Thrombus - 2009

Should patients with venous thrombosis have cancer screening?
Raj K Patel
pp 1-4
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.Where occult cancer is present, it is metastatic in 40–60% of cases.7,9,10 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

Comment: Problems with implementing NPSA alert 18
Peter Rose
pp 2-2
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). Many of us are currently suffering from NPSA ‘alertitis’, with alerts on numerous medications requiring treatment plans and rapid action.

Orally active antithrombotic agents: a new era in the prevention of VTE
Simon P Frostick
pp 5-6
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. In a Phase II dose-ranging study for TKR patients, there was reduction of venous thromboembolism (VTE) events in the apixaban groups, but also a statistically significant increase in bleeding associated with the drug.

Developing a national risk assessment model to prevent VTE in hospital
Trevor Baglin
pp 7-9
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). Among seven million patients discharged from nearly 1,000 US acute care hospitals, postoperative VTE was the second most common complication, the second most common cause of excess length of stay, and the third most common cause of excess mortality and excess cost.

Self-management of oral anticoagulation and quality assurance
Ellen Murray, Ian Jennings and David Fitzmaurice
pp 10-12
Patient self-management of oral anticoagulant therapy using point-ofcare (POC) devices has the potential to become as routine as diabetes selfmonitoring. 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.

Update on NPSA patient safety alert 18
Rosalind Perrott
pp 14-15
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.

Thrombus was previously supported by Bayer from 2014 to 2016, by Boehringer Ingelheim from 2009 to 2013, by sanofi-aventis from 2007 to 2008 and by Leo Pharma from 1998 to 2006.

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ISSN 1369-8117 (Print) ISSN 2045-7855 (Online)