Volume 13, Number 2

Caroline Baglin RGN Thrombophilia Nurse Specialist, Addenbrooke’s Hospital, Cambridge

Deep vein thrombosis (DVT) and pulmonary embolism (PE) can be triggered by a variety of risk factors. Using the iliofemoral vein by intravenous drug users is considered to be a significant cause. However, many anticoagulant service staff say intravenous drug users do not present with venous thromboembolism (VTE) to their service. It is thought the reason for this is that these patients do not continue with treatment and do not attend anticoagulant clinics. It is difficult for anticoagulant staff to share their experience of caring for these patients due to the small number attending each service. Also, there have not been any randomised, controlled trials of this group of patients and no grade A recommendations are available.

Peter Rose, Editor

In this edition of Thrombus, practical advice is given for the implementation of hospital inpatient thromboprophylaxis. The recent production of a template for thromboprophylaxis is to be considered a substantial step forward; however, from local experience, production of a form for thromboprophylaxis assessment, and its distribution to all wards, does not equate with assessments actually undertaken or thromboprophylaxis actually prescribed.

Anne M Sermon MSc Biomedical Scientist, Department of Coagulation, Northern General Hospital, Sheffield; Steve Kitchen PhD Clinical Scientist, Coagulation Department, Royal Hallamshire Hospital, Sheffield

The international normalised ratio (INR) and the international sensitivity index (ISI) systems were developed as ways to standardise the prothrombin time (PT) during the monitoring of patients undergoing oral anticoagulant therapy with vitamin K antagonists (VKAs) such as warfarin. The wide acceptance of the INR has led to its use in other clinical scenarios, including as one of three parameters in the Model for End-Stage Liver Disease (MELD) scoring system (to aid the prioritisation of patients for liver transplant). Recently published literature has highlighted the potential inadequacy of the INR system in this context.

Catherine Bagot MB BS MD MRCP FRCPath Senior Clinical Research Fellow, King’s Thrombosis Centre, King’s College Hospital, Denmark Hill, London

In June 2008, a new edition of the American College of Chest Physicians (ACCP) guidelines, Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition), was published. This article reviews the chapter Prevention of Venous Thromboembolism.

John Pasi MB ChB PhD FRCP FRCPath FRCPCH Professor of Haemostasis and Thrombosis, Barts and The London NHS Trust

Venous thromboembolism (VTE) is a major public health issue. Each year, more than 25,000 people in the UK die as a result of VTE that occurs in hospital. This is more than the combined total of deaths from breast cancer, AIDS and traffic accidents, and five times the number who die from methicillin-resistant Staphylococcus aureus (MRSA). Not only is the human cost of this huge, so is the financial cost to the nation: it is estimated the total cost of VTE morbidity to the UK is over £600 million per annum. Despite shorter hospital stays, with an increase in the number of surgical operations, cancer treatments and cases of obesity within the general population, it is probable that the cost of VTE will rise if appropriate preventive strategies are not used.

David A Fitzmaurice MD FRCGP Professor of Primary Care, Primary Care Clinical Sciences, University of Birmingham

Pulmonary embolism (PE) is one manifestation of venous thromboembolism (VTE), and can vary in its clinical presentation from sudden death to acute shortness of breath. At its most severe, PE is associated with significant mortality and morbidity, including pulmonary hypertension.