Volume 12, Number 3

Peter Rose, Editor

While many in the past 40 years have foretold of forthcoming new anticoagulants it does now appear that this new era has finally arrived. The holy grail has always been well defined, namely to develop an anticoagulant that can be taken orally, that does not require laboratory monitoring, does not interact with other medications (including alcohol), with a good safety profile.

David Fitzmaurice MBChB MRCGP MD FRCGP Professor of Primary Care Research, University of Birmingham; Janusz Kaczorowski BA MA PhD Associate Professor of Family Medicine, Univeristy of British Columbia

Tests are part of the diagnostic process that includes history, examination and investigation. It has been suggested that within primary care the first two of these processes are most important, yielding around 90% of diagnoses. The specificity of physical signs and symptoms tends to decrease as patients move along the diagnostic pathway from primary to secondary care, as patients in primary care often present with undifferentiated symptoms and signs, at an early stage in the disease process and with a wide differential diagnosis.

Andrew D Blann PhD FRCPath Consultant Clinical Scientist and Senior Lecturer, University Department of Medicine, City Hospital, Birmingham

In 2007 the government published three documents on the management of venous thromboembolism (VTE): the report of the independent expert working group (IEWG), Report 46 from the National Institute for Health and Clinical Excellence (NICE), and Alert 18 from the National Patient Safety Agency (NPSA).

Barry Hill CSci FIBMS Chief Biomedical Scientist, Blood Transfusion Department, Wigan Royal Infirmary

There is no doubt that the now ready availability of blood components such as fresh frozen plasma (FFP) has made a significant contribution to the treatment of haematological bleeding disorders and management of uncontrolled bleeding during trauma situations. However, despite these proven benefits to patients, several safety issues and concerns regarding inappropriate usage, viral or bacterial transmission risks, variant Creutzfeldt–Jakob disease (vCJD) considerations and immune complications of transfusion surround their deployment.

Elizabeth A Warburton MA MBBS DM MRCP Consultant in Stroke Medicine, Department of Clinical Neurosciences, Cambridge University, NHS Foundation Trust, Cambridge; Philip L Clatworthy MB/BChir MA MRCP MRC Training Fellow, Department of Clinical Neurosciences, Cambridge University, NHS Foundation Trust, Cambridge

Stroke is the leading cause of disability in the UK, and a leading cause of death. Thrombolysis using intravenous recombinant tissue plasminogen activator (rt-PA) is the only licensed and proven therapy for acute stroke. If administered early (within three hours of symptom onset), this can reduce death and disability due to ischaemic stroke by about one-third.