Volume 11, Numer 2

Peter Rose, Editor

In anticoagulant services, as in so many things in life, nothing seems to happen for long periods only for three buses to come along at the same time. Anticoagulant services are now facing difficult decisions as to which initiative to comply with first. In the space of a few months there have been three new developments. The first was the National Patient Safety Agency (NPSA) producing much-needed guidance to improve patient safety for the 900,000 UK patients on oral anticoagulant therapy.

Bruce Warner BSc MSc DPharm MRPharmS Senior Pharmacist, National Patient Safety Agency, London

Anticoagulants have been highlighted as one of the groups of medicines most likely to cause harm to patients. Much of this harm is the result of avoidable medication error, as demonstrated by both the published literature and reports to the National Patient Safety Agency (NPSA) National Reporting and Learning System (NRLS). Indemnity and litigation bodies also identify anticoagulants as a major source of claims resulting from error.

Sarah Bond MRPharmS MSCClin Pharm Specialist Anticoagulant Pharmacist; E Sarah Green MA FRCP FRCPath Consultant Haematologist; Lyn Williamson MA FRCP Consultant Rheumatologist, Great Western Hospital, Swindon

There is a misconception among patients that herbal medicines are safe and do not interfere with prescribed medicines. However, many have been shown to directly interact, or have the potential to interact, with oral anticoagulants and others may have an antiplatelet effect. The use of complementary therapies is increasing and herbal medicines represent the most popular branch of treatment.

Roopen Arya MA PhD FRCP FRCPath Consultant Haematologist, King’s College Hospital, London

The Chief Medical Officer (CMO) for England, Sir Liam Donaldson, recently published the report of the independent expert working group on the prevention of venous thromboembolism (VTE) in hospitalised patients. This is the culmination of a political process initiated in March 2005 by the publication of the House of Commons Health Committee report that concluded that much more needed to be done to prevent avoidable deaths from VTE.

Carol Arbuthnot MBChB MRCP MRCPath Specialist Registrar in Haematology; Will Lester MBChB MRCP MRCPath Consultant Haematologist, University Hospital Birmingham

Warfarin has been in clinical use for over 60 years. The National Institute for Health and Clinical Excellence (NICE) recommends that 1.4% of the population in the UK require anticoagulant therapy. Curiously, there are still no published data from randomised trials to inform clinicians about the most effective management strategies for oral anticoagulation in the perioperative period.