Thrombus - 1999

Hepatic veno-occlusive disease following stem cell transplantation
Premini Mahendra
pp 1-4
The syndrome of hepatic venoocclusive disease (VOD) is one of the many regimen-related toxicities of high-dose chemo/radiotherapy and stem cell transplantation. VOD causes damage of zone 3 of the liver acinus resulting in hyperbilirubinaemia, jaundice and fluid retention. It usually presents within the first 30 days of the transplant. The reported incidence varies from between 5% and 50%; this wide variation is probably due to diverse diagnostic criteria and sample sizes used in different studies. It varies in severity from mild to severe, with multi-organ failure.

Comment: Management of DVT – secondary care
Peter Rose
pp 2-2
A general practice serving a population of 5,000 patients can expect to see no more than five new cases of DVT per annum, therefore many GPs may not see a single patient with a DVT within a 12-month period. In contrast, by developing the role of a nurse specialist within the hospital setting, regular review of over 200 new cases per annum would allow development of a degree of clinical expertise within the hospital service, which has not been previously available.

Use of D-dimer in deep vein thrombosis
Denise O'Shaughnessy and Martin Thomas
pp 5-5
DVT cannot be diagnosed by clinical means alone; it is well recognised that legs exhibiting signs of swelling and tenderness may be free of thrombus and apparently normal legs may contain extensive clot. The definitive tests of venography and duplex scan are both reliable techniques for confirming DVT. However, they both require time and expertise to perform. Up to 75% of patients referred to A&E or medical admissions wards with a clinically suspected DVT will not have a DVT confirmed after appropriate investigation. Such patients may receive initial anticoagulation treatment pending a definitive test.

Community phlebotomy – a service for vulnerable patients
Caroline Schlach and Jeanne Birchenhall
pp 6-7
The problem of ever-expanding anticoagulant clinics has occurred in Manchester in much the same way as it has around the rest of the country. In 1996, the Local Health Authority called together a group representing the three main hospital trusts in the city to look at possible developments that would accommodate the increasing demands of an anticoagulant service. After lengthy discussions it was agreed that each of the three trusts would be given £10,000 to run a pilot project. The projects would be audited and further developments would depend upon the outcome of these.

Epidurals, heparin and haematomas
Hugh Antrobus
pp 8-9
Bleeding in the vertebral canal can follow central nerve block. If a drug that impairs haemostasis is given at or about the same time it may make s haematoma more likely or bigger. Fortunately, serious consequences are rare. The combination of epidural analgesia and heparin thromboprophylaxis is becoming more common as Acute Pain Services expand, because the strongest indication for epidural analgesia often occurs in patients with the highest risk of thromboembolism. The risks and benefits of epidural analgesia were debated at the 6th National Pain Management Conference in Leicester on 1 March 1999.

Nurse-led outpatient management of DVT
Lindsey Murray
pp 10-11
DVT is an increasingly common condition with potentially serious complications. Traditionally, all patients with confirmed DVT were admitted to hospital for inpatient care. However, recent advances in drug treatment now allow patients to be treated on an outpatient basis. Treatment of DVT with anticoagulant drug therapy is aimed at preventing the two most common complications – clot extension and embolization.

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)