often in my paediatric work, the use of medications is based on evidence extrapolated from adult data; it is pleasant to see some studies dedicated to outcomes in children. I especially enjoyed discussion generated from Chantal Attard’s presentation on comparison of stroke incidence in Fontan patients receiving warfarin or aspirin. In this, I learnt that whilst there are different standards of care in this scenario around the world, outcomes and risks are similar in each group. With advances in modern medicine, I am thrilled to see these patients surviving well into adult years and interested to see how other risk factors seen in adult life may interact with the underlying risk. As with other scenarios, I feel long-term anticoagulation in such patients needs to be considered from a personalised medicine approach.
I chaired a meeting with some colleagues from around Australia, to discuss a project in haemophilia I am working on. I once again was grateful for the collaboration opportunities that this large congress has provided. I also attended the haemophilia novel therapies session, and particularly focused on the data coming from the HAVEN and STASEY trials related to emicizimab in the management of haemophilia A. The look forward to the next chapter of management in haemophilia A.
I could not decide which SSC session to attend yesterday afternoon, so I attempted to get the most out of two! I attended the beginning of SSC on the women’s health issues in thrombosis and haemostasis and learnt a lot from the session on management on von Willebrand disease in pregnancy by Michelle Lavin.
"This is a hugely relevant topic, and in my training I have managed many such circumstances; I certainly agree that there needs to be some consistency and deeper understanding in managing these patients with the most common bleeding disorder. I also attended the Disseminated Intravascular Coagulation SSC and felt particularly engaged in the discussions surrounding DIC in emergency presentations, by Bernd Jilma. Being from a country full of venomous snakes, I still had no idea that a person dies from a snake bite every FOUR minutes around the world, with many of these deaths of course being from coagulation complications."
The incidence is almost as high as the worldwide incidence of mortality from post-partum haemorrhage, discussed earlier in the congress, and once again more than 50% of deaths in the developing world. To me, this demonstrates the huge unmet need for easily accessible global health measures to manage these preventable deaths.
Today is the final day of ISTH in Melbourne 2019. I went for a walk around Melbourne this morning and got a fancy breakfast with a friend before the start of the sessions. This morning I learnt a lot at the State-Of-The-Art Sessions regarding acquired coagulation in children and enjoyed the mid-morning oral presentations on haemophilia; in particular, the systematic review on Intracranial Haemorrhage in Haemophilia, by AnneFluer Zwagemaker from the Netherlands.
The Highlights of ISTH session was amazing — I was glad to recap some of the sessions I attended and get a summary of the amazing sessions I was not able to go to.
Take care! Hope to see you in Milan 2020!