Blood Coagulation and Beyond: Position Paper from the Fourth Maastricht Consensus Conference on Thrombosis

Area of Science:

• Cardiovascular Medicine
• Hematology
• Thrombosis Research

Background:

• The coagulome, encompassing blood coagulation proteins, plays critical roles in cardiovascular disease and organ-specific pathophysiology.
• Understanding novel thrombosis mechanisms, including factor XII interactions and microbiome influences, is crucial.
• Managing bleeding risks and hemostasis in extracorporeal systems presents ongoing clinical challenges.

Purpose of the Study:

• To synthesize current knowledge and address key controversies in thrombosis and antithrombotic therapy.
• To explore organ-specific roles of coagulation proteins and novel thrombosis mechanisms.
• To discuss strategies for limiting bleeding risks and managing hemostasis in extracorporeal circuits.

Main Methods:

• Consensus-based discussions and presentations from leading investigators.
• Review of translational studies, genetic determinants, and drug metabolism.
• Evaluation of ex vivo models, nanotechnology, and organoid systems for hemostasis research.

Main Results:

• The coagulome is a critical driver of cardiovascular disease with organ-specific implications.
• Novel mechanisms involving factor XII, microbiome, and viral infections contribute to thrombosis.
• Advances in genetic analysis, reversal agents, and ex vivo models aid in managing bleeding risks and thrombosis.

Conclusions:

• The conference highlighted the complexity of thrombosis, emphasizing the coagulome's role and novel contributing factors.
• Strategies for reducing bleeding risks and improving antithrombotic therapy safety were discussed.
• Clinical dilemmas and future directions in thrombosis management, including COVID-19-associated coagulopathy, were addressed.