Thrombus - 2000

Thrombosis and the antiphospholipid syndrome
Beverly J Hunt
pp 1-4
Antiphospholipid or Hughes’ syndrome is the association between antiphospholipid antibodies (aPL), venous and arterial thromboses and pregnancy morbidity. Antiphospholipid syndrome (APS) commonly coexists with autoimmune diseases, usually systemic lupus erythematosus (SLE), when it is known as secondary APS. When present in isolation it is known as primary APS. In APS thrombosis can occur in any vascular bed, thus the protean forms of manifestation of the syndrome are being increasingly recognised. However, diagnosing the presence of the antibody can be confusing and difficult for the non-specialist, and there is a lack of clinical studies to guide clinical management.
Comment: Orthopaedic surgery and thromboprophylaxis: where now?
Peter Rose
pp 2-2
The optimal method of prevention of venous thromoboembolism (VTE) following orthopaedic surgery continues to provide debate among orthopaedic surgeons and haematologists, often without agreement. What is clear however, is that every trust will be required to have guidelines in place for thromboprophylaxis and be able to provide evidence to support their practice. While the short-term risks of DVT and PE post-elective hip or knee replacement surgery are well recognised, long-term venous insufficiency problems with post-phlebetic syndrome (PPS) have a major impact on the quality of life of patients and healthcare costs.
Deep vein thrombosis or ruptured Baker’s cyst?
John Lanham
pp 5-5
A swollen painful lower leg is a common presentation for admission. Once cellulitis has been excluded on clinical grounds, the diagnosis is invariably that of a deep vein thrombosis (DVT). The principal alternative diagnosis – a ruptured Baker’s cyst is often overlooked. Failing to recognise this diagnosis can have far reaching consequences.
My experience with anticoagulation therapy
Edward Bibby
pp 6-6
Having recently retired at 71 after 55 years of working life, my wife and I were anxious to catch up on our travels and were immediately co-opted by one of our daughters and her husband who were embarking on a round-the-world cycling trip. As the trip was to take some years, they wanted us to meet them in various places bringing along the necessary tyres, spares and appropriate clothing for the weather in that area.
The role of the D-dimer in the diagnosis of DVT
David Keeling
pp 7-8
The diagnosis of venous thromboembolism (VTE), whether as deep vein thrombosis (DVT) or pulmonary embolism (PE), can be difficult, time consuming, and expensive. There is increasing interest in the use of D-dimer tests to improve the diagnostic procedure by reducing the need for expensive, invasive testing. The strategy is to employ tests whose sensitivity is so high that a negative result rules out clinically important VTE (high negative predictive value for VTE), while paying much less attention to their specificity (and accepting low positive predictive values).
Von Willebrand factors high on meeting agenda
Denise O'Shaughnessy
pp 9-9
At the recent International Society of Thrombosis and Haemostasis meeting in Washington DC, the most interesting symposium was undoubtedly on the role of Von Willebrand factor (VWF) in the aetiology of thrombotic thrombocytopenia purpura (TTP). VWF is a glycoprotein circulating in plasma as a series of multimers ranging in size from 500 kDa to 20,000 kDa and containing over 250 units. The main function of VWF is to initiate first degree haemostasis involving adhesions of platelets to damaged vessel wall.
Thromboprophylaxis in orthopaedic surgery
David Warwick
pp 10-11
While the plethora of randomised trials and review articles suggest that chemical prophylaxis is mandatory in orthopaedic surgery some orthopaedic surgeons have their doubts. Consequently thromboprophylaxis is not universally used in the UK. This article discusses these doubts in a provocative but hopefully informative way. The great majority of clinical trials in orthopaedic surgery describe the effects of thromboprophylaxis on elective hip replacement patients. There are some studies on knee replacement and hip fracture patients, but very few studies on the great majority of orthopaedic patients who have other surgery such as knee arthroscopy, foot or lower-limb surgery. .

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)