Daria Pašalić
Department of Medical Chemistry, Biochemistry and Clinical Chemistry
Zagreb University School of Medicine
Šalata ul 2.
10 000 Zagreb, Croatia
Phone +385 (1) 4590 205; +385 (1) 4566 940
E-mail: dariapasalic [at] gmail [dot] com

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Ana Bronić. Thromboembolic diseases as biological and clinical syndrome – Role of the Mediterranean League against Thromboembolic Diseases. BiochemiaMedica 2010;20(1):9-12.
MLTD consultant for Croatia, University Hospital of Traumatology, Zagreb, Croatia
Corresponding author:
Keywords: venous thromboembolism; deep vein thrombosis; thromboembolic diseases; arterial thrombosis; Mediterranean League against Thromboembolic Diseases (MLTD)
As early as 150 years ago, it was established that pathological occurrence of blood clot or thrombosis is due to changes in vascular wall, blood flow and blood content. Still, considerable effort had to be made through history in order for the thrombosis to be accepted as a specific entity that entails investigations and clinical studies. Until 1960’s, scientists were chiefly focused on investigating hemorrhage, with very few studies of the factors and mechanisms responsible for the occurrence of thrombosis that was actually more complex and less known (1-3). Accordingly, there was practically no society worldwide to gather researchers investigating this entity.
In such circumstances, after her return in 1967 from internship at the National Blood Transfusion Center in Paris, dr. Jasone Monasterio organized in Bilbao the first Spanish-French symposium on hemorrhagic syndromes and thromboembolic diseases with support of dr. Jose Antonio Iriarte, Institute of Procardíacos. The principal idea was to gather leading French and Spanish scientists in hemostasis, angiology and cardiology, and other fields related to thrombosis. The symposium discussed hypercoagulability as a biological and clinical syndrome, as a potential cause of venous thromboembolism, then risk factors for myocardial infarction and its sociological effects, control of anticoagulant therapy, and conditions of hyperfibrinolysis. A protocol for diagnosis and treatment of thromboembolism was established and agreement was reached to organize biannual gatherings of scientists in this and related fields. It was also agreed that experts from other Mediterranean countries should be invited to future meetings.
The symposium was actually the beginning of the idea about founding the Mediterranean League against Thromboembolic Diseases (MLTD), one of the first organizations to bring together basic scientists and specialists, clinicians interested in thrombosis and hemostasis.
The following meeting was held again in Bilbao in October 1969 as the 1st Mediterranean Congress on Thromboembolism where the League was officially founded. During the Congress, General Assembly was held and the League by-laws were adopted, while Dr. Jose Antonio Iriarte, one of its founding members, was appointed the first General secretary of the League. The following countries were original members of the League: Bulgaria, France, Greece, Italy, Israel, Spain and Turkey. According to its Statute, the League was established for scientific and educational purposes, with the goal of promoting research of the pathogenesis of thromboembolic diseases, their prevention, diagnosis and treatment, and thus of providing overall better care of patients. In order to ensure exchange of results and experience, it was agreed that International Thrombosis Congress (ITC) was to be organized every other year in one of the member countries, with symposia in years in between. Accordingly, the following three congresses were held in countries that were among the League founders, and in the same order that their members were appointed as Councillors: in 1971 in Instanbul, Turkey, in 1973 in Tel Aviv, Israel, and in 1976 in Athens, Greece. During the first decade of its activity, another four countries from different Mediterranean regions became members of the League: Egypt, Tunisia, and Yugoslavia in 1971, and Rumania in 1973 (3,4).
After the 5th ITC that was held in Bologna in 1978, the League strengthened its position during the following ten years as an international scientific society in the field of thromboembolic diseases. Based on intense interest in attending such meetings and on their high scientific rating, the founding Councillors suggested that MLTD be registered as a scientific society in the National Registry of Associations in Spain, which was implemented in 1980. At the IT congresses to follow, organized in Monte Carlo (1980), Valencia (1982), Istanbul (1984), Jerusalem (1986) and Athens (1988), an ever increasing number of attendees was recorded from all over the world, as well as of leading international experts in the field of thrombosis as lecturers. In that period, collaboration was established with associations worldwide that were active in similar scientific and clinical fields as, for instance, Latin-American cooperative association for hemostasis and thrombosis (Grupo Cooperativo Latino Americano de Hemostasia y Trombosis, CLAHT), European Thrombosis Research Organisation (ETRO), Danubian League against Thrombosis and Haemorrhagic Disorders, and with national societies for thrombosis and hemostasis in countries that were the League members. Particularly intense collaboration was achieved with International Society on Thrombosis and Haemostasis (ISTH). ISTH participates in organization of MLTD courses, and annual meetings of the MLTD Executive Board are held during ISTH congresses (3,4).
Due to increased international success in the third decade after its foundation, the League had to update the original bylaws in order to keep pace with the increasing number of its member countries and scientific activities. Slovenia, Portugal and Morocco joined the League during that period. Also, the bylaws were in 1996 translated in English and in the same year the journal Haemostasis (today: Pathophysiology of Haemostasis and Thrombosis) was accepted as the official journal of MLTD (3,4).
Positive developing trend has continued in this decade as well. An exceptionally high number of participants attended IT congresses in Porto in 2000, Bologna in 2002, Ljubljana in 2004, and in Tel Aviv in 2006, while Saudi Arabia and Cyprusbecame new members of the League. In April 2004, the League web pages ( were created as a modern tool for efficient and global diffusion of activities, and also MLTD Foundation was established in 2006. The aim of the Foundation is to gather necessary financial resources through drives and/or donations from private and public institutions interested in development of the Mediterranean region. The plan is to spend the collected funds to include in the League activities those Mediterranean countries that have not as yet become its members, and to design awards for best studies in this scientific field. Activities of the Foundation will be focused on the League members, scientific community of Mediterranean countries, and on the patients affected or at risk of developing arterial or venous thrombosis and their associations in Mediterranean community (3,4).
During the 20th ITC that was held in Athens at the end of June 2008, researchers and clinicians from Croatia were invited to become active in MLTD, exchange their insights with colleagues from other countries and thus contribute together to advancement of research in the field.
Croatia belongs to the Mediterranean region both geographically and by its climate and in Croatia, as in most transitional European countries, thromboembolic diseases are major public health problem and one of the main causes of increased healthcare costs (5,6). The rate of deaths due to cardiovascular diseases in Croatia with regard to overall mortality was 50.6% in year 2007; the leading diagnostic subgroups were ischemic cardiac diseases and cerebrovascular disease with mortality rates of 36.5% and 31.4%, respectively (7,8). Epidemiologic data on morbidity and mortality rates for venous thromboembolism (VTE) in Croatia are yet to be estimated. In Europe, VTE is the third cause of death with over 500,000 death casesper year. Almost 60% of all VTE cases are hospitalized patients, with the proportion of pulmonary embolism (PE) of 5-10%, which means that VTE is the most preventable cause of death of hospital patients. Major orthopedic surgeries without prophylaxis carry a serious risk of VTE, while even 60% of surgical patients may develop deep vein thrombosis (DVT) without preventative treatment, i.e. 0.2-10% of them may develop PE (9). It is therefore not surprising that the progress in development of new antithrombotics, antiplatelet drugs, and diagnostic tests for therapy of patients is the major topic of the forthcoming 21st International Congress on Thrombosis which is organized by MLTD and by an internationally recognized hematologist prof. Mannucci and will take place in Milan, Italy, during July 2010 (10,11).
Although the strategy of prevention, diagnosis and treatment have significantly advanced during the past twenty years, high prevalence of thromboembolic events places emphasis on investigation of new risk factors of the disease with a view to explaining pathogenesis and achieve fast and accurate recognition of the causes of thrombosis (11,12). One of the main future objectives of the League is establishment of a network of working groups that should make the axis of MLTD, and initiation of international projects involving cooperation of the League members with international experts with the purpose of promoting research of epidemiology, diagnosis and treatment of thrombosis and thus reducing the risk of disease, its spread and improving patient care.
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2. Stengle JM. Thrombosis. Blood 1970;35:867-8.
3. Monasterio J. The Mediterranean league against thromboembolic disease. Past, present and future and relations with ISTH (Conference given in the II Educational Course, held in Tunis, May 18-19th, 2007). Available at: Accessed: October 25th, 2009.
4. Available at: Accessed: October 25th, 2009.
5. Kern J, Strnad M, Coric M, Vuletic S. Cardiovascular risk factors in Croatia: struggling to provide the evidence for developing policy recommendations. BMJ 2005;331:208-10.
6. Dzakula A, Sogoric S, Polasek O, Jurisa A, Andric A, Radakovic N, Todorovic G. Cardiovascular Diseases, Risk Factors and Barriers in Their Prevention in Croatia. Coll Antrop 2009;33(suppl 1):87-92.
7. Hrabar-Zerjavic V, Kralj V, Silobrcic-Radic M. [Javnozdravstvena važnost najčešćih kardiovaskularnih bolesti]. Medicus 2003;12:9-16. (in Croatian)
8. Kralj V, Hrabar-Zerjavic V, Silobrcic-Radic M. [Javnozdravstveni značaj kardiovaskularnih bolesti]. Available at: Accessed: November 10th, 2009. (in Croatian)
9. Cohen AT, Agnelli G, Anderson FA, Arcelus JI, Bergqvist D, Brecht JG et al. Venous thromboembolism (VTE) in Europe. The number of VTE events and associated morbidity and mortality. Thromb Haemost 2007;98:756-64.
10. Available at: Accessed: October 29th, 2009.
11. Weitz JI. Unanswered questions in venous thromboembolism. Thrombosis research 2009;123(supp l4):S2-S10.
12. Graham IM. Guidelines on cardiovascular disease prevention in clinical practice: the European perspective. Curr Opin Cardiol 2005;20:430-9.