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Volume 13, Number 1 |
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| Orally active antithrombotic agents: a new era in the prevention of VTE |
Simon P Frostick MA DM FRCS Professor of Orthopaedics, University of Liverpool |
As warfarin was introduced as an oral antithrombotic agent 60 or so years ago, the arrival of new orally active antithrombotic agents represents a significant advance. So far, two agents have been licensed for the prophylaxis of orthopaedic patients undergoing total hip replacement (THR) or total knee replacement (TKR): dabigatran (Pradaxa®, Boehringer Ingelheim, UK) and rivaroxaban, (Xarelto®, Bayer AG, UK). A third drug, apixaban (Pfizer, UK), has completed a Phase III trial, but failed to achieve non-inferiority (NI) in THR patients. |
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| Problems with implementing NPSA alert 18 |
Peter Rose, Editor |
Anticoagulant management is ultimately predestined to fail. Any system that requires correct sample analysis, reporting of results, data interpretation, communication, patient understanding and compliance will, on occasions, fail. The recent National Patient Safety Agency (NPSA) alert, aims to minimise these failures (see Rosalind Perrott’s article on page 14 of this issue for further insights). |
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| Should patients with venous thrombosis have cancer screening? |
Raj K Patel MD MRCP FRCPath Consultant Haematologist, King’s Thrombosis Centre, King’s College Hospital, London |
Ten per cent of patients with idiopathic venous thromboembolism (VTE) will have underlying occult malignancy, and there is a threefold increased risk of new cancer diagnosis in the months following VTE diagnosis.1–8 Where occult cancer is present, it is metastatic in 40–60% of cases. The issue of whether or not to screen patients with acute VTE for occult cancer at diagnosis is controversial, and there is no consensus on how extensive any screening programme should be. Few studies have addressed the cost, safety, psychological stress and health benefits associated with extensive screening strategies. |
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| Update on NPSA patient safety alert 18 |
Rosalind Perrott MRPharmS Senior Anticoagulation and Clinical Thrombosis Pharmacist, King’s College Hospital, London |
The National Patient Safety Agency (NPSA) published patient safety alert 18, Actions that can make anticoagulation therapy safer, in March 2007. The alert was issued in response to a risk assessment of UK anticoagulation services, which highlighted many areas of high risk. The target date for implementation was 31 March 2008. |
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| Self-management of oral anticoagulation and quality assurance |
Ellen Murray PhD Research Fellow, Department of Primary Care, University of Birmingham; Ian Jennings PhD CSci FIBMS Scientific Programme Manager, UK National External Quality Assessment Service; David Fitzmaurice MBChB MRCGP MD FRCGP |
Patient self-management of oral anticoagulant therapy using point-of-care (POC) devices has the potential to become as routine as diabetes self-monitoring. However, there are concerns that POC devices outside the laboratory setting, particularly those used by patients, can be inaccurate due to analytical error (in part due to lack of knowledge about quality assurance procedures). Please note, this article is based on a previously published report. |
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| Developing a national risk assessment model to prevent VTE in hospital |
Trevor Baglin MA MB ChB PhD FRCP FRCPath Consultant Haematologist, Cambridge University Hospitals NHS Trust |
VTE (venous thromboembolism) describes deep vein thrombosis (DVT) with or without symptomatic pulmonary embolus. Recent hospitalisation for surgery or medical illness is responsible for approximately half of all cases of VTE. In addition, approximately half of all hospitalised patients are at risk of VTE and one in ten hospital deaths are due to pulmonary embolism (PE). |
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