Representing Hemostasis and Thrombosis: An Interview With Roy Silverstein, MD

Roy Silverstein, MD
Chair of the Department of Medicine and Linda and John Mellowes Professor of Medicine, Medical College of Wisconsin; Senior Investigator at the Blood Research Institute, Versiti Blood Center of Wisconsin, Milwaukee

2019 American Society of Hematology (ASH) President Roy Silverstein, MD, speaks about the goals of the ASH Working Group on Hemostasis and Thrombosis.

What is the hemostasis and thrombosis (HT) community’s relationship to the broader hematology/oncology field?

The HT community is a core component of the broader field, and coagulation, hemostasis, and thrombosis are key clinical and scientific priorities for the field. Venous thromboembolism (VTE), in particular, was identified as one of six priority areas of the ASH Agenda for Hematology Research.

All of medicine, including hematology, is becoming increasingly subspecialized. This can lead to members of certain subspecialties feeling disenfranchised within a broad-based society, such as ASH. The feeling is not unique to HT; as president, I have heard these concerns from members of nearly all the constituency groups.

What is the ASH Working Group on Hemostasis and Thrombosis? Why was it established?

The ASH Executive Committee established the Working Group in January 2018 to ensure that the needs of the HT community were being met. Its membership spans all ASH constituents interested in HT, including adult and pediatric hematologists, basic and clinical scientists, and North American and international members. Its goals are to gather broad input on the state of HT within ASH and to make specific recommendations to the Executive Committee about strengthening the relationship of the HT community to ASH.

As both a member of the HT community and an ASH officer, I looked at this Working Group as an opportunity to strengthen our role as the leading medical organization for hematologists.

What surprised you in learning about the things that ASH does for this community?

ASH does more for the HT community than we realized. There’s so much going on in this field; part of the Working Group’s value is in consolidating all that information. During our meetings, we discuss existing ASH initiatives and brainstorm additional activities the Society could undertake to support the community – as well as how we can communicate those initiatives to the community.

What additional priorities and opportunities has the Working Group identified, and how is it tackling them?

The Working Group has tried to make the hemostasis and thrombosis community feel welcome at the annual meeting. So, one of our priorities was organizing a Networking Reception for the Hemostasis and Thrombosis Community that immediately follows the Special Symposium on the Basic Science of Hemostasis and Thrombosis at the annual meeting. Last year, we had great turnout; it showed that there were a lot of people at that meeting interested in this field.

We also were fortunate that the first five ASH evidence-based VTE guidelines were published in Blood Advances concurrently with last year’s annual meeting. ASH invested in the development of a number of tools and educational resources ( to make the guidelines more accessible and help clinicians to digest the recommendations. These were promoted in multiple creative ways throughout the meeting, providing tangible evidence of ASH’s commitment to the HT field.

This year, we’re continuing the Networking Reception and hope to highlight additional new guidelines relevant to HT, including VTE, von Willebrand disease, and immune thrombocytopenia, and also ensuring that the HT community has a visible presence at ASH-a-Palooza, where we can show undifferentiated trainees that this is a thriving subspecialty.

How is the Working Group helping to improve mentorship and career development opportunities for this subspecialty?

Mentorship is an important issue across ASH, but we want to make it clear to the early-career folks that the ASH meetings are a great place to meet and interact with world leaders in the field and that we can use that venue to help mobilize those interactions.

This year, we’re starting something brand new at the annual meeting: a curated hemostasis and thrombosis “poster walk” for hematologists in training. This is an exclusive opportunity where well-known thought leaders will escort small groups of trainees to view a selected group of posters and discuss them with the early-career investigator presenting the poster. It’s an opportunity for trainees to get exposure to and feedback from senior leaders in the field, and we think this will be quite impactful.

The annual meeting is the highlight of the year for ASH as an organization, but we are addressing the needs of this community year-round, including ways to connect potential mentors to early-career faculty or trainees interested in HT.

In your opinion, what are the most exciting advances happening in hemostasis and thrombosis?

It’s an exciting time for our subspecialty and for hematology in general. At the clinical level, gene therapies for hemophilia are progressing much faster than anyone would have predicted five years ago, and we’re seeing potential curative therapies emerge that won’t require routine, inconvenient, expensive factor infusions. Another piece of this puzzle is the development of novel approaches to treating patients with hemophilia and inhibitors. In clinical thrombosis, we are learning through innovative clinical trials how to best use the direct oral anticoagulants in many common clinical settings, including cancer and pregnancy.

There also are interesting developments in the science of platelet biology – how platelets contribute to thrombosis, coagulation, inflammation, and perhaps even cancer metastases. Another hot area is the potential to use human induced pluripotent stem cells to grow platelets outside of the body for transfusion. That’s further into the future than the hemophilia treatment, but it’s out there and is progressing swiftly.