Thrombus - 2005

Anticoagulation in advanced malignancy
Simon Noble
pp 1-4
Patients with cancer are at high risk of venous thromboembolism (VTE) and the prothrombotic risk increases with disease progression. The prevalence of clinically apparent VTE in cancer patients is up to 15%. The actual incidence is much higher, with post-mortem studies demonstrating VTE in up to 50% of cancer patients. Patients admitted to specialist palliative care units (SPCUs) are at particularly high risk of VTE. A study of 298 consecutive cancer patients admitted to an SPCU found a 52% incidence of deep vein thrombosis (DVT) on admission. Of those diagnosed with asymptomatic DVT, 32% went on to develop symptoms (p<0.001) and 13% had symptoms suggestive of pulmonary emboli (p<0.02) over a median 36-day follow-up.

Comment: Can leeches prevent HUS?
Peter Rose
pp 2-2
Infection with Escherichia coli 0157:H7 may result in haemorrhagic colitis, but for a small number of patients the disease progresses to the haemolytic uraemic syndrome (HUS). This syndrome is associated with a micro-angiopathic haemolytic anaemia, thrombocytopenia and renal failure. The disease represents the most common cause of acute renal failure in children and, while the clinical effects are often reversible, it can result in long-term morbidity. Unfortunately, it remains difficult to predict which patients are at greatest risk of developing the full-blown syndrome and which patients would, therefore, benefit from strategies to prevent progression to HUS.

Affording new drugs in the NHS
Christopher Newdick
pp 5-6
New drugs are often extremely effective, but they are also expensive. How does the law balance individual patients’ interests with the interests of the community as a whole? What legal framework governs the introduction of new drugs into the NHS? Let us start with a basic question: is rationing inevitable in the NHS? After all, the government has promised increased funding and, soon, the NHS will spend almost £1,800 per person per year.1 Waiting times are coming down and patients will soon have more choice about where they will be treated. Is rationing really a problem?

Nurse-led management of inpatient warfarin dosage
Fran Pressley
pp 7-8
Plans have been initialised to change practice in the Royal Gwent Hospital (part of the Gwent Healthcare Trust) for the management of inpatients receiving warfarin therapy. At present, the anticoagulant nurse service (ACNS) has taken over the warfarin management and adjustment of five acute medical wards, with plans to eventually offer this service to the whole of the adult hospital population. This article discusses how the service has been implemented thus far.

Ethnic communities and venous thrombosis
Raj K Patel and Roopen Arya
pp 9-11
In populations of European origin, the epidemiology and risk factors for venous thromboembolism (VTE) are well characterised but such data are scanty for other ethnic groups. Traditionally, venous thrombosis has been recognised as a condition confined to the populations of Europe, this has been strengthened by the lack of diagnostic services in developing countries and the low incidence of known hereditary prothrombotic mutations in non- Europeans. Recent data, however, confirm that venous thrombosis is prevalent across a variety of different racial groups.

Autumn 2005, Volume 8 Number 3

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)