Thrombus - 2016

Can direct oral anticoagulants be used in patients who experience hair loss with warfarin?
Magdalena M Watras
pp 17-20
Alopecia was initially reported as an adverse effect with anticoagulants in the 1950s – first with unfractionated heparin and then with the oral coumarins, with reported incidences of 54–66% and 30–40% respectively. Since then, all anticoagulants have been implicated with causing alopecia to some extent and it has been listed as a side-effect in the summaries of product characteristics of the heparins and warfarin. With the recent availability of direct oral anticoagulants (DOACs) and their widespread use in clinical practice, it is of interest to know if the DOACs are likely to be implicated and, thus, whether or not they could be successfully prescribed for patients who suffer from coumarin-or heparin-related alopecia.

Comment: Medicine, rarely a solitary clinical issue
Peter Rose
pp 18-18
An evidence–based approach to medicine is helpful in improving care of individual clinical conditions. A good example is the management of stroke risk in patients with atrial fibrillation (AF). There is ample guidance as to which patients would and would not benefit from anticoagulation for stroke prevention, together with evidence on the best therapeutic approaches. Unfortunately, medicine is seldom straightforward and rarely comes as discreet issues. Up to a third of patients with AF will also have problems with coronary artery disease (CAD). There is good evidence for CAD management to include antiplatelet therapy. However, when used in conjunction with anticoagulation, it further increases the risk of adverse bleeding events to a level that concerns many. Unfortunately evidence–based medicine has clearly shown that antiplatelet therapy is of no overall benefit for stroke prevention in patients with non-valvular AF, hence the need for combined anticoagulant and antiplatelet therapy for certain patients with CAD and AF.

Twenty years of deep vein thrombosis management in the community
Peter Rose
pp 21-22
The first issue of Thrombus, published 20 years ago, included a consensus review of deep vein thrombosis (DVT) treatment in the community. The topic is revisited in this article, considering how DVT management has changed in this time frame, what progress has been made and what remains problematic. It is also interesting to speculate how DVT management is likely to evolve over the next 20 years.

World Congress of the International Society of Hematology
Sarah Bond
pp 23-23
The 2016 World Congress of the International Society of Hematology was hosted by the British Society of Haematology at the Scottish Exhibition and Conference Centre in Glasgow. The theme of the meeting was haematology and practice.

Antithrombotic therapy in patients with atrial fibrillation and coronary artery disease
Marie Lordkipanidzé and Léna Rivard
pp 24-27
The optimal regimen of anticoagulant and antiplatelet therapies in patients with coronary artery disease and new onset atrial fibrillation (AF), long-standing AF undergoing coronary stenting, or acute coronary syndrome is unclear. The bleeding risks associated with triple therapy with aspirin, clopidogrel and oral anticoagulants require that this combination be used judiciously, in order to counterbalance the well known thrombotic risk in some patients. However, novel approaches to antithrombotic therapy, including omission of aspirin in some cases, and combination with direct oral anticoagulants, may change the way patients are treated. This article describes the risks and benefits associated with these treatment approaches, and summarises the current international recommendations for combined antiplatelet and anticoagulant therapy.

Clot slot

pp 27-27
The finishing touches are being put in place for the CLOT conference in Birmingham on Friday 14 October 2016. The conference will cover various topics, including: the law; warfarin and the nurse; the psychological effects of suffering a venous thromboembolism (VTE); working in a nurse-led treatment centre; the use of direct oral anticoagulants (DOACs); and the new obstetric guidelines for the treatment and prevention of VTE. We are also celebrating CLOT’s 20th year with a fun general knowledge quiz following Thursday evening’s gala dinner. We hope as many delegates as possible will be able to join us.

Primary care interests
David A Fitzmaurice
pp 28-28
In this column, we feature a collection of abstracts that highlight some of the new research in the field of thrombosis, anticoagulation and clotting disorders. Research into this field is diverse and rapidly expanding, and we will endeavour to give you a sample of new findings and trends. We have collated abstracts from a number of peer-review ed journals. Links to the full articles are provided, although you may need a subscription access to view them.

The what, why and how of D-dimer testing in primary care
Dianne P Kitchen
pp 29-31
When the clotting cascade is activated and forms a clot, the fibrin strands within that clot are cross linked to stabilise it. As the body is in a constant balance between thrombosis and bleeding, the body will start to break the clot down in a process called fibrinolysis. The clot is broken down into smaller pieces, known as D-dimer fragments.

NCAT

pp 31-31
The National Centre for Anticoagulation Training (NCAT) is based in the Institute of Applied Health Research at the University of Birmingham. We provide a wide range of courses to meet the educational needs of all healthcare professionals. Our portfolio of anticoagulation courses has now been extended to include a masterclass for nurses and training for professionals to support patients self-monitoring their warfarin. Other courses offered include Diagnosis and Management of Atrial Fibrillation, Heart Failure and Hypertension, Respiratory, Gastrointestinal and Gynaecological Disorders. Our courses are delivered by leading national figures with lectures based on up-to-the-minute information. Please see our website for further details.

Spring 2016, Volume 20 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)