Volume 12, Number 4

Louise Knowlson MB ChB BSc ST2 in CMT, University Hospital of Coventry and Warwickshire; Katie Randall MB ST3 in Haematology, Queen Elizabeth Hospital, Birmingham

Disseminated intravascular coagulation (DIC) is a complicated, life-threatening condition that is usually coupled with an equally serious underlying cause. In this article, the diagnosis of patients with DIC and practical issues in the management of this diverse group are discussed.

Peter Rose, Editor

The benefit in symptomatic atrial fibrillation (AF) of oral anticoagulant therapy is well established in clinical trials. Overall, stroke is five to six times more prevalent in patients with AF, with a 1% risk per year for patients over 65 years with no risk factors, rising to 12% per year for patients over 65 years with previous stroke, transient ischaemic attack (TIA) or venous thromboembolic disease. Furthermore, stroke in AF patients is associated with a greater mortality, morbidity, disability and longer inpatient admissions.

Samreen Siddiq MB BCh MRCP Specialist Registrar in Haematology; Owen Williams PhD MRCP MRCPath Consultant in Microbiology and Infectious Diseases; Andrew Mumford MB ChB PhD MRCP MRCPath Senior Clinical Lecturer in Haematology, Bristol Royal Infirmary

Thrombosis of the internal jugular vein (IJV) is an uncommon condition that is usually associated with direct trauma from indwelling venous catheters, or through intravenous drug abuse. Less commonly, IJV thrombosis may be precipitated by localised sepsis in oropharyngeal tissues adjacent to the IJV. This association has been variously described as necrobacillosis or postanginal septicaemia, although it has latterly attracted the eponymous title of Lemierre’s syndrome (LS) – in recognition of the French physician who first described the condition systematically in 1936.

Peter Rose FRCP FRCPath Consultant Haematologist, Department of Haematology; Grace O’Hare Clinical Nurse Specialist, Department of Haematology, Warwick Hospital

The modern day management of venous thromboembolism (VTE) is best undertaken using a multidisciplinary approach. This involves a formal assessment with core members providing the clinical, diagnostic and treatment input to the management plan. It is important that the diagnosis is confirmed, as radiological investigations can often be misinterpreted. Each patient requires a risk assessment for recurrence of VTE and bleeding risk.

David Fitzmaurice MBChB MRCGP MD FRCGP Professor of Primary Care Research, University of Birmingham

Oral anticoagulation management is a complicated business because of the nature of oral anticoagulants. Not only do they have a very narrow therapeutic window, they are also affected by numerous drugs, foods, alternative medications and, of course, alcohol.