Volume 4, Number 1

Dr Will Lester, Haem Specialist Registrar, Department of Haematology, Queen Elizabeth Hospital, Birmingham

The role of anticoagulation in primary and secondary prevention of ischaemic stroke due to atrial fibrillation (AF) is well established. Analysis of pooled data from five randomised controlled trials of primary prevention that began in the 1980s, demonstrated a 68% risk reduction for patients treated with warfarin, with virtually no increase in the frequency of major bleeding.1

Damian Wren DM FRCP Consultant Neurologist, Atkinson Morley’s Hospital, Wimbledon

Cerebral venous thrombosis (CVT) was first recognised in the early 19th century. The first report is attributed to Ribes by Bousser,1 with a case in the puerperium described by Abercrombie in 1828. Since then there have been many reports and series published.

Carole Connor RGN DN PgDip BSc (Hons) DPSN Senior Lecturer, Coventry University

In just over two years, the anticoagulant nursing service at Birmingham Heartlands and Solihull NHS Trust has safely and appropriately managed over 1,000 patients through a hospital outreach service at home instead of in acute hospital beds.

Peter Rose, Editor

This issue covers topics as diverse as the ever-increasing problems of atrial fibrillation in the elderly, to the rare but often catastrophic problems seen with cerebral venous thrombosis (CVT). CVT is seldom seen in routine clinical practice and rarely discussed outside the world of neurology. An encounter, however, with a case of cavernous sinus thrombosis in a teenager, secondary to staphylococcal infection of the face, left me determined never to be overconcerned about matters related to one’s own complexion. It is reassuring to read in this edition that cases secondary to infection are now declining with the exception of immunocompromised patients. The value of thrombophilia screening in this condition and the role of anticoagulant therapy is however an interesting area for further evaluation and discussion.

Andrew J McGuire BSc MRPharmS Practice Pharmacist; David S. Binnie MB ChB MRCGP General Practitioner, Lagmhor Surgery, Perthshire

In this article, we report on an apparent drug interaction between warfarin and tramadol (Zydol), which led to an increase in the INR of a patient in our care. The apparent interaction came to light after the 82-year-old female patient presented with a short history of pain in her right buttock, groin and thigh in December 1998. Specialist orthopaedic opinion indicated that this was referred pain from her right sacroiliac joint.