Volume 6, Number 2

Kirsty Sansum RN Anticoagulant Nurse Practitioner; E Sarah Green MA FRCP FRCPath Consultant Haematologist; Sarah Bond MRPharmS MSc Clin Pharm Anticoagulant Pharmacist; Sue Rhodes RN Anticoagulant Nurse Practitioner; Michelle Taylor RN Anticoagulant Nurse Practitioner, Princess Margaret Hospital, Swindon

In recent months, there has been an increase in media reports about the risk of venous thromboembolism (VTE) in connection with long-haul flights. Here we examine the evidence for such an association and ask what advice travellers should be given.

Peter Rose, Editor

It is certainly the case that patients with atrial fibrillation and a history of previous stroke or transient ischaemic attack benefit from long-term oral anticoagulation in terms of reducing their risk of recurrent stroke events. It is estimated that only 12 such patients need be treated with warfarin to prevent one further stroke event. Not only does this represent good clinical practice, but also good economic sense. The stroke-recurrence rate in this patient group is significantly less for patients treated with warfarin, compared with antiplatelet agents. The value of anticoagulation to reduce recurrent strokes is a very different question for patients without atrial fibrillation.

Tobias Menne Cert State Exam (Berlin) MRCP Specialist Registrar in Haematology, Addenbrooke’s Hospital, Cambridge; Gillian Evans MRCP MRCPath Consultant Haematologist, Haemophilia Centre, Kent and Canterbury Hospital, Kent

Thrombocytopenia – the condition of having a platelet count below the lower limit of the normal laboratory range (usually around 150 x 109/l) – is a common incidental finding of a full blood count (FBC). The degree of thrombocytopenia that is identified and the related risk of haemorrhage will determine the need for further investigation – and the urgency with which this is required. The risk of spontaneous bleeding is low when the platelet count remains above 50 x 109/l; however, it increases significantly when the platelet count falls below 20 x 109/l.

KK Hampton MD Senior Lecturer and Consultant Haematologist, Division of Genomic Medicine, Royal Hallamshire Hospital, Sheffield; Richard Hobbs FRCP FRCGP Professor and Head of Primary Care and General Practice, University of Birmingham

Venous thromboembolism (VTE) remains a major cause of mortality and morbidity during acute medical illness. Despite clinical evidence indicating the substantial thromboembolic risk in general medical patients, particularly those with cardiorespiratory disease, management guidelines for thromboprophylaxis are not widely implemented. A greater awareness of the risks and effective risk stratification is essential – for both hospital physicians and GPs – to improve outcomes for acutely ill medical patients.

Andrew Radley MPhil MCPP MRPharmS Principal Pharmacist, Tayside NHS Trust

The initiation of anticoagulation has long been recognised as a particularly haphazard phase of treatment. Notably, there are many uncertainties as to how the patient will respond to starting doses and as to how quickly their dose can be adjusted to achieve an appropriate level of anticoagulation.