Clot Chronicles: What’s on the Horizon for 2022

Hello, I’m Dr. Sam Goldhaber. I’m the president of NATF, and it’s a pleasure for me to speak with you on Clot Chronicles. My task today is rather difficult – it’s to predict what thrombosis issues are going to come up in 2022 which we will be particularly interested in. 

So first, I want to talk about COVID and thrombosis. There is so much we have yet to learn about the relationship between the two. It’s not only COVID and venous thrombosis, PE and DVT, but also COVID and arterial thrombosis, myocardial infarction. And closely related to this are some inflammatory diseases of the heart – one that children get and the other in adults – myocarditis. So we don’t know how to predict who’s going to be susceptible. And therefore, at the moment, we’re saying get your vaccine and definitely get the booster. What happens next? Hard to know. Will there be special biomarkers that predict who’s susceptible, or will there be additional genetic tests? Time will tell. 

The second issue that I’m sure will come up is the excitement over a novel group of anticoagulants, which are anticlotting factor XI anticoagulants. These are not yet FDA approved, but they’re in active trials at the moment. The trials usually start with orthopedic surgery, and there are both intravenous and oral antifactor Xa inhibitors. These are very interesting because those individuals who are born with no factor XI whatsoever, no clotting factor XI, or very low levels of clotting factor XI will go through their whole lives usually without any major bleeding episodes. 

And if they do have a bleeding episode, it would be most likely to occur in the context of surgery where, due to the incision, one would expect some bleeding. I don’t think those new compounds will be available for use, perhaps, for another 3 years or so, but the speed in which they’re being developed is quite impressive. And further on the horizon are antifactor XIIa inhibitors where the same phenomenon has been observed with factor XII deficiency individuals, generally, do not have a bleeding problem. 

The third issue to talk about is a renewed interest in atrial fibrillation, and there are many questions left for us. Is atrial fibrillation a causative factor of dementia or does it make dementia worse? Are the Apple devices useful to diagnose atrial fibrillation early? Now we can have the Apple Watch set it to detect atrial fibrillation, set it also to take a rhythm strip of us and, through the cloud, fax it to our physician. And at the same time, if we have fallen down, to call 911 for us as well. And one of my patients feels that his life was saved by the Apple Watch when he got into a car accident and had the new onset of atrial fibrillation.  

Finally, the cancer survival rate is increasing, which is fantastic, but cancer is related to DVT and pulmonary embolism. And while we have anticoagulants to treat established cancer in VTE, we need to do more work on the prediction of who will suffer PE or DVT in the presence of cancer. So these are some of the top issues to look out for in 2022. There are many more. And we, at NATF, hope to run educational programs on many of these topics. 

So this is Dr. Sam Goldhaber signing off for Clot Chronicles.