Thrombus - 2000

Imaging modalities to investigate DVT and PE
Nick Screaton
pp 1-4
Venous thromboembolism is a common, potentially fatal disease. About 85–95% of pulmonary emboli originate in veins of the lower limbs. Therapeutic anticoagulation is of benefit for both deep vein thrombosis (DVT) and pulmonary embolism (PE). Accurate diagnosis is essential because anticoagulation may cause significant morbidity. The spectrum of investigations available for both DVT and PE are described below.
Comment: Coughs, colds and clots
Peter Rose
pp 2-2
In the last issue of Thrombus, the role of bacterial pathogens in the development of ischaemic heart disease was considered. There is however, increasing recognition that a wider spectrum of pathogens may modulate endothelial cell function and result in vascular endothelial surfaces changing from anticoagulant to procoagulant activity. The role of infection in the development of micro-thrombi is perhaps best illustrated in the haemolytic uraemic syndrome where the exotoxin (verocytotoxin) produced by Escherichia coli 0157:H7 is responsible for the thrombotic microangiopathy with thrombocytopaenia, red cell haemolysis and renal failure.
An anticoagulant service for the 21st century
Paul Stross
pp 5-7
In common with other anticoagulant services, we have noticed a marked increase in workload at St Richard’s Hospital. We currently perform approximately 2,300 tests per month, which represents a doubling in the last two-and-a-half years. We have sought to develop a flexible system to cope with increasing demand and the differing requirements of our users. In this article, the adoption of email as a method of transmitting information to patients will be discussed.
Primary care management of deep venous thrombosis
David A Fitzmaurice, Ellen T Murray, FD Richard Hobbs and Peter E Rose
pp 8-9
The primary treatment for acute deep vein thrombosis (DVT) traditionally involves the administration of intravenous (IV) unfractionated heparin followed by a period of oral anticoagulation therapy. The goals of treatment are the prevention of pulmonary embolism and recurrent DVT, and the restoration of venous patency and valvular function. The latter is of major significance, since up to 70% of venous leg ulcers result from venous insufficiency (which is usually secondary to DVT), and leg ulcer management consumes between £100–600 million of healthcare expenditure per year in the UK.
The developing role of the clinical nurse specialist
Caroline Baglin
pp 10-11
The role of the anticoagulation nurse specialist has evolved with the recognised need for standardised care and an increasing patient demand for warfarin therapy. The supply and administration of medicines by nurses, the implications of clinical governance and the requirements for a recognised training programme need to be addressed. The Cambridge anticoagulant service has seen a progressive increase in demand since the 1990s. Before the introduction of standardised care, insufficient time was allowed for patient education and problem solving, and addressing issues such as patient dissatisfaction, poor access to clinics and long waiting times.

Thrombus is funded by an unrestricted educational grant from Bayer HealthCare, with no editorial input into the contents of this journal.

Thrombus was previously supported 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)