SCIENTIFIC SUBCOMMITTEE SESSION
6 July 2007 Palexpo, Geneva, Switzerland  

Women’s Health in Thrombosis & Haemostasis

Chair: Andra H. James (USA)
Co-Chairs: Margareta Blombäck (Sweden), Benjamin Brenner (Israel), Jacqueline Conard (France), Sabine Eichinger (Austria), Ian Greer (UK), Barbara Konkle (USA), Claire Philip (USA)

Minutes:

Introduction and Overview:

In the introduction and overview Dr. Andra James presented the

• Purpose and function of the scientific subcommittees
• to develop standards, methods, nomenclature
• to address issues of practical importance to the research community
• to complete a specific program of work
• to create international collaborations for the purpose of planning, executing and completing projects of benefit to the international community
• to generate, publish and distribute reports, recommendations and other documents concerning the above
• Route to publication of SSC reports, recommendations and documents
• development
• approval by a “vote” of international experts within and possibly outside of the SSC
• approval by 2 external reviewers
• approval by the chair of the scientific subcommittee who forwards the document to the Chair of the SSC and ISTH headquarters
• approval by the Chair of the SSC and the ISTH
• Options for publication
• on the ISTH Website
• in the Journal of Thrombosis and Haemostasis
• short communication (1 ½ pages) – usual route for SSC publication – requires approval by editors of JTH
• full-length article – requires usual peer review and approval by editors of JTH
• (official SSC documents may not be published elsewhere.)
• Development of standards (similar process to development of document)
• After approval by ISTH, a recommendation is forwarded to the Expert Committee on Biological Standardization (ECSB) of the World Health Organization (WHO)

Dr. Marilyn Manco-Johnson presented an overview of the history of the Women’s Health in Thrombosis and Haemostasis including its origins and accomplishments.

Educational Activities

Dr. Benjamin Brenner reported on the successful 2 nd Symposium on Women’s Issues in Thrombosis and Hemostasis held in Vienna the first week of February 2007 and announced the next symposium to be held February 6-8, 2009.

Report on the Women’s Health in Thrombosis & Haemostasis Subcommittee Inspired or Sponsored Publications

Dr. Brenner reported on a Scoring System for Pregnancy Outcomes. Application of this scoring system to patients at his institution has shown a strong correlation between the score and the level of anticoagulation required during pregnancy. Publication of these results will emanate from his institution. Future directions include, possibly, application to women who have and have not received anticoagulation and an international, multi-center validation of the study.

Dr. Margareta Blomback summarized the Women’s Issues SSC publication, Blomback et al, Preanalytical conditions that affect coagulation testing, including hormonal status and therapy. JTH 2007; 5 (4), 855–858.

Report from the 8th American College of Chest Physicians’ Conference on Antithrombotic and Thrombolytic Therapy

Dr. Shannon Bates summarized her group’s recommendations for the chapter, “Use of antithrombotic agents during pregnancy,” and highlighted the differences from the last version published in 2004. Of interest to the audience were expanded options for the management of women with mechanical heart valves and the absence of a recommendation to screen women with a history of poor pregnancy outcome for thrombophilia. The reasons cited for the latter were weak associations between thrombophilia and poor pregnancy outcome and limited data on the benefits of anticoagulation in these women.

Update on Registries

Pregnancy outcome in women with antithrombin deficiency:
Dr. Jacqueline Conard presented a summary of the incidence of thrombosis during pregnancy among women with antithrombin deficiency. The only contributors to the registry have been from France.

Pregnancy outcome in women with mechanical heart valves:
Dr. James reported that only one subject has been added to the registry this year. Dr. Claire McLintock has been recruited to assist with enrollment. Dr. McLintock reported on 15 cases from New Zealand that she expects will be added to the registry.

Thrombosis and thrombotic risk in women receiving ovarian stimulation for pregnancy:
Dr. Barbara Konkle reported that to date no subjects have been enrolled in this registry and it will be withdrawn.

Update on New and Proposed Registries:

Mirena IUD for menorrhagia in women with bleeding disorders:
Dr. Rezan Kadir reported that she and Dr. Peter Kouides have completed a questionnaire that can be used to gather data about women with bleeding disorders and their experience with the Mirena IUD. The questionnaire is ready to be added to the website.

Application of pregnancy scoring system to neonatal thrombosis – joint activity with the Perinatal/Pediatric Scientific Subcommittee
Dr. Manco-Johnson reported that the concept for this study is evolving into a case-control study. The study will likely not take the form of a registry.

Update on Other New and Proposed Projects:

Monitoring anti-Xa activity during pregnancy:
Dr. Sandy Duncan spoke to the benefits of monitoring anti-factor Xa levels in pregnancy. In the ensuing discussion, questions were raised about the methodological problems in trying to answer the relevant research questions using a registry. An outcome of the discussion was the recognition of the need for a registry for women who have received fondaparinux during pregnancy. Dr. James will pursue the establishment of such a registry with Dr. Duncan.

New Opportunities for Collaboration: Studies of Reproductive Tract Bleeding in Women with Bleeding Disorders:

Dr. Althea Grant summarized the past and current research on women with bleeding and clotting disorders being conducted at the United States Centers for Disease Control and Prevention. Her presentation was followed by a presentation by Dr. Flora Peyvandi on her group’s proposal of a study on menorrhagia in women affected by bleeding disorders. Data would be collected from multiple international sites. There was general consensus regarding the merits of the study and the feasibility of an international collaboration.

Future Meetings:

There was support for the new congress meeting structure that will include educational sessions. The Women’s Health SCC will propose that 1 to 1.5 hours at their next meeting be devoted to education. The two topics that will be proffered are, “Anticoagulation during Pregnancy,” and “Reproductive Tract Bleeding in Women with Bleeding Disorders.”

There were approximately 100 persons in attendance.