https://www.um.edu.mt/library/oar/handle/123456789/485 2026-05-22T07:05:12Z 2026-05-22T07:05:12Z Casanegra, Ana I. Sharif, Sobia Rothschild, Cynthia Riva, Nicoletta Sarkar, Amrita Orsi, Fernanda A. Ariëns, Robert A. S. https://www.um.edu.mt/library/oar/handle/123456789/146477 2026-05-15T07:38:23Z 2026-01-01T00:00:00Z

Title: International society on thrombosis and haemostasis conflict of interest management and tools : presentation of a case study Authors: Casanegra, Ana I.; Sharif, Sobia; Rothschild, Cynthia; Riva, Nicoletta; Sarkar, Amrita; Orsi, Fernanda A.; Ariëns, Robert A. S. Abstract: Management of conflicts of interest (COIs) is a critical element in supporting the mission, core values, and code of conduct of the International Society on Thrombosis and Haemostasis (ISTH). The ISTH Ethics Committee and Council recently developed clear guidelines and educational materials to help members at all levels appropriately manage COIs. COI refers to the existence of material or intellectual interests outside the ISTH in the fields of thrombosis and hemostasis, hematology, or cardiology that could influence an individual’s actions or decisions in ways not aligned with the ISTH mission or values. The primary measures that can be implemented whenever a COI arises are disclosure, recusal, resignation, or divestment. To better illustrate the nature of COI considerations and the possible application and consequences of each measure, we present the following hypothetical case: “Professor Baker is a recognized expert in platelet physiology, with more than 200 publications as a lead author. He has recently joined the speakers’ bureau of a large pharmaceutical company that is preparing for the launch of a new antiplatelet agent. He was invited to participate in several educational activities related to the introduction of the new agent. In this role, he is expected to prepare written materials and deliver presentations at medical meetings and company-sponsored educational events.”

2026-01-01T00:00:00Z Gurumurthy, Gerard Swan, Dawn Roberts, Lara Riva, Nicoletta Gatt, Alexander Thachil, Jecko https://www.um.edu.mt/library/oar/handle/123456789/146476 2026-05-15T06:03:47Z 2026-01-01T00:00:00Z

Title: Thrombosis after surgical splenectomy - why, in whom and can we prevent it? Authors: Gurumurthy, Gerard; Swan, Dawn; Roberts, Lara; Riva, Nicoletta; Gatt, Alexander; Thachil, Jecko Abstract: Splenectomy remains a common operation performed in the setting of trauma, haematological disease, malignancy and diagnostic purposes. Contemporary evidence indicates an increased risk of thromboembolism after splenectomy. This includes both systemic venous thromboembolism (deep vein thrombosis and pulmonary embolism) and splanchnic thrombosis involving the portal-splenic-mesenteric axis. Comparator-based population studies demonstrate a pronounced early postoperative risk and disease-matched cohorts suggest that risk can persist beyond the immediate perioperative period. This suggests a durable post-splenectomy prothrombotic phenotype. Mechanistically, this phenotype may reflect the loss of splenic functions that are intrinsically antithrombotic, including clearance of procoagulant cellular substrates and microparticles, sequestration and regulation of platelet mass, modulation of portal haemodynamics, and facilitation of thrombus remodelling and resolution. Splenectomy as a risk factor is over-represented among patients with chronic thromboembolic pulmonary hypertension (CTEPH) with evidence for biological links between thrombotic risk and impaired thrombus resolution. Anticoagulation strategies in splenectomised patients remain heterogeneous and evidence for its use is largely based on observational studies. Most guidance supports routine perioperative pharmacologic thromboprophylaxis and consideration of extended prophylaxis in selected cases. When post-splenectomy thrombosis occurs, therapeutic anticoagulation is the mainstay for the first three to six months. Extended therapy is reserved for persistent risk factors and those who develop CTEPH.

2026-01-01T00:00:00Z Tripodi, Armando La Mura, Vincenzo Piscaglia, Fabio Stefaninin, Bernardo Riva, Nicoletta Ageno, Walter https://www.um.edu.mt/library/oar/handle/123456789/146418 2026-05-13T08:48:55Z 2026-01-01T00:00:00Z

Title: Managing coagulation abnormalities, bleeding, and thrombosis in patients with cirrhosis Authors: Tripodi, Armando; La Mura, Vincenzo; Piscaglia, Fabio; Stefaninin, Bernardo; Riva, Nicoletta; Ageno, Walter Abstract: Cirrhosis is associated with a narrow balance between procoagulant and anticoagulant factors that may lead to potentially serious complications. Interpretation of laboratory tests, prevention of bleeding during invasive procedures, and use of anticoagulant drugs for the prevention and treatment of thromboembolism are often challenging. After reviewing the most contemporary literature, we hereby provide guidance to navigate the evidence and support clinical decisions. Based on current knowledge, prothrombin time and activated partial thromboplastin time do not accurately describe hemostasis in patients with cirrhosis and should not be used to predict bleeding. Rather, a careful assessment of patient and procedure-related variables better helps to identify patients at increased bleeding risk. Because procedure-related bleedings are uncommon in patients with cirrhosis, the use of prophylactic strategies is seldom necessary in daily practice. In case of perioperative bleeding, viscoelastometry may be useful to drive decisions on the use of transfusion products. Portal vein thrombosis is a common complication in patients with cirrhosis and requires a timely start of anticoagulant treatment, especially when vessel obstruction exceeds 50% of the lumen diameter. Treatment should be continued for at least 6 months. The direct oral anticoagulants are increasingly used in this setting, representing a valid alternative to the heparins and vitamin K antagonists. Atrial fibrillation in cirrhosis is associated with a high risk of ischemic stroke and treatment-related major bleeding. The benefit of anticoagulants is supported by the results of observational studies, and the direct oral anticoagulants are suggested as the first line of treatment also for this population.

2026-01-01T00:00:00Z Kuiper, Jonas JW Prinz, Jörg C. Stratikos, Efstratios Kuśnierczyk, Piotr Arakawa, Akiko Springer, Sebastian Mintoff, Dillon Padjen, Ivan Shumnalieva, Russka Vural, Seçil Kötter, Ina van de Sande, Marleen G Boyvat, Ayşe de Boer, Joke H Bertsias, George de Vries, Niek Krieckaert, Charlotte LM Leal, Inês Valentinčič, Nataša Vidovič Tugal-Tutkun, Ilknur Ahanach, Hanane el Khaldi Costantino, Félicie Glatigny, Simon Zimak, Danijela Mrazovac Lötscher, Fabian Kerstens, Floor G Bakula, Marija Sousa, Elsa Viera Böhm, Peter Bosman, Kees Kenna, Tony J. Powis, Simon J. Breban, Maxime Gul, Ahmet Bowes, John Lories, Rik JU Nowatzky, Johannes Wolbink, Gerrit Jan McGonagle, Dennis G Turkstra, Franktien https://www.um.edu.mt/library/oar/handle/123456789/146400 2026-05-13T05:45:50Z 2023-01-01T00:00:00Z

Title: EULAR study group on ‘MHC-I-opathy' : identifying disease-overarching mechanisms across disciplines and borders Authors: Kuiper, Jonas JW; Prinz, Jörg C.; Stratikos, Efstratios; Kuśnierczyk, Piotr; Arakawa, Akiko; Springer, Sebastian; Mintoff, Dillon; Padjen, Ivan; Shumnalieva, Russka; Vural, Seçil; Kötter, Ina; van de Sande, Marleen G; Boyvat, Ayşe; de Boer, Joke H; Bertsias, George; de Vries, Niek; Krieckaert, Charlotte LM; Leal, Inês; Valentinčič, Nataša Vidovič; Tugal-Tutkun, Ilknur; Ahanach, Hanane el Khaldi; Costantino, Félicie; Glatigny, Simon; Zimak, Danijela Mrazovac; Lötscher, Fabian; Kerstens, Floor G; Bakula, Marija; Sousa, Elsa Viera; Böhm, Peter; Bosman, Kees; Kenna, Tony J.; Powis, Simon J.; Breban, Maxime; Gul, Ahmet; Bowes, John; Lories, Rik JU; Nowatzky, Johannes; Wolbink, Gerrit Jan; McGonagle, Dennis G; Turkstra, Franktien Abstract: The ‘MHC-I (major histocompatibility complex class I)-opathy' concept describes a family of inflammatory conditions with overlapping clinical manifestations and a strong genetic link to the MHC-I antigen presentation pathway. Classical MHC-I-opathies such as spondyloarthritis, Behçet's disease, psoriasis and birdshot uveitis are widely recognised for their strong association with certain MHC-I alleles and gene variants of the antigen processing aminopeptidases ERAP1 and ERAP2 that implicates altered MHC-I peptide presentation to CD8+T cells in the pathogenesis. Progress in understanding the cause and treatment of these disorders is hampered by patient phenotypic heterogeneity and lack of systematic investigation of the MHC-I pathway. Here, we discuss new insights into the biology of MHC-I-opathies that strongly advocate for disease-overarching and integrated molecular and clinical investigation to decipher underlying disease mechanisms. Because this requires transformative multidisciplinary collaboration, we introduce the EULAR study group on MHC-I-opathies to unite clinical expertise in rheumatology, dermatology and ophthalmology, with fundamental and translational researchers from multiple disciplines such as immunology, genomics and proteomics, alongside patient partners. We prioritise standardisation of disease phenotypes and scientific nomenclature and propose interdisciplinary genetic and translational studies to exploit emerging therapeutic strategies to understand MHC-I-mediated disease mechanisms. These collaborative efforts are required to address outstanding questions in the etiopathogenesis of MHC-I-opathies towards improving patient treatment and prognostication.

2023-01-01T00:00:00Z