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Volume 3, Number 4 |
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| Clinical nurse specialists and D-dimer assessment of suspected deep vein thrombosis – lessons from Warwick |
Peter Rose FRCP FRCPath Consultant Haematologist; Susan Poole SRN Clinical Nurse Specialist; Ruth Brown MRCPath Audit Analyst; Supratik Basu MRCP MRCPath Consultant Haematologist; David Clarke FRCR Consultant Radiologist, Warwick Hospital |
This study evaluates the role of a clinical nurse specialist (CNS) in the management of patients who presented with suspected deep vein thrombosis (DVT) at the Warwick Hospital over a period of nine months. The nurse assessed new patients and initiated investigations and treatment where it was necessary. Patients were then followed up in the community by the same nurse who administered low molecular weight heparin (LMWH) injections and managed oral anticoagulant care. |
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| The use of compression hosiery to prevent post thrombotic syndrome |
Patricia Weston RN Thrombosis Nurse Specialist, Addenbrooke’s Hospital NHS Trust, Cambridge |
The thrombosis treatment team at the Addenbrooke’s Hospital in Cambridge was established in February 1998 for the ambulatory treatment of patients with a proven deep vein thrombosis (DVT). It became immediately evident after the team’s foundation that the treatment given needed to be extended to the fitting of compression hosiery in the hope of reducing the occurrence of post thrombotic syndrome (PTS). |
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| The varying clinical efficacy of D-dimer screening tests |
Peter Rose, Editor |
Many centres now use a D-dimer level and/or a clinical probability score to screen patients with suspected deep vein thrombosis. This reduces the need for further diagnostic investigations by venogram or ultrasound scanning. As discussed in this issue, this has considerable merits. It is, however, necessary to monitor laboratory quality assurance with these kits and to continually review their effectiveness. |
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| Heparin monitoring in pregnancy |
Caroline Shiach BSc MD FRCP FRCPath Consultant Haematologist, Manchester Royal Infirmary |
Pregnancy increases the risk of venous thromboembolism (VTE) approximately fivefold compared to the non-pregnant state. Increase in the plasma level of many coagulation factors and decreased venous flow velocity are risk factors for VTE which are common to all pregnancies. However, it is recognised that there is a particular increased risk in association with increasing maternal age, inherited or acquired thrombophilia risk factors, immobility and obesity. Furthermore there is an especial risk of pulmonary embolism (PE) in association with operative deliveries, which is most pronounced with emergency caesarean sections. VTE is the most frequent cause of maternal death in many western countries.1,2 |
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| DVTs and primary care |
Rod Smith MA MB BChir MRCGP Clinical Governance Head, Reading Thames Primary Care Group |
Deep vein thrombosis (DVT) is a relatively common condition that affects one patient in every 1000.1 An initial putative diagnosis is commonly made by the GP who then has to refer the patient to hospital for confirmation of the diagnosis, usually by venogram or Doppler ultrasound, and subsequent treatment. |
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