Thrombus - 1999

DVTs and primary care
Rod Smith
pp 1-3
Deep vein thrombosis (DVT) is a relatively common condition that affects one patient in every 1000. An initial putative diagnosis is commonly made by the GP who then has to refer the patient to hospital for confirmation of the diagnosis, usually by venogram or Doppler ultrasound, and subsequent treatment. That DVT can be treated in an outpatient setting is now well established with the development of low molecular weight heparins (LMWH). For an individual practice, the number of cases is relatively small and the effort required to achieve the cultural shift of transferring DVT management into primary care has held up its movement.
Comment: The varying clinical efficacy of D-dimer screening tests
Peter Rose
pp 2-2
Many centres now use a D-dimer level and/or a clinical probability score to screen patients with suspected deep vein thrombosis. This reduces the need for further diagnostic investigations by venogram or ultrasound scanning. As discussed in this issue, this has considerable merits. It is, however, necessary to monitor laboratory quality assurance with these kits and to continually review their effectiveness. Different commercial kits have different cut-off levels for normal/high D-dimers. Furthermore, changes to kits may alter the usefulness of the screening tests.
Heparin monitoring in pregnancy
Caroline Schlach
pp 4-6
Pregnancy increases the risk of venous thromboembolism (VTE) approximately fivefold compared to the non-pregnant state. Increase in the plasma level of many coagulation factors and decreased venous flow velocity are risk factors for VTE which are common to all pregnancies. However, it is recognised that there is a particular increased risk in association with increasing maternal age, inherited or acquired thrombophilia risk factors, immobility and obesity. Furthermore there is an especial risk of pulmonary embolism (PE) in association with operative deliveries, which is most pronounced with emergency caesarean sections.
Clinical nurse specialists and D-dimer assessment of suspected deep vein thrombosis – lessons from Warwick
Peter Rose, Susan Poole, Ruth Brown, Supratik Basu, David Clarke
pp 7-9
This study evaluates the role of a clinical nurse specialist (CNS) in the management of patients who presented with suspected deep vein thrombosis (DVT) at the Warwick Hospital over a period of nine months. The nurse assessed new patients and initiated investigations and treatment where it was necessary. Patients were then followed up in the community by the same nurse who administered low molecular weight heparin (LMWH) injections and managed oral anticoagulant care.
The use of compression hosiery to prevent post thrombotic syndrome
Patricia Weston RN
pp 10-11
The thrombosis treatment team at the Addenbrooke’s Hospital in Cambridge was established in February 1998 for the ambulatory treatment of patients with a proven deep vein thrombosis (DVT). It became immediately evident after the team’s foundation that the treatment given needed to be extended to the fitting of compression hosiery in the hope of reducing the occurrence of post thrombotic syndrome (PTS).

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)