Innovations 2022 in Hemostasis and thrombosis

Cédric Hermans, Catherine Lambert Published in the journal : February 2023 Category : Hémostase – Thrombose

what’s new ?

We summarize hereafter five topics that caught our attention in 2022, related to anticoagulants and hemophilia. First, we will address rivaroxaban treatment of atrial fibrillation (AF) associated with rheumatic valve disease. We then discuss the role of new anticoagulants targeting Factor XI in both the prevention of AF-related thromboembolic events and recurrent ischemic stroke. With respect to hemophilia, we detail the results of the largest ever conducted gene therapy study in patients with severe Factor VIII (FVIII) deficiency. We conclude with the therapeutic successes of emicizumab, a bispecific antibody mimicking FVIII, which has been shown to be effective in patients with non-severe hemophilia A (Haven 6) and in newborn with severe hemophilia A (Haven 7).

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Innovations 2022 in the field of hemostasis-thrombosis

Sarah Bailly1,2, Eric Van Den Neste1, Stefan N. Constantinescu1,2,3,4 Published in the journal : February 2023 Category : Hematology/Oncology

The specific characteristics of the CD19 cell marker make it an ideal therapeutic target in the treatment of B-cell lymphoma. Several molecules targeting CD19 have recently been made available, or are currently being developed, and show promising results for this therapeutic indication. This seems to be particularly true in the management of relapsing or refractory diffuse large B-cell lymphoma, as demonstrated by the results of the different studies described in this article. The choice of the right molecule and the best sequence for these treatments is still to be defined.

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Innovations 2022 in hepato-gastroenterology

Géraldine Dahlqvist 1, Bénédicte Delire 1, Olivier Dewit 1, Nicolas Lanthier 1,2, Hubert Piessevaux 1 Published in the journal : February 2023 Category : Hépato-Gastro-Entérologie

The year 2022 was rich in lessons and saw the issuance of many recommendations in hepatology. Indeed, animal and human studies have shown that hepatic steatosis is closely linked to insulin resistance, justifying not only to search for diabetes in patients suffering from hepatic steatosis but also to evaluate the severity of the possible hepatic impairment in diabetic patients. In addition, new recommendations (Baveno VII) were published in 2022 and propose threshold values for hepatic elastometry for the screening of clinically significant portal hypertension in compensated advanced chronic liver disease and its treatment with non-cardioselective beta blockers to prevent the first episode of cirrhotic decompensation. In January 2022, the American Association for the Study of Liver Diseases also published guidelines for the palliative management of patients with decompensated cirrhosis in whom liver transplantation is not indicated. In the area of inflammatory bowel diseases, two new drugs have been added to the therapeutic arsenal for ulcerative colitis in Belgium in 2022: filgotinib and ozanimod. In addition, the first randomized controlled study of comBIOtherapy was carried out: the “VEGA” study. This is the first randomized study to focus on the combination of biologicals in the field of digestive inflammatory diseases. On the other hand, the “SPARE” study investigated a treatment tapering strategy, particularly in patients with Crohn’s disease. Finally, a group of Belgian experts met several times during the years 2021 and 2022 to establish Belgian recommendations for the management of irritable bowel syndrome. The product of this comprehensive work was published in April 2022.

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2022 innovations in dermatology domain

Axel De Greef, M.D., Marie Baeck, M.D., Ph.D. Published in the journal : February 2023 Category : Dermatology

The emergence of Janus kinase inhibitors (JAKi) in the medical dermatology arsenal has enabled a considerable advancement in the management of several inflammatory skin diseases, such as atopic dermatitis or autoimmune diseases like alopecia areata or vitiligo. JAKi’s broad action profile in terms of cytokine blockade, which has been associated with beneficial therapeutic effects, nonetheless requires a certain degree of precaution with respect to the safety profile of this drug class. This article sought to review the latest safety data on JAKi. As shown herein, it is essential to distinguish the risk in keeping with the populations treated and the pathologies targeted by these molecules. Yet, caution is still required in elderly patients, in those with cardiovascular risk factors including active or past smoking, as well as those with a previous cancer.

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Innovations 2022 in orthopedic surgery and traumatology

Xavier Libouton*, Othmane Miri*, Randy Buzisa Mbuku*, Anaelle Mottet*, Julie Manon, Robin Evrard, Hervé Poilvache, Solange de Wouters, Karim Tribak, Dan Putineanu, Maïte Van Cauter, Vincent Druez, Jean-Emile Dubuc, Jean-Cyr Yombi, Nadia Irda, Ludovic Kami Published in the journal : February 2023 Category : Chirurgie orthopédique et traumatologie

The limitation of financial means in health care compels us to justify our choices by bringing the proof of a real improvement for the patient, reflected by his/her ability to quickly reintegrate the economic circuit and resume an active social life, or by developing less invasive techniques that shorten the period of incapacity or reduce the complications to which the patient is exposed. The Department of Orthopedic Surgery and Traumatology has chosen to highlight different approaches in this context: the usefulness of a functional evaluation in hand surgery in terms of objectifying the benefit of different therapeutic modalities, the still early prospects of phage therapy in infections of orthopedic implants by multidrug-resistant bacteria avoiding the need for major surgical interventions, and two biological and bio-technological approaches to successfully treat fracture healing defects, without exposing the patient to the complications of autologous bone harvesting.

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Innovations 2022 in hepato-bilio-pancreatic surgery

Lancelot Marique, Astrid De Cuyper, Laurence Annet, Anca Dragean, Pierre Goffette, Delphine Hoton, Renaud Lhommel, Geneviève Van Ooteghem, Ivan Borbath, Catherine Hubert Published in the journal : February 2023 Category : Chirurgie hépato-bilio-pancréatique

The year 2022 has been full of innovations in the management of borderline or locally advanced pancreatic adenocarcinoma and offers new opportunities for multimodal treatments at the Cliniques universitaires Saint Luc. Here, we illustrate the importance of multidisciplinary management for this type of patients through two clinical cases. We then detail the innovations and specificities regarding the different medical specialties, whose expertise is crucial within the group.

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Innovations 2022 in pediatric cardiology

Jelena Hubrechts, Catherine Barrea, Lien Meirlaen, Karlien Carbonez, Stéphane Moniotte Published in the journal : February 2023 Category : Cardiologie pédiatrique

In 2022, three major themes in pediatric cardiology have captured our attention. From fetal life to adolescence, these topics are very varied and thus illustrate the broad field of competence of our team of pediatric cardiologists.

First, despite coarctation of the aorta (CoAo) being one of the most common congenital heart diseases, its prenatal diagnosis remains challenging. Because of the subtlety of the ultrasound signs of CoAo during the morphological examination in the second trimester of pregnancy, screening is difficult. Yet, the prognosis of these patients depends on prompt management in the neonatal period. The development of fetal cardiac MRI and improved knowledge in cardio-genetics tend to improve fetal detection of CoAo.

Second, postural tachycardia syndrome (POTS) affects the quality of life of adolescent patients. Simple indicators such as heart rate and blood pressure during a head-up tilt test have a predictive value regarding treatment efficiency and prognosis in children with POTS. Recently, a new hypothesis has suggested vaccine-induced autoimmune POTS following mRNA COVID-19 vaccination.

Third, postoperative pulmonary hypertension (PH) after correction of congenital heart defects is a serious and potentially lethal complication. In recent years, PH-targeting drugs have been increasingly used in the postoperative setting. The scientific evidence of an improved outcome is discussed in the last part of this manuscript.

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Innovations 2022 in Cardiology

Anne-Catherine Pouleur, Joëlle Kefer, Agnès Pasquet Published in the journal : February 2023 Category : Cardiology

The year 2022 has been marked by many new developments in the fields of heart failure and valvulopathy treatment. These advances will certainly improve our daily practice and the treatment of many patients.

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Innovations 2022 in hematological biology

Véronique Deneys1, Antoine Buemi2*, Virginie Chapelle1, Tom Darius2*, Martine De Meyer2*, Arnaud Devresse2,3*, Yannick France2*, Valérie Dumont2, Thibaut Gervais1, Eric Goffin3*, Louise Guillaume, Nada Kanaan³*, Youssra Khaouch1, Catherine Lambert1*, Urs Published in the journal : February 2023 Category : Biologie Hématologique

The year 2022 saw a gradual return to normal after the COVID-19 pandemic. This was an opportunity to optimize processes that had sometimes been undermined and to update procedures. It was also an occasion to take on new challenges: to consider acquiring new equipment for the coming years, to implement new techniques that are more sensitive, faster, and better adapted to the needs of prescribers.

In the Special Hematology Laboratory, and in particular in the specialized hemostasis sector, the automation of the ADAMTS13 protein assay was critical for the diagnosis and biological follow-up of patients with immune thrombotic thrombocytopenic purpura (iTTP). This uncommon condition can rapidly deteriorate if not diagnosed early and managed appropriately based on ADAMTS13 testing. This assay also allows identifying patients at risk of relapse who should receive preventive treatment.

The determination of erythrocyte blood groups is most often straightforward using serological techniques. However, in certain situations, it is necessary to use molecular biology techniques. The Immunohematology - Molecular Biology Laboratory has implemented a real-time PCR technique that allows for extensive erythrocyte genotyping and the detection of antigenic variants missed by serological techniques. This is an essential tool for determining blood groups in polytransfused patients and for selecting bags for individuals with a variant or deletion blood group.

It has been known for over 50 years that the HLA system plays a central role in human immunity and is at the same time one of the main obstacles to organ transplantation. The involvement of anti-HLA antibodies in early and late rejection is indisputable. In 2021, the Leuko-Platelet Immunology Laboratory has implemented a new test for a more specific identification of clinically relevant anti-HLA antibodies, which facilitates graft allocation. In 2022, the records of patients awaiting renal transplant who had anti-HLA antibodies were reviewed, and controls were performed on old sera using the new technique. This allowed the removal of "forbidden" antibody specificities in more than half of the patients, thereby increasing their chance of receiving a compatible graft. Six patients received a kidney graft carrying an HLA antigen previously listed as forbidden with the old technology and removed after revision. Currently, all these patients have displayed a functional graft without immunological complications. These results will be presented at the European Foundation for Immunogenetics (EFI) Congress in April 2023. Although transfusion is a common and beneficial therapeutic procedure for the patient, transfusion reactions can occur. The diagnosis of these reactions is sometimes confusing and difficult. The Hemovigilance Transfusion Sector has developed new decision-making algorithms based on the main symptoms presented by the patient and the blood component involved in the reaction. These algorithms are intended to guide towards a diagnosis and, in order to achieve this, to determine the controls and laboratory tests that must be carried out in each situation. These algorithms have been published in the journal of the Société Francophone de Transfusion Sanguine.

While there were already warning signs of a shortage in 2021, the supply situation for O-negative red blood cells worsened considerably in 2022. The Blood Bank, in consultation with the Medical Direction and the Transfusion Committee, had to deal with this by implementing various actions to try to stop the "hemorrhage". This is the subject of a specific procedure: implementation of very strict and closely monitored indicators, prioritization of transfusion indications, exclusive unitary distribution (outside of hemorrhagic situations), and medical decision to transfuse Rh-positive erythrocyte concentrates to Rh-negative recipients. Various very precise assessments of this situation are still underway and will soon be submitted for publication. Concerted action has been taken within the network hospitals and initiatives are also being taken at the national level.

Finally, the year 2022 also witnessed the publication of a new European directive and new EDQM (European Directorate for the Quality of Medicines) standards defining blood as a SoHO (Substance of Human Origin), similar to cells and tissues. For this reason, it was decided that the Blood Bank and the Erythrocyte Immunology Laboratory would join the Banking Department as of January 1, 2023.

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Case report of a pseudoaneurysm of the pedal artery: a rare ankle sprain complication

Yaseen Golamhossein, Pierre Milet Published in the journal : January 2023 Category : Clinical Report

Ankle sprains represent a frequent reason for general or emergency medicine consultations. The most common complications are ligament lesions, bone avulsions, and hemarthroses. The pseudoaneurysm of the pedal artery is an often overlooked and rare complication. The case presented in this article is that of a 32-year-old man treated for a sprained ankle 3 weeks before. He received conservative treatment because no fractures were detected during the X-ray examination. Two weeks later, he presented with a pulsatile mass in front of the anterior talofibular ligament, associated with a small wound.

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