Thrombus - 2011


Meeting CQUIN targets for reduction in VTE – the Colchester experience
Adam Howard and James Wright
pp 1-4
Safe, efficacious and cost-effective methods of preventing the onset of venous thromboembolism (VTE) are well known, but compliance in hospitals has been poor, resulting in unnecessary deaths. The Commissioning for Quality and Innovation (CQUIN) payment framework enables NHS commissioners to reward excellence by linking a proportion of the provider’s income to the achievement of local quality improvement goals, such as VTE prevention. These recent CQUIN targets have been designed to drive change using financial incentives, with potential penalties, to encourage hospitals to follow the Chief Medical Officer’s recommendations and the National Institute for Health and Clinical Excellence’s (NICE) Clinical Guideline (CG) 922 for improved VTE prophylaxis.
Comment: Anticipating NICE approval of dabigatran
Peter Rose
pp 2-2
The Thrombus Innovation Awards Ceremony has just taken place in London at The Royal Society of Medicine (see the accompanying supplement for more details). I would like to take the opportunity to thank all those who submitted applications. There was an excellent response and the judges had a difficult task in choosing the shortlist. The importance of the innovation, the multidisciplinary nature of the entry, patient/service benefit, and evidence that the innovation is transferable to UK services are the main judging criteria. Despite an ever-increasing clinical and management workload, it is important to highlight the extra commitment from all the applicants.
Thromboprophylaxis for cancer patients
Suzanne Hall and Peter Rose
pp 5-6
The association between malignancy and venous thromboembolism (VTE) is well established, and VTE poses significant morbidity and mortality risk to cancer patients. Thrombosis may be caused by the biological and physical consequences of malignancy itself or may in part be due to procedures and drugs used during treatment. Specific risk factors for VTE in patients with established malignancy are less well recognised, and there is no widely accepted method of risk-stratifying patients with the aim of providing thromboprophylaxis to those most at risk.
The new BCSH warfarin guidelines
David Keeling
pp 7-8
As we stand on the threshold of a new era in anticoagulation, we must not forget the huge number of patients who are taking, and will continue to take, vitamin K antagonists. The fourth edition of the British Committee for Standards in Haematology (BCSH) warfarin guidelines has just been published. This article will review its recommendations, concentrating on the key ones and the new developments. The guidelines refer to target international normalised ratios (INRs) rather than target ranges, although the target range is generally taken to be within 0.5 of the target; for example, a target INR 2.5 equates to a target range of 2.0–3.0.
Diagnosis and management of catastrophic antiphospholipid syndrome
Sangam Hebbali and Peter Rose
pp 9-13
Antiphospholipid syndrome (APS), also known as Hughes syndrome, is an autoimmune disorder characterised by hypercoagulability in the presence of cardiolipin/ß2-glycoprotein 1 (ß2-GP1) antibodies and lupus anticoagulant (LA). Catastrophic APS (CAPS) is a potentially fatal and extreme variant of APS, first defined by Ronald Asherson in 1992. CAPS manifests with acute thrombotic microangiopathy, multiple organ failure and tissue necrosis. Although only 1% of APS patients go on to develop CAPS, it is an important clinical entity, due to high mortality rates of up to 50%. The majority of CAPS patients require management in an intensive care setting, as they have multiple organ failure requiring multiple organ support. The rarity of CAPS makes it extremely difficult to study in a systematic way; hence, an international CAPS registry was established in the year 2000, and now has more than 300 reported cases.
The Nursing Forum at the ISTH 2011
Caroline Baglin
pp 14-14
The Nursing Forum at the International Society on Thrombosis and Haemostasis (ISTH) took place during the Scientific and Standardization Committee’s programme. It was held over one-and-a half days in the form of educational sessions immediately before the 23rd congress scientific programme. This forum gives nurses the opportunity to come together to share on the topics of understanding, prevention, diagnosis and treatment of thrombotic and bleeding disorders, which are of common concern globally. With this in mind, the forum committee developed a programme to enhance national and global knowledge, and skills in the field. This encourages and allows policymakers to drive quality and efficiency improvements within their own health services.

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)