Thrombosis and hemostasis

At the LUMC, there is a long-standing research line into aetiology, management and prognosis of venous thrombosis (the composite of deep vein thrombosis and pulmonary embolism), carried out in close collaboration between the departments of Clinical Epidemiology and Thrombosis and Hemostasis, and the Einthoven Laboratory for Experimental Vascular Medicine, a laboratory created to facilitate interaction between medical doctors and basic researchers in the fields of thrombosis/hemostasis, surgery and oncology. Research from this group has been instrumental in the identification of a large series of determinants of venous thrombosis, such as factor V Leiden and the prothrombin G20210A mutation.

A major aim is to fine-tune our knowledge of thrombotic risk, the main question being: why does this patient develop thrombosis today? The answer to this question depends on further knowledge of risk factors for thrombosis. Subsequently, the interaction of all possible combinations of risk factors needs to be known. One of the studies to answer this question is a very large case-control study, including almost 5000 patients with thrombosis (the MEGA study). These data are being used to identify new genetic and environmental risk factors for venous thrombosis. Other studies into the aetiology of venous thrombosis are THE-VTE and the At-Age study.

Recently we have started to study how combinations of several of these determinants can identify patients in high-risk situations, with the aim to target anticoagulation therapy to this group only. This way, needless exposure to the burden and risk of this treatment can be prevented in subjects with low thrombotic risk. Examples of such high-risk situations are a history of venous thrombosis, a history of cancer, or surgery, and several scores to predict risk in these situations have been developed.

In addition, we perform pharmacoepidemiologic studies evaluating the efficacy and safety of anticoagulant treatment and other medications, as in the KIDOAC / MONDOAC and START trials.

Finally, we study optimal prevention of venous thrombosis in high risk situations such as after plaster cast and knee arthroscopy in the Pot-(k)cast trials.