Thrombus - 2004

The anticoagulated patient undergoing dental surgery
Pippa K Blacklock
pp 1-4
Many of the large numbers of patients on warfarin still have their own dentition and continue to require dental treatment. However, recent changes in guidelines and differences in advice offered by the varied involved specialties often leads to confusion and a lack of consensus in the management of this group of patients. The fact that a patient is on warfarin should not exclude them from having routine treatment and simple surgery in the dentist’s practice. This article will cover recent guidelines, advise on which patients should be treated in primary care or referred to the hospital team and discuss the management of the warfarinised patient undergoing a surgical dental procedure (tooth extraction). It is imperative that for each patient the risk of perioperative and postoperative bleeding is balanced against their individual risk of thromboembolism. Most postoperative bleeding following dental surgery can be controlled with local measures.

Thrombosis in PNH and PV
Peter Rose
pp 2-2
Just as most physicians can recall the only case of phaeochromocytoma presented to them, so most haematologists find immense satisfaction in diagnosing paroxysmal nocturnal haemoglobinuria (PNH).

Beware the superwarfarins
Malcolm Tait
pp 5-6
With the number of rodents increasing during summer and with the extended period of warm weather experienced in the UK last summer, there has been a significant increase in the rodent population. Consequently, the use of rodenticides has risen, with an estimated 70% of UK farms now using them. Almost all currently registered rodenticide products contain an anticoagulant. Due to their wide availability, accidental or deliberate human ingestion is not uncommon and may lead to long-term coagulopathy (13,345 exposures were reported in the USA during 1996).1 The majority of cases occur in children and are due to accidental poisoning. In adults, most of the cases occur as a result of deliberate ingestion, either due to a suicide attempt or in patients with Munchausen’s syndrome, and occasionally cases of industrial exposure or accidental poisoning have been reported.

Venous thromboembolic events and malignancy – a varied approach
Myles Bradbury
pp 7-8
Venous thromboembolism (VTE) is a common problem in patients with malignancy and is a significant cause of morbidity and mortality. It also appears to be a more aggressive disease process when compared with thrombosis in patients without malignancy. Despite its negative effect on outcome, the perceived risk, prevention and treatment of VTE varies among different specialties treating malignancy and among peers.

Chocolate or aspirin? Cocoa as thromboprophylactic agent
Louisa Brown, Nichola Biggs, Timothy Farren, Cedric Ghevaert and Denise O’Shaughnessy
pp 9-11
Cocoa has recently been shown to have an antiplatelet activity. It is thought that this effect is mediated by the flavonoids contained in chocolate, which have aspirin-like properties. If these findings are confirmed, chocolate could potentially be used as an alternative to aspirin in thromboprophylaxis. This idea would be especially attractive in situations such as deep vein thrombosis (DVT) prevention in air passengers.

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)