|Year : 2017 | Volume
| Issue : 3 | Page : 125-126
A tribute to a pioneer thrombosis researcher - Sir Vijay V Kakkar, MD 1937–2016
Gundu HR Rao
Department of Laboratory Medicine and Pathology, Lillehei Heart Institute, University of Minnesota, Minneapolis, MN, USA
|Date of Web Publication||4-Jul-2017|
Gundu HR Rao
Lillehei Heart Institute, University of Minnesota, Minneapolis, MN, 12500 Park Potomac Ave Unit, 306, Potomac, MD 20854, Minneapolis, MN
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Rao GH. A tribute to a pioneer thrombosis researcher - Sir Vijay V Kakkar, MD 1937–2016. J Clin Prev Cardiol 2017;6:125-6
In my entire career as a thrombosis researcher (over four decades), I have never met another researcher, who was more dedicated, passionate, and accomplished as Professor (Sir) Vijay V Kakkar. Once, when he was asked by the Daily Telegraph about his hobbies, he told, “I do not play Golf, What should I do, Thrombosis Research is my Hobby.” Many obituaries related to his passing away (on November 5, 2016) have been published in the News Papers (Wall Street Journal), Journals (Br. Med. J. 2017:356:i6852), and on the Internet. This essay is not an obituary. It is a recollection of memories and his accomplishments. In other words, it is a celebration, of his life and works.
He has been a recipient of number of distinctions and awards including the Hunterian Professorship, from the Royal College of Surgeons, the Gunnar Bayer Memorial Lecture, the David Patey Prize of the Surgical Society of Great Britain and Ireland, Visiting Professorship at the Harvard University, the James Finlayson Lecture, the Cross Memorial Lecture, the Wright-Schultz award from the International Society on Thrombosis and Haemostasis for original outstanding contribution in Thrombosis, the Freyer Memorial Lecture, and Honorary Fellowship of the Academy of Medicine in Singapore and the Association of Surgeons in India. He was awarded a lifetime achievement award from the International Union of Angiology, France, and South Asian Society on Atherosclerosis and Thrombosis (SASAT), USA, for the outstanding leadership in the investigation of thrombotic disorders and an annual award of the Medicine from the Guild of British Asians for outstanding contribution by Asian Doctors to British Medicine. He was the Founder of the British Society for Haemostasis and Thrombosis and Co-Founder and the First President of the SASAT, USA. In the year 2010, he was awarded an Honorary PhD Degree at the Loyola University, Chicago. He was also awarded an Order of the British Empire. On his retirement from the University in 1997, he was awarded the title of Emeritus Professor of the University of London. His publications include over 680 original articles, six books, and contributions to 44 textbooks.
I first met Prof. Vijay V. Kakkar, when I was spending a summer at the Biochemistry Department of Royal College of Surgeons (1986) at Nuffield College of Surgical Sciences, Lincolns Inn Fields, London. Prof. Kakkar invited me, to the Department of Surgery, King's College, to give a lecture. I was working those days on adrenaline-induced modulation of platelet activation signals. Following year, I spent a summer in his department at the King's College. Once the Thrombosis Research Institute was inaugurated in Chelsea, I spent a summer at that Institute. I get to know him well during those 3 years. Later, when I started a professional society (SASAT), I invited him to join us, as the first President of our Society. He served on the Board of SASAT for almost a decade (1993–2003). We coedited our first book on Coronary Artery Disease (Rao GHR, Vijay V. Kakkar. Eds): Coronary Artery Disease in South Asians: Epidemiology, Risk Factors and Prevention. New Delhi, India: JP. Brothers Medical Publishers; 2001.
Vijay V. Kakkar was born on March 22, 1937, to Harbhagwan Kakkar, a medical Practitioner, and Lilavathi Kakkar in Sialkot (North-East Punjab). The family migrated to Uttar Pradesh, India, after the partitioning of India and Pakistan. He spent early childhood days in Lucknow and graduated with MBBS degree, from the Gandhi Medical College, Bhopal, India, in 1960 (in one of the published biographies, it has been mentioned that he obtained his MBBS degree from Vikarm University Ujjain in 1960). He met his future wife and life-long companion, Ms. Savitri Karnani, at the Medical college the very 1st day he attended the college on August 17, 1955. They were married in 1962, in Chesterfield, UK. He completed his studies for FRCS England and Edinburgh in 1964. His wife specialized in anesthesiology. In 1976, he was appointed as Professor of Surgery at King's College, London. It is to be noted that Vijay V. Kakkar was one of the first doctors of Indian origin, to be appointed at a London Teaching Hospital, an honor and an inspiration we all should share and cherish. In 1997, he was awarded the title of Emeritus Professor of the University of London.
After his postgraduate medical education in London, he joined as a Lecturer in the Department of Surgery, King's Medical College, London. As a researcher, Vijay Kakkar noticed during the autopsy of two postsurgical cases that the cause of death was due to massive pulmonary embolism. What motivated this young surgeon to devote his entire life to research in this field was the death of two postoperative patients at the King's Medical College and Hospital. It was a seminal finding, but it was difficult to prove to his colleagues, that the clots in the blood vessels could kill both surgical and medically ill patients. Prof. Vijay Kakkar developed a preliminary clinical study to explore this hypothesis. His 1969 study on the natural history of postoperative deep-vein thrombosis (DVT) was the first to identify the severity of this problem. He introduced the use of a radiolabeled fibrinogen uptake test, which involves injecting radiolabeled fibrinogen into a developing blood clot and monitoring the radioactivity in the affected limb. He also identified and described several risk factors that increase a patient's chance of developing acute vascular events leading to DVT.
In 1971, he expanded his research with Dr. Mike Scully and used low-dose heparin subcutaneously for patients undergoing surgery. The preliminary explorative studies demonstrated the beneficial effect of preoperative use of low-dose heparin in preventing or reducing the incidence of venous thromboembolism/DVT in surgical patients. The landmark multicenter (28 centers around the world) clinical trial in 1975 with well over 4,000 patients further demonstrated the efficacy of anticoagulant therapy for surgical patients (Kakkar et al.: Lancet 1975). Despite these findings, many hospitals were reluctant to introduce such a prophylactic preoperative procedure. Part of the problem was that patients needed an injection of heparin every 8 h and a close monitoring for any bleeding episodes. In view of this concern and considerable skepticism that existed among the medical community, Prof. Vijay Kakkar started exploring for safer alternate therapies. His search led him to the introduction of low-molecular-weight heparin (LMWH), which acts for longer time and reduces the risk for bleeding. Since the time it was introduced in clinical settings (three decades ago), it has become widely used by hospitals all over the world, to prevent and treat venous thrombosis as well as for angina and for those who have suffered heart attacks.,, It is estimated that its use on high-risk surgical patients has saved thousands of lives per year. In 1982, the first clinical evaluation of LMWH in the prevention of DVT was published. These drugs are now considered the gold standard for antithrombotic therapy for the past 30 years.
In 1989, he founded the Thrombosis Research Institute at Chelsea, London, with the backing of Prime Minister, Margaret Thatcher. I had the privilege of spending a summer at this institute, in the very 1st year of its existence. He established a sister Institute in Narayana Hrudayalaya Campus, Bengaluru, India, in 2006. The President of India, Dr. APJ Abdul Kalam, inaugurated this Institute. I attended the inauguration of this Institute as a guest of Prof. Vijay V. Kakkar.
Dr. Cohen and Kakkar published an article from TRI in 1996, which analyzed the data of 14,467 necropsy reports every year from 1965 to 1990 and 6436 venograms performed from 1976 to 1990 in a single teaching hospital. They noted a progressive reduction in the percentage of necropsies reporting fatal embolism over the 25-year period. They also noted significant reduction in the rate of venographically diagnosed postoperative DVT. They concluded that the introduction of thromboprophylactic measures, in addition to changes in hospital practice, might have had a significant effect on the pattern of serious, but potentially avoidable disease (Cohen, et al. Haemostasis. 1996;26:65-71).
Prof. Jawed Fareed, a close friend and an associate of ours, in the obituary of Prof. Vijay V Kakkar published during the 100-year celebration of heparin discovery writes, “It is tough for me to write these words in such emotional moments.” However, we think always as the wise word of Dr. Seuss: “Don't cry because it is over: Smile because it has happened.” We all miss a superb clinician, scientist, and a leader in the area of thrombosis research.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Kakkar VV, Howe CT, Flanc C, Clarke MB. Natural history of postoperative deep-vein thrombosis. Lancet 1969;2:230-2.
Kakkar VV, Corrigan TP, Fossard DP. Prevention of fatal postoperative pulmonary embolism by low dose heparin: An international multicenter trial. Lancet 1975;12:45-51.
Kakkar VV, Corrrigan T, Spindler J, Fossard DP, Lute PT, Crellin RQ, et al
. Efficacy of low doses of heparin in prevention of deep-vein thrombosis after major surgery. A double blind randomized trial. Lancet 1972;2:101-6.
Kakkar VV, Stamatakis JD, Bentley PG, Lawrence D, de Haas HA, Ward VP. Prophylaxis for postoperative deep-vein thrombosis. Synergistic effect of heparin and dihydroergotamine. JAMA 1979;241:39-42.
Kakkar VV. Low-dose heparin-present status and future trends. Scand J Hematol 1980;24:158-80. [Doi: 10.1111/j.1600-0609.1980.tb02523.x].
Kakkar VV, Djazaeri R, Fok J, Fletcher M, Scully MF, Westick J. Low-molecular-weight heparin fractionated by affinity chromatography on immobilized antithrombins. Br Med J 1982;284:375-9.
Kakkar VV, Adams PC. Preventive and therapeutic approach to venous thromboembolic disease and pulmonary embolism – Can death from pulmonary embolism be prevented? J Am Coll Cardiol 1986;8 6 Suppl B:146B-58B.