Thrombus - 2002

Antiplatelet therapy following oral anticoagulant treatment for VTE
Peter K MacCallum
pp 1-4
Venous thromboembolism (VTE) is a common and potentially life-threatening problem. The annual incidence of VTE in North American and European populations is about one per 1,000 per year. Like many disorders the incidence is age-related, ranging from about one in 10,000 per year in young adults (and even less in children) to approaching 1% per year in the elderly. In a Swedish study of men followed prospectively between the ages of 50 and 80, pulmonary embolism was responsible for about 4% of deaths.
Comment: Coagulation markers and cancer
Peter Rose
pp 2-2
Survival in patients with known malignancy at the time of presentation of deep vein thrombosis (DVT) is worse than in patients with a similar malignancy who show no evidence of venous thromboembolic disease. The survival rate is notably poor among patients with malignancy and DVT compared with those with no malignancy at the time of DVT diagnosis. Data collected from three local hospitals showed that of 686 patients with ultrasound-confirmed DVT, 111 (16.2%) were known to have a malignancy at the time of diagnosis. The overall mortality rate six months from diagnosis was 53% for patients with known malignancy and DVT.
The combined pill and VTE
Anne Szarewski
pp 5-6
On 29 July, the Honourable Mr Justice Mackay handed down his judgement in the group action against the manufacturers of third-generation combined oral contraceptive (COC) pills. He concluded, ‘I find that there is not as a matter of probability any increased relative risk of VTE carried by any of the third generation oral contraceptives supplied to these Claimants by the Defendants as compared with second generation products containing levonorgestrel’.
Oral vitamin K for excessively anticoagulated patients
Sarah Bond, E Sarah Green, Sue Rhodes, Kirsty Sansum and Michelle Taylor
pp 7-8
The use of oral anticoagulant therapy has significantly increased over the last decade, both for prophylaxis and treatment of venous thromboembolic disease and for atrial fibrillation. Even well controlled patients spend only 70% of the time in their therapeutic range and overanticoagulation is a common problem that significantly increases the patient’s risk of bleeding. There are many variables associated with an increased risk of bleeding.
Exclusionary testing – plasma D-dimers
James Kelly and Beverly J Hunt
pp 9-11
The number of patients with suspected venous thromboembolism (VTE) referred for evaluation has increased since the advent of venography and pulmonary angiography 30 years ago, while the proportion with confirmed disease has fallen. This is a reflection of three factors. First, some form of objective testing is always required once the clinician has reasonable suspicions that a patient may have VTE as clinical features alone cannot exclude or confirm the diagnosis. Second, non-invasive imaging modalities of ultrasound (US), ventilationperfusion (V/Q) scanning and spiral CT, which now largely obviate the need for invasive testing, are readily available in secondary care.

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)