Volume 13, Number 3

Neil Rane MA MB BChir Specialist Registrar in Radiology, John Radcliffe Hospital, Oxford; Nick Chalmers FRCR Consultant in Interventional Radiology, Manchester Royal Infirmary, Manchester; Raman Uberoi FRCR Consultant in Interventional Radiology, John Radcliffe Hospital, Oxford

The standard treatment for deep vein thrombosis (DVT) and for prevention of pulmonary embolism (PE) is systemic anticoagulation with low molecular weight heparin followed by oral warfarin. Without treatment, patients with venous thromboembolism (VTE) are at high risk of developing PE, which can be fatal in up to 25% of patients.

Peter Rose, Editor

The latest treatment to emerge in the struggle to find new and safe anticoagulant treatments is dabigatran, a direct thrombin inhibitor currently licensed in the UK for thromboprophylaxis following hip and knee surgery, as detailed in this issue. Since ximelagatran sank without trace following adverse liver events highlighted with prolonged administration, long-term safety issues remain a priority for agents in development.

Helen Gray MSc MIBMS Specialist Biomedical Scientist, Anticoagulant Department, Stepping Hill Hospital, Stockport

National Patient Safety Agency (NPSA) patient safety alert 18: Actions that can make anticoagulation therapy safer highlighted the variability of warfarin dosing systems used throughout the UK. Recommendations were made that all doses should be in mg, using mixed sizes of tablets in order to achieve a constant daily dose with the minimum number of tablets. Within the anticoagulant community, there has been much debate as to whether the recommendations are advisable or achievable and it is unlikely that a true consensus will be established.

Ann J Davenport RN RM Lead Thrombosis Nurse Specialist, Thrombosis Treatment Team, Addenbrooke’s Hospital, Cambridge

Venous thromboembolism (VTE) is a medical condition caused by the formation of blood clots. It manifests clinically as deep vein thrombosis (DVT) and pulmonary embolism (PE). It occurs for the first time in about 100/100,000 patients each year in the USA. About one-third of patients with symptomatic VTE manifest PE, whereas two-thirds manifest DVT alone. Death occurs in about 6% of DVT cases, and in 12% of PE cases within one month of diagnosis.

Chee W Khoo MRCP Research Fellow; Kok-Hoon Tay MRCP Research Fellow; Eduard Shantsila MD Research Fellow; Gregory YH Lip MD FRCP Professor of Cardiovascular Medicine, University of Birmingham Centre for Cardiovascular Science, City Hospital, Birmingham

The current gold standard oral anticoagulant therapy (OAC) is warfarin, the most commonly prescribed OAC worldwide for various thromboprophylactic and therapeutic indications (atrial fibrillation [AF], mechanical heart valves and pulmonary emboli). The usefulness of warfarin, however, is overshadowed by its problems of unstable pharmacokinetics and pharmacodynamics, which can lead to bleeding complications.