Combinatie van de 5 reports die dienden te schreven worden voor internationalisation @home
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Institución
Katholieke Universiteit Leuven (KU Leuven)
Dit document bevat een combinatie van reports over de volgende lezingen van de volgende speakers: Ian del conde, Kleinschek, Krebs, Dzeroski, Vandenburgh
Lecturer Dr. Ian del Conde
Seminar title Thrombosis and Anti-thrombotic Therapies
Date 24-10-2022
CONTENT
What were the main topics of the seminar? Discuss them briefly
-Part 1.1: Thrombosis from various perspectives
Doctor del Conde initiated his lecture with framing thrombosis in the medical field. He focused on the fact
that thrombosis research is highly financed by exterior companies and investors. The cardiovascular, but
surely the thrombosis field has been booming since the doctor was a student. Therefrom came his passion
to be a cardiologist and thrombosis researcher. To better understand the massive amount of problems
thrombosis causes in the human body, the doctor explained the basic components of a thrombotic
pathology. He explained that the occlusion of arteries and veins is a direct effect of platelet adherence
mechanisms. Fibrin and thrombin are key elements in these mechanisms and pathways. They ensure
stability of the clot by forming a fibered network within. Thus Dr. del Conde hinted that these mechanisms
could be used as a therapeutic target to (possibly) cure thrombosis. We as well discussed the intrinsic and
extrinsic pathway of blood clotting. This made clear that factor Xa has a central role and that it should and
will be used for pharmacological properties.
-Part 1.2: Therapeutic targets for thrombosis
Doctor del Conde previously spoke about some molecules that could be used as a therapeutic target. In
this part however we concluded that there are a numerous amount of molecules and substances fit for
therapeutical use. These could eventually prevent and cure thrombosis. A historical and surprisingly
effective drug is known as ‘Aspirin’, chemically: ‘acetylsalicylic acid’. It interferes with the workings of
thromboxane A2 therefor having a direct effect on platelet activation. To test if Aspirin was indeed an
effective drug, a specific test was needed. Dr. del Conde announced the concept of ‘plasma rich platelets’.
To obtain a blood sample filled with PRP, centrifugal forces are needed. When you prepared the PRP a
clotting test follows. When the sample in the tube clots, more light will shine through. Studies show that
blood tubes treated with aspirin are indeed less translucent. Thus, proving that aspirin is truly functional in
preventing clot formation. Quickly other drugs became available for consumer use. ‘Plavix’ also known as
‘clopidogrel’ proved a barely better efficiency than aspirin, but still managed to conquer the consumer
market.
Another main therapeutic approach to tackle thrombosis is mechanically removing the clot. This was (and
still is) mostly done by using stents. By inserting a catheter coupled to a balloon in a vessel, a small mesh
can be placed on top of the occlusion. This procedure is known as ‘Angioplasty’. While the positive effects
of the procedure have been statistically confirmed, the disadvantages still make the technique a delicate
task. The two main problems are ‘restenosis’ and ‘second occlusion’. Both can lead to inflammation thus
often coma and dead. Later Dr. del Conde elaborated on the fact that arterial stents currently have
countless technical modifications. These modifications try to tackle the problem of restenosis.
To finish part 1 of the lecture Dr. del Conde mentioned the importance of GP IIb/IIIa. When looking at the
different pathways of platelet activation, numerous routes lead to this specific molecule. Thus GP IIb/IIIa-
antagonists like ‘abciximab’ proved to be the best working option for treating thrombosis. Nowadays these
drugs are outdated and outperformed by countless other drugs.
-Part 2: Interventional therapies: A new paradigm
When commencing this topic, Dr. del Conde centered around ‘atrial fibrillation’ and the problems these
provoke. Because atrial fibrillation often causes strokes thus frequently death in many patients, a direct
solution was needed. Clots nearly always form in the atrial appendage. Preventing platelet accumulation in
this specific place can be done with a plug. The plug is surgically placed with the help of a catheter. The use
of plugs and stents proved to be very efficient for cardiac use. However, it is also widely used in the legs,
lungs (pulmonary embolism), arms, and so on. Because of the intense procedure of manipulating blood
vessels, an alternative therapy is often needed for a specific group of patients. In these groups blood
thinners and pro-fibrinolytic drugs prove to be sufficient.
-Part 3: Lesson’s Dr. del Conde learned during his career
Dr. del Conde ended his lecture by giving some general tips and advice about being active in the
medical/scientific field. There he focused on his own findings while building his personal career.
Give a literature reference that can be linked to this seminar (topic and/or lecturer) and explain why you
chose this reference.
B. MEIER. Coronary angioplasty after the age of 80 — why not dust where the dust is? Eur Heart J (1990).
This short report about angioplasty has a direct link to the lecture of doctor del Conde. This technique was
emphasized when different therapeutical approaches for treating thrombosis were explained. We received
an extensive explanation about the topic, later we build on this knowledge to justify the efficiency and
sufficiency of angioplasty. However, the mechanic removal of a clot is a delicate task that has a need for
competence and knowledge. By carefully inserting a catheter in the groin, a fold up balloon can reach the
coronary arteries. When reaching the vessel, a mesh is placed above the clot. The intensity and delicacy of
the surgical procedure made me doubt about the approach in the elder. The senior population is the group
who suffers the most from myocardial infarcts. Intense chirurgical practices however are often denied to
these patients. Therefor specific studies need to be performed to analyze the efficiency and need for
suchlike procedures in the elder. The chosen report talks about a study performed by Kähler et al.
regarding angioplasty. Two subpopulations were studied, one with a mean age of 62 the other of 83. Both
groups underwent angioplasty as a treatment for myocardial infarcts. The outcome was not to be
expected. While the survival rate of the procedure was much lower in the older population, the
improvement of quality of life was slightly higher in the 83-year-old group. This confirms that angioplasty is
surely an option for elderly patients who suffer cardiac problems, specifically myocardial infarcts.
What subject/subtopic discussed in this lecture would you like to know more about?
I would have liked to know more about angioplasty. I like the mechanical and innovative part about finding
(new) treatment options for all kinds of diseases. It would have been exciting to see some video material
of suchlike procedures. After hearing the many possibilities of the small catheter and balloon, I will try to
see the instruments used in angioplasty in real life. I think that seeing the size of these pieces would be
interesting. Stenting of the atrial appendage with a specifically designed plug was as well one of my main
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