Thrombus - 2000

Treatment of atrial fibrillation in the elderly
Dr Will Lester
pp 1-4
The role of anticoagulation in primary and secondary prevention of ischaemic stroke due to atrial fibrillation (AF) is well established. Analysis of pooled data from five randomised controlled trials of primary prevention that began in the 1980s, demonstrated a 68% risk reduction for patients treated with warfarin, with virtually no increase in the frequency of major bleeding. Evidence for the efficacy of warfarin in AF has continued to accumulate, with similar benefits evident in secondary prevention. The superiority of adjusted dose warfarin over low-intensity fixed-dose warfarin and aspirin has also become clear.

Comment: What’s the problem with prothrombin?
Peter Rose
pp 2-2
This issue covers topics as diverse as the ever-increasing problems of atrial fibrillation in the elderly, to the rare but often catastrophic problems seen with cerebral venous thrombosis (CVT). CVT is seldom seen in routine clinical practice and rarely discussed outside the world of neurology. An encounter, however, with a case of cavernous sinus thrombosis in a teenager, secondary to staphylococcal infection of the face, left me determined never to be overconcerned about matters related to one’s own complexion. It is reassuring to read in this edition that cases secondary to infection are now declining with the exception of immunocompromised patients.

Interaction between tramadol and warfarin
Andrew J McGuire and David S Binnie
pp 5-6
In this article, we report on an apparent drug interaction between warfarin and tramadol (Zydol), which led to an increase in the INR of a patient in our care. The apparent interaction came to light after the 82-year-old female patient presented with a short history of pain in her right buttock, groin and thigh in December 1998. Specialist orthopaedic opinion indicated that this was referred pain from her right sacroiliac joint.

An anticoagulant outreach service – a viable alternative to hospitalisation
Carole Connor
pp 7-8
In just over two years, the anticoagulant nursing service at Birmingham Heartlands and Solihull NHS Trust has safely and appropriately managed over 1,000 patients through a hospital outreach service at home instead of in acute hospital beds.

Cerebral venous thrombosis
Damian Wren
pp 9-11
Cerebral venous thrombosis (CVT) was first recognised in the early 19th century. The first report is attributed to Ribes by Bousser, with a case in the puerperium described by Abercrombie in 1828. Since then there have been many reports and series published. Most were initially from postmortems. These led to the classic description of the disease – still given in some text books – of a severe and often fatal neurological disease, characterised clinically by headache, papilloedema, seizures, focal neurological deficits and coma, and pathologically by haemorrhagic venous infarction of the brain. This resulted in the view that anticoagulation would be contraindicated.

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)