Volume 9, Number 2

Tony Todd MB ChB MRCP Specialist Registrar in Haematology, Addenbrooke’s Hospital, Cambridge

Buerger’s disease was first described by the German physician, von Winiwarter1 in 1879, although it is named after Leo Buerger, Professor of urological surgery at the Mount Sinai Hospital in New York. In 19082 he published a detailed description of the disease and the pathological findings in 11 limbs amputated from young Jewish men. However, it was not until the late 1960s that the disease was universally accepted as a distinct clinical condition.

Peter Rose, Editor

D-dimer assays are commonly used as part of the screening assessment for patients with suspected venous thromboembolic disease (VTE). The assay results are best interpreted in conjunction with a formal clinical probability score. As D-dimer levels may be raised in many acute medical conditions, the clinical consensus is that the only useful D-dimer assay is a negative result that has a high negative predictive value for VTE.

Isabelle Gouin-Thibault PhD; Virginie Siguret PhD Laboratoire d’Hématologie; Eric Pautas MD Médecine Interne, Gériatrie, Hôpital Charles Foix (University Hospital of Paris), Ivry/Seine, France

The incidence of acute thromboembolic events increases with age. The number of elderly patients treated with low molecular weight heparins (LMWHs) at therapeutic dose is rising steadily as the population ages.1,2 Meta-analysis of randomised trials has shown that LMWHs given at a bodyweight-adjusted dose, once or twice daily, are at least as safe and effective as unfractionated heparin (UFH) in the initial treatment of deep vein thrombosis (DVT), non-life-threatening pulmonary embolism (PE),3–5 and for the management of patients with acute coronary syndromes (ACS).6–8

Christopher Davies MD FRCP Consultant Respiratory Physician, Department of Respiratory Medicine, Royal Berkshire and Battle NHS Hospitals Trust, Reading

Pulmonary embolism (PE) is a potentially fatal disease requiring early and accurate management and is a frequent reason for assessment in hospital.1,2 The principal treatment for confirmed PE has been the administration of heparin, followed by oral anticoagulation, such as warfarin. This treatment is still predominantly administered, while patients are admitted as inpatients due to the perceived risk of mortality from PE.

Jenny Voke MBBS FRCPath Consultant Haematologist, East and North Hertfordshire NHS Trust and Luton and Dunstable Hospital NHS Trust

In pregnancy, acute venous thromboembolism (VTE), including deep vein thrombosis (DVT), pulmonary embolism (PE) and rarer events, such as cerebral venous thrombosis (CVT), pose different, less familiar problems from those encountered in non-pregnant patients, and require specialist input to ensure the safety of both mother and baby. Many hospitals encounter fewer than five antenatal patients with VTE per year; therefore, the management of these patients is challenging, due to limited local experience and the lack of evidence on which to base guidelines.