Thrombus - 2015

New trends in the imaging of deep venous thrombosis: differentiating acute from chronic
Matthew Jaring and Paul McCoubrie
pp 17-21
A thrombus is a consequence of disruption to the normal vascular environment, as depicted by the classic triad, described by Virchow in 1856, of hypercoagulability, stasis and vessel wall injury. A thrombus can be problematic in the location in which it formed, as with deep vein thrombosis (DVT), or at a distant site, as with a pulmonary embolism, the much feared consequence of DVT. Thromboembolisms can occur in both the arterial and venous systems; however, this article will focus on venous thromboembolisms, specifically DVT.

Comment: Red cell parameters in VTE disease: can I be bothered?
Peter Rose
pp 18-18
It is common practice to check a full blood count, and automated red cell parameters, at presentation with suspected venous thromboembolic disease. You may well question why as, apart from a very high or low haemoglobin that are helpful in identifying polycythaemia or anaemia and blood loss, the red cell parameters are largely ignored. There is, however, quite a lot to be gained on closer inspection of red cell parameters.

Can primary care help to prevent 25,000 deaths per year?
David A Fitzmaurice
pp 22-23
Figures show that hospital-associated thrombosis kills more people in the UK than breast cancer, HIV/AIDs, road traffic accidents and MRSA, combined. The startling figure is said to be around 25,000 deaths per year in the UK, yet very few people outside the hospital setting seem to be aware of it. The most likely reason given as a cause of venous thrombosis would undoubtedly be ‘air travel’, despite high-profile victims following surgery, such as Serena Williams, Andrew Flintoff and Paul Robinson.

How long should you anticoagulate new VTE cases?
David Keeling
pp 24-24
A finite period of anticoagulation is required to treat acute venous thromboembolism. Thereafter, continued anticoagulation may be recommended to prevent late recurrence (ie, new future blood clots). The benefit of anticoagulation continues only for as long as therapy is continued; therefore, continued anticoagulation effectively equates to long-term treatment.

Reversal of non-vitamin K oral anticoagulants
Jecko Thachil
pp 25-27
Non-vitamin K antagonist oral anticoagulants (NOACs) are a major advancement in the anticoagulation landscape. Compared with conventional drugs, such as heparins and coumarin derivatives, they have the practical advantages of rapid onset of action and shorter half-lives. These factors can be relevant in the management of patients with thrombotic tendencies who may also have increased bleeding risks. In this article, details about the reversal of the currently licensed NOACs, the anti-Xa agents rivaroxaban and apixaban, and the anti-IIa agent dabigatran are discussed. These include a summary of the bleeding risks associated with NOACs, the situations where reversal of NOACs may be required, bleeding management in these patients, and a snapshot of the reversal agents available.

The pharmacist’s view of NOACs for atrial fibrillation
Helen Williams
pp 28-31
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, affecting about 1.6% of the population. Since the risk of AF increases with age, it is estimated that the AF population will double by 2050 as life expectancy increases. The main health burden associated with AF is the increased risk of stroke, with around 12,500 cases per year in the UK being directly related to AF.

Spring 2015, Volume 19 Number 1

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)