World Thrombosis Day 2024: Move Against Thrombosis

World Thrombosis Day, observed on October 13, 2024, brings awareness to a global health issue that accounts for one in four deaths worldwide. This year’s theme, “Move Against Thrombosis,” emphasizes the critical role of physical movement in reducing the risk of thrombosis, particularly for those at risk due to immobility or sedentary lifestyles. Led by the International Society on Thrombosis and Haemostasis (ISTH), the campaign will highlight thrombosis prevention through increased awareness and proactive strategies.

Thrombosis occurs when a blood clot forms in a blood vessel, obstructing blood flow, and can lead to life-threatening conditions like stroke, heart attack or pulmonary embolism (PE). It is also a major cause of preventable death in hospitalized patients.

Clinical Trials and Research Trends in Thrombosis

Next-Generation Anticoagulation: Reducing Bleeding Risk

Ongoing clinical trials focus on making anticoagulation safer, particularly for patients with atrial fibrillation and high bleeding risks. The US Food and Drug Administration (FDA) recently approved Hympavzi (marstacimab-hncq), the first anti-tissue factor pathway inhibitor (anti-TFPI) therapy for hemophilia A and B. It simplifies treatment with a once-weekly subcutaneous injection, significantly reducing bleeding rates.

Additionally, researchers at the Feinstein Institutes for Medical Research have developed new perioperative management protocols for patients on direct oral anticoagulants (DOACs). These protocols might be helpful in providing safer guidelines for elective and non-urgent surgeries, reducing the need for extensive testing or heparin bridging​.

COVID-19 and Thrombosis: Preventing Life-Threatening Events

A recent study demonstrated that patients with higher thrombus burden — the volume and extent of blood clots obstructing blood flow — had a significantly higher risk of early mortality. The ACTIV-4 trial has been investigating antithrombotic therapies in patients hospitalized with COVID-19. The latest results show that therapeutic doses of anticoagulants help reduce life-threatening thrombotic events in moderately ill patients. The pandemic also brought a surge in venous thromboembolism (VTE), with research showing a 33-fold increase in VTE risk in the first week after infection.

Pulmonary Embolism: Mechanical Thrombectomy for PE Patients

The RECOVER-AV trial, launched by AngioDynamics, is evaluating the AlphaVac F1885 system for intermediate-risk PE. With an estimated 435,000 PE events occurring annually in the European Union (EU) alone, mechanical thrombectomy presents a promising option to manage the condition more effectively. The study aims to improve patient outcomes by reducing the right ventricular/left ventricular ratio and major bleeding events. PE remains a leading cause of mortality, and this trial could become crucial in advancing its management.

Factor XI Inhibitors: Safer Anticoagulation with Less Bleeding

Factor XI inhibitors are paving the way for safer anticoagulation by selectively targeting the coagulation cascade. In the AZALEA-TIMI 71 study, abelacimab showed low levels of periprocedural bleeding in patients with atrial fibrillation — a 67 percent reduction — compared to standard treatments, even during invasive procedures. This class of anticoagulants could initiate a new type of stroke prevention and thrombosis management option.

AI Risk Prediction: Enhancing Diagnostic Accuracy

Artificial intelligence (AI) is transforming how thrombosis is diagnosed and managed. AI models are already being used to predict VTE risks more accurately than traditional methods like the Wells and Geneva scores which clinicians use to assess the probability of PE. By analyzing patient data, AI personalizes treatment plans and predicts risks more effectively. These models also streamline imaging decisions, reducing unnecessary tests like computed tomography pulmonary angiography (CTPA).

Thrombectomy Innovation in Europe: Faster Clot Removal

Penumbra’s Lightning Flash 2.0 and Lightning Bolt 7 systems recently received CE Mark approval in Europe. These computer-assisted vacuum thrombectomy (CAVT) devices allow for rapid clot removal while minimizing blood loss. Lightning Flash 2.0 targets venous and pulmonary thrombus, while Lightning Bolt 7 is designed to treat arterial conditions like acute limb ischemia (ALI).

Stroke Treatment Expansion: Broadening Acute Care Access

Basking Biosciences recently began dosing patients in a Phase II trial of BB-031, an RNA aptamer designed to inhibit von Willebrand factor — which is known to drive hemostasis — and promote thrombolysis in patients with acute ischemic stroke (AIS). With a 24-hour window for treatment and the potential to reverse the effects of BB-031 using a reversal agent (BB-025), this therapy could likely fill a substantial gap in stroke care, particularly for patients unable to receive traditional fibrinolytics or mechanical thrombectomy.

Get Out the Clot: A Campaign to Improve VTE Care

Launched just ahead of World Thrombosis Day 2024, the Get Out the Clot campaign brings together leading organizations like the ISTH and the PERT Consortium to tackle gaps in VTE care. The campaign plans to emphasize standardizing treatment protocols and expanding access to newer therapies such as mechanical thrombectomy, which helps reduce hospital stays and improve patient outcomes.

A key part of the initiative is raising awareness of the life-saving impact of prompt, accurate treatment for conditions like PE and deep vein thrombosis (DVT).

As Leslie Lake, a PE survivor and president of the National Blood Clot Alliance, shared in the campaign’s press release, “The Get Out the Clot campaign is a crucial step toward changing that reality. By uniting experts and standardizing care, we can prevent the delays and misdiagnoses that cost lives, ensuring that more people receive the urgent, life-saving treatment they need.”