World Thrombosis Day, October 10, 2020, and commemorating Professor Krystyna Zawilska

World Thrombosis Day 2020

World Thrombosis Day was launched in 2014 by the International Society on Thrombosis and Hemostasis to focus global awareness on the often overlooked and misunderstood condition. World Thrombosis Day takes place every year on October 13, the birthday of Rudolf Virchow, who was a pioneer in research on pathophysiology of thrombosis.

On the initiative of late professor Krystyna Zawilska, the Working Group on Hemostasis of the Polish Society of Hematology and Transfusion Medicine became a partner of the International Society of Thrombosis and Haemostasis.¹ We took initiative right away, and already in 2014, organized a multispecialty educational conference.

This year, we held the VII Scientific Conference entitled “Venous thromboembolism: an underestimated problem” (“Żylna choroba zakrzepowo-zatorowa – niedoceniony problem”) on October 10, 2020, in the form of a webinar.

Worldwide, 1 in 4 people die from conditions caused by thrombosis. Up to 900 000 people in the United States alone are affected. Venous thromboembolism (VTE) is an important public health problem, with estimated 60 000 to 100 000 deaths in the United States each year. Objective testing for deep vein thrombosis (DVT) and pulmonary embolism is necessary because clinical assessment alone is unreliable.

During the conference, important issues related to pulmonary embolism were discussed, including, for example, difficulties related to the management of this disease in patients with cancer. Professor Adam Torbicki emphasized that also in patients with cancer examined for pulmonary embolism, computed tomography pulmonary angiography is the study of choice, but the measurement in plasma of the main thrombosis biomarker, D-dimer, can help to establish the diagnosis and decrease the utilization of computed tomography pulmonary angiography.

Professor Piotr Pruszczyk critically assessed the grounds for selecting thrombolysis or anticoagulation in patients with pulmonary embolism.

Anticoagulation therapy is complex and associated with substantial benefits and risks. The common indications for anticoagulation therapy, for example, fondaparinux, in VTE prophylaxis for hospitalized noninterventional patients were discussed by Professor Jerzy Windyga. Also, VTE prophylaxis during and after hospitalization was scrutinized by Professor Jacek Musiał.

Direct oral anticoagulants (DOACs) have to be applied with knowledge and skill in order to achieve the optimal balance between reduction in recurrent VTE and the risk of potentially life-threatening bleeding. The selection of an anticoagulant is not an easy task as each drug is unique, and dosing and monitoring requirements can be affected by patient-specific factors, therefore individualization of therapy is required—this issue was addressed by Professor Anetta Undas.

Professor Zbigniew Krasiński focused on the recurrence DVT and post-thrombotic syndrome.

Our knowledge on the management of DOAC-associated coagulation disorders, particularly life-threatening bleeding, remains limited. At the moment, there are 2 available reversal agents for DOACs: idarucizumab for dabigatran and andexanet alfa for factor Xa inhibitors. Indications for use of reversal agents of DOACs are limited, for example, life-threatening bleeding, persistent bleeding despite local hemostatic measures, need for an urgent intervention or emergency surgery. Professor Magdalena Łętowska elaborated on the topic.

Some clinical conditions with simultaneous occurrence of bleeding and thrombosis pose a major challenge. Diagnostic and therapeutic approaches to thrombotic microangiopathy were critically discussed. Professor Jerzy Windyga spoke about the determinants of thrombotic microangiopathy as a complication in patients with severe hemophilia A treated with emicizumab.

I focused on 2 issues: First, the perioperative care in patients with hemophilia treated with emicizumab can be challenging, as it is required to use a chromogenic assay for factor VIII measurement. Second, in patients with paroxysmal nocturnal hemoglobinuria, thrombotic complications are the major cause of morbidity and mortality. Eculizumab, a monoclonal antibody directed against the active component of C3, given biweekly, reduces the risk of clinical thromboses. A new drug, ravulizumab, is equally effective, and is administered every 8 weeks.

Professor Krystyna Zawilska

A commemorative plaque to Professor Krystyna Zawilska was unveiled on August 28, 2020 at the Department of Hematology, Medical University in Poznań (Figures 1 and 2).² University authorities were represented by Maciej Cymerys, MD, PhD, dean of the Faculty of Medicine, Karol Marcinkowski Medical University. Professor Zbigniew Krasiński, vice-dean for human resources and postgraduate studies, sent a letter. A letter from Szczepan Cofta, MD, PhD, director general of the University Hospital of the Transfiguration, was delivered by the Vice-Director Anita Pikosz, MSc.

Among other guests, there were Professor Stefan Grajek, former head of the Department of Cardiology, Medical University in Poznań, Bernardetta Pieczyńska, MD, chairwoman of the Poznań Group of the Polish Haemophilia Society (Polskie Stowarzyszenie Chorych na Hemofilię), and Janusz Zawilski, MSc, the son of the late Professor Zawilska. Also, the following team of hematologists were present: Head of the Department of Hematology, Professor Krzysztof Lewandowski and Chair of Clinic, Professor Lidia Gil. Finally, the team as follows were also present: Joanna Rupa-Matysek, MD, PhD, Dominik Dytfeld, MD, PhD, Kazimierz Kazimierczak, MD, PhD, Renata Kroll-Balcerzak, MD, PhD, Andrzej Balcerzak, MD.

The Working Group on Hemostasis of the Polish Society of Hematology and Transfusion Medicine was represented by: Professor Maria Podolak-Dawidziak, Professor Wojciech Młynarski, Professor Krzysztof Chojnowski, Professor Jerzy Windyga, and Professor Magdalena Łętowska.

Various aspects of professional activities of Professor Krystyna Zawilska were recalled during the ceremony. Her special merits as an eminent hematologist and wise physician with a high level of empathy were emphasized. In the last years, she described in collaboration with Professor Anetta Undas a new mutation in the fibrinogen gene (fibrinogen Poznań) which causes a mild bleeding tendency, and was a coauthor of the descriptive characteristics of Polish patients with inherited deficiencies in natural anticoagulants, that is, antithrombin, protein C, and protein S.

For years, Professor Krystyna Zawilska greatly influenced the field of hemostatic disorders in Poland.^3,4 She was a coinitiator and, since 2007, the head of the Working Group on Hemostasis of the Polish Society of Hematology and Transfusion Medicine. She served as a member of the Advisory Board of the Ministry of Health for the National Program for the Treatment of Patients with Hemophilia and Related Bleeding Disorders. She was a member of International Board in Polish Archives of Internal Medicine, largely contributing to the current standing of this journal. Professor Zawilska was a true academic—well-read and with a real curiosity for medicine, biology, literature, film, music, and politics.