Thrombus - 2011


The impact of new drugs on anticoagulation services
Sam Schulman, Matthew Fay, Tim Nokes, Nicola Korn, Caroline Baglin, Steve Kitchen and Patrick Kesteven
pp 1-8
Dabigatran, a direct oral thrombin inhibitor, and rivaroxaban, a factor Xa inhibitor, have both recently been licensed for thromboprophylaxis in the UK, for elective hip and knee replacement surgery. Dabigatran has also just received its UK licence for stroke prevention in atrial fibrillation (AF). It is likely that rivaroxaban will receive this too, and also one for venous thromboembolism (VTE) treatment. The introduction of these drugs has caused much speculation over how they will alter anticoagulation practice in the UK. These articles consider the impact that these drugs will have on primary and secondary care, as well as the effect they will have for pharmacists, nurses and laboratories. As a starting point, we look at the example of Canada, where dabigatran was similarly approved in late 2010.
Managing superficial thrombophlebitis in a nurse-led DVT service
Caroline Lewis
pp 9-10
The Thrombosis Treatment Team (TTT) at Cambridge University Hospitals NHS Foundation Trust was established in 1998 to treat patients with confirmed deep vein thrombosis (DVT) as outpatients. This nurse-led service was established in response to the availability of the then new low molecular weight heparins (LMWHs), and the need to free up junior doctors’ hours.
Prophylactic dosing of low molecular weight heparins in obese patients
Jig Patel
pp 11-12
The prevalence of obesity has increased substantially, with the WHO predicting that by 2015 more than 700 million adults will be obese worldwide. This increased prevalence raises some important questions around drug dosing in this population.Does the dose of a particular drugneed to be increased to achieve the same therapeutic effect observed in normally weighted patients? If so, by how much? For those drugs that are dosed on a mg/kg basis, should the dose be capped to prevent accumulation? These dosing uncertainties are not new, and are not unique to anticoagulant therapy.
Caution with interpreting renal function in patients on phenindione
Julie Stinson, Claudia Tomkins and Sethsiri Wijeratne
pp 14-15
Phenindione is an inandione that is used as an anticoagulant, with actions similar to warfarin. It functions by antagonising vitamin K, which is required for the synthesis of coagulation factors II, VII, IX, and X, and anticoagulant proteins C and S, which are essential for the process of blood clotting. This results in decreased prothrombin and, therefore, less thrombin is synthesised, reducing the thrombogenicity of clots. Phenindione is rarely used, due to the higher incidence of side-effects. However, phenindione may sometimes be used; for example, in patients who have developed sideeffects to warfarin, or who have had problems with warfarin absorption.
The 5th scientific meeting of the PCCS – Anticoagulation
Tamara Ball
pp 15-15
Professor David Fitzmaurice welcomed 160 delegates, including GPs, practice nurses, biomedical scientists, pharmacists and patients to the ‘Anticoagulation in Practice Conference 2011’, which, for the first time, was led by the Primary Care Cardiovascular Society (PCCS) – Anticoagulation, (a special interest group of the PCCS). Professor Michael Greaves, Head of the School of Medicine and Professor of Haematology, University of Aberdeen, delivered his keynote speech, ‘The history of anticoagulation’. This ranged from the use of leeches in medicine, to the advent of new oral anticoagulation agents, making for a fantastic opening to the conference.

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)