Thrombus - 2009

The use of thrombolysis for the treatment of pulmonary embolism
David A Fitzmaurice
pp 1-3
Pulmonary embolism (PE) is one manifestation of venous thromboembolism (VTE), and can vary in its clinical presentation from sudden death to acute shortness of breath. At its most severe, PE is associated with significant mortality and morbidity, including pulmonary hypertension. The mainstay of treatment for PE has been initial treatment with heparin followed by an extended period of treatment with oral anticoagulation (principally warfarin),
Comment: Chronic obstructive pulmonary disease
Peter Rose
pp 2-2
In this edition of Thrombus, practical advice is given for the implementation of hospital inpatient thromboprophylaxis. The recent production of a template for thromboprophylaxis is to be considered a substantial step forward; however, from local experience, production of a form for thromboprophylaxis assessment, and its distribution to all wards, does not equate with assessments actually undertaken or thromboprophylaxis actually prescribed.
Using the international normalised ratio in patients with liver disease
Anne M Sermon and Steve Kitchen
pp 4-6
The international normalised ratio (INR) and the international sensitivity index (ISI) systems were developed as ways to standardise the prothrombin time (PT) during the monitoring of patients undergoing oral anticoagulant therapy with vitamin K antagonists (VKAs) such as warfarin. The wide acceptance of the INR has led to its use in other clinical scenarios, including as one of three parameters in the Model for End-Stage Liver Disease (MELD) scoring system (to aid the prioritisation of patients for liver transplant). Recently published literature has highlighted the potential inadequacy of the INR system in this context.
The 8th ACCP guidelines on thrombosis prevention – core reading for everyone
John Pasi
pp 7-7
Venous thromboembolism (VTE) is a major public health issue. Each year, more than 25,000 people in the UK die as a result of VTE that occurs in hospital. This is more than the combined total of deaths from breast cancer, AIDS and traffic accidents, and five times the number who die from methicillinresistant Staphylococcus aureus (MRSA). Not only is the human cost of this huge, so is the financial cost to the nation: it is estimated the total cost of VTE morbidity to the UK is over £600 million per annum. Despite shorter hospital stays, with an increase in the number of surgical operations, cancer treatments and cases of obesity within the general population, it is probable that the cost of VTE will rise if appropriate preventive strategies are not used.
American College of Chest Physicians guidelines on thromboprophylaxis
Catherine Bagot
pp 8-12
In June 2008, a new edition of the American College of Chest Physicians (ACCP) guidelines, Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition), was published. This article reviews the chapter Prevention of Venous Thromboembolism. The guidelines given in Prevention of Venous Thromboembolism refer almost exclusively to the management of hospitalised patients. This article seeks to highlight the major changes that have been made to this chapter since the previous edition in 2004, examine the evidence base for these changes, and discuss the limitations of the guidance given. In particular, it concentrates on new sections that have been introduced for specific patient groups. Providing a system
Intravenous drug use, deep vein thrombosis and anticoagulation
Caroline Baglin
pp 14-15
Deep vein thrombosis (DVT) and pulmonary embolism (PE) can be triggered by a variety of risk factors. Using the iliofemoral vein by intravenous drug users is considered to be a significant cause. However, many anticoagulant service staff say intravenous drug users do not present with venous thromboembolism (VTE) to their service. It is thought the reason for this is that these patients do not continue with treatment and do not attend anticoagulant clinics. It is difficult for anticoagulant staff to share their experience of caring for these patients due to the small number attending each service. Also, there have not been any randomised, controlled trials of this group of patients and no grade A recommendations are available.

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)