Thrombus - 2001

Antiplatelet agents and ischaemic heart disease
Sarah L Alford
pp 1-5
Unstable angina, non-Q-wave myocardial infarction (MI) (or non-ST segment elevation MI) and Q-wave MI are all acute manifestations of ischaemic heart disease. Atheromatous plaque rupture is often the underlying pathological precipitant with consequent platelet activation, thrombus formation and vessel occlusion. Platelets are a significant component of this thrombus and may remain activated for at least one month post-presentation. Primary therapy is directed at reopening the vessel and reestablishing perfusion, which must subsequently be maintained. Antiplatelet agents are increasingly used in all of these areas.

Cancer and thromboembolic disease
Peter Rose
pp 2-2
In approximately 20% of new cases of deep vein thrombosis (DVT) there is a history of underlying malignancy. In these cases the management of the malignancy is complicated by the need for anticoagulation, while the prethrombotic state resulting from the malignancy can alter anticoagulant requirements. Little is known about the optimal management of this group of patients. Current research is focused on identifying increasingly rare heritable causes of thrombophilia to satisfy the interest of haematologists and geneticists alike, with little input into this common cause of DVT.

Anticoagulant results by voicemail
Paul L Cervi and Robert Duck
pp 6-7
At Basildon and Thurrock we have delivered more than 13,000 INR results by phone to our active client population (nine months after introduction; 1,755 evaluable patients, 51% over 70 years age). There are 1,419 (81%) patients using the system regularly, with 336 (19%) non-users.

Anticoagulation and osteoporosis
Sandra Young Min
pp 8-9
Increasing numbers of the population are taking long-term anticoagulation and this looks likely to continue. Although haemorrhage remains the main side-effect of anticoagulation, the occurrence of osteopenia and osteoporosis may be related to anticoagulation. Heparin is indicated for acute thromboembolic events before establishing oral anticoagulation. It is also used prophylactically for surgery when there is a perceived risk of thrombosis. There are no reports of osteoporosis after short-term use for such indications. Long-term heparin is used when anticoagulation is required during pregnancy because of its inability to cross the placenta, thus avoiding warfarin-induced embryopathy.

Nurse-led thrombophilia clinics
Kath Yates
pp 10-11
At Southampton University Hospitals Trust (SUHT) there has been the continuing problem of growing numbers of referrals from GPs and consultants for thrombophilia screening. Thrombophilia clinics were held three times per month, but as referral numbers grew the clinics became increasingly booked up, resulting in fewer and fewer ‘new patient’ slots. Once referrals were sent for thrombophilia screening, the patient was sent a form asking them to attend the haematology outpatient department for a blood test.

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)