Thrombus - 2009

The new oral anticoagulants
Chee W Khoo, Kok-Hoon Tay, Eduard Shantsila and Gregory YH Lip
pp 1-7
The current gold standard oral anticoagulant therapy (OAC) is warfarin, the most commonly prescribed OAC worldwide for various thromboprophylactic and therapeutic indications (atrial fibrillation [AF], mechanical heart valves and pulmonary emboli). The usefulness of warfarin, however, is overshadowed by its problems of unstable pharmacokinetics and pharmacodynamics, which can lead to bleeding complications. New OAC drugs are emerging, such as the oral factor Xa inhibitors and the direct thrombin inhibitors (DTIs). The quest for an OAC with stable pharmacokinetics and pharmacodynamics, and lower risk of bleeding, continues.
Comment: Assessing dabigatran for atrial fibrillation
Peter Rose
pp 2-2
The latest treatment to emerge in the struggle to find new and safe anticoagulant treatments is dabigatran, a direct thrombin inhibitor currently licensed in the UK for thromboprophylaxis following hip and knee surgery, as detailed in this issue. Since ximelagatran sank without trace following adverse liver events highlighted with prolonged administration, long-term safety issues remain a priority for agents in development
The objectives of the caval filter registry
Neil Rane, Nick Chalmers and Raman Uberoi
pp 8-9
The standard treatment for deep vein thrombosis (DVT) and for prevention of pulmonary embolism (PE) is systemic anticoagulation with low molecular weight heparin followed by oral warfarin. Without treatment, patients with venous thromboembolism (VTE) are at high risk of developing PE, which can be fatal in up to 25% of patients. Furthermore, 4% of patients may develop a breakthrough PE while on anticoagulation therapy. This can also result in serious complications, with a mortality rate of 5%, and may need to be discontinued due to haemorrhage.
Establishing an outpatient pulmonary embolism service
Ann J Davenport
pp 10-12
Venous thromboembolism (VTE) is a medical condition caused by the formation of blood clots. It manifests clinically as deep vein thrombosis (DVT) and pulmonary embolism (PE). It occurs for the first time in about 100/100,000 patients each year in the USA. About one-third of patients with symptomatic VTE manifest PE, whereas two-thirds manifest DVT alone. Death occurs in about 6% of DVT cases, and in 12% of PE.
Review of NPSA 18 on warfarin dosing
Helen Gray
pp 14-15
National Patient Safety Agency (NPSA) patient safety alert 18: Actions that can make anticoagulation therapy safer highlighted the variability of warfarin dosing systems used throughout the UK. Recommendations were made that all doses should be in mg, using mixed sizes of tablets in order to achieve a constant daily dose with the minimum number of tablets. Within the anticoagulant community, there has been much debate as to whether the recommendations are advisable or achievable and it is unlikely that a true consensus will be established.

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)