Volume 6, Number 4

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

The use of oral anticoagulant therapy has significantly increased over the last decade, both for prophylaxis and treatment of venous thromboembolic disease and for atrial fibrillation. Even well controlled patients spend only 70% of the time in their therapeutic range1 and overanticoagulation is a common problem that significantly increases the patient’s risk of bleeding.2 There are many variables associated with an increased risk of bleeding, as shown in Table 1.

Peter K MacCallum MD FRCP FRCPath Senior Lecturer and Honorary Consultant Haematologist, Barts and The London, Queen Mary’s School of Medicine and Dentistry, London

Venous thromboembolism (VTE) is a common and potentially life-threatening problem. The annual incidence of VTE in North American and European populations is about one per 1,000 per year.1,2 Like many disorders the incidence is age-related, ranging from about one in 10,000 per year in young adults (and even less in children) to approaching 1% per year in the elderly. In a Swedish study of men followed prospectively between the ages of 50 and 80, pulmonary embolism was responsible for about 4% of deaths.3

Peter Rose, Editor

Survival in patients with known malignancy at the time of presentation of deep vein thrombosis (DVT) is worse than in patients with a similar malignancy who show no evidence of venous thromboembolic disease. The survival rate is notably poor among patients with malignancy and DVT compared with those with no malignancy at the time of DVT diagnosis.

James Kelly MRCP Research Fellow; Beverley J Hunt MD Consultant, Department of Haematology, Guy’s & St Thomas’ Trust

The number of patients with suspected venous thromboembolism (VTE) referred for evaluation has increased since the advent of venography and pulmonary angiography 30 years ago, while the proportion with confirmed disease has fallen.1 This is a reflection of three factors. First, some form of objective testing is always required once the clinician has reasonable suspicions that a patient may have VTE as clinical features alone cannot exclude or confirm the diagnosis.

Anne Szarewski MBBS DRCOG PhD MFFP Clinical Consultant, Cancer Research UK; Senior Clinical Medical Officer, Margaret Pyke Centre, London

On 29 July, the Honourable Mr Justice Mackay handed down his judgement in the group action against the manufacturers of third-generation combined oral contraceptive (COC) pills.1 He concluded, ‘I find that there is not as a matter of probability any increased relative risk of VTE carried by any of the third generation oral contraceptives supplied to these Claimants by the Defendants as compared with second generation products containing levonorgestrel’.2