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Volume 10, Number 2 |
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| Training for anticoagulation management |
David Fitzmaurice, Editorial Board Member and Director of the National Centre for Anticoagulation Training |
One of the frustrations of working within the area of thrombosis and haemostasis has been the lack of recognition of the importance of anticoagulation therapy. For example, a 68% reduction in the risk of stroke for patients with atrial fibrillation makes warfarin one of the most powerful therapeutic interventions we have.1 Despite this, and possibly because warfarin is not a patented drug, it is only recently that anticoagulation services have been taken seriously; for example, with their inclusion in the new Quality and Outcomes Framework for primary care. |
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| Inferior vena caval filters: current concepts |
Hasan I Hasan MRCP FRCR Specialist Registrar in Radiology Matthew B Matson MRCP FRCR Consultant Vascular and Interventional Radiologist, Royal London Hospital |
Venous thromboembolism (VTE) is a major cause of morbidity and mortality worldwide, with an estimated incidence of 100 per 100,000 population per year.1 Pulmonary embolism (PE) is the most dangerous complication of VTE and arises due to thrombus propagation from deep vein thrombosis (DVT), usually from the lower limbs or pelvis. |
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| Use of low molecular weight heparins in the long-term treatment of VTE |
Marios E Daskalopoulos MD MSc DIC Consultant Vascular Surgeon, Department of Vascular Surgery, First Hospital of Athens, Greece; Christos D Liapis MD FACS FRCS Director, Department of Vascular Surgery, University of Athens, Greece |
Low molecular weight heparins (LMWHs) have successfully replaced unfractionated heparin (UFH) both in the prevention and in the initial treatment of deep venous thrombosis (DVT) and pulmonary embolism (PE).1 Current research is focused on evaluation of the effectiveness, safety and cost-effectiveness of LMWHs in the long-term treatment of venous thromboembolism (VTE) compared with conventional treatment with UFH followed by oral anticoagulants (OAs). |
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| The validity of pre-test probability scoring to predict PE in routine practice |
P Jayne Norcliffe MRCP Specialist Registrar, Churchill Hospital, Oxford; Christopher WH Davies MD FRCP Consultant Physician, Royal Berkshire and Battle Hospitals NHS Trust, Reading |
Pre-test probability (PTP) scoring, such as the Wells score, may help estimate the likelihood of pulmonary embolism (PE) before diagnostic tests are performed and may exclude PE without the need for further investigation. The British Thoracic Society (BTS) has published a PTP scoring system – which has not yet been validated – in its guidelines for management of PE.1 This study assesses the validity of the BTS and Wells PTP scores in a UK population. |
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| A problem of recurrent DVT despite adequate treatment with warfarin |
Sarah Bond MRPharmS MScClinPharm Specialist Anticoagulant Pharmacist, Great Western Hospital, Swindon |
A 59-year-old man who is paraplegic as a result of transverse myelitis suffered his first deep vein thrombosis (DVT) in 1997 and had radiologically confirmed pulmonary embolism (PE) soon afterwards in 1998. As a result of this, he was recommended for long-term treatment with warfarin at a target international normalised ratio (INR) range of 2–3. |
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