Thrombus - 2012

Prothrombotic effects of hormonal therapy
Will Lester and Louise Fryearson
pp 1-4
This review aims to summarise current knowledge about the risk of thrombosis associated with hormonal therapy, specifically oestrogen, progesterone and testosterone. Ideally, this risk should be appreciated by both the prescriber and user in the wider context of other benefits and risks of treatment, and with reference to alternative pharmacological and nonpharmacological options.
Comment: NICE try, but an unqualified benchmark
Peter Rose
pp 2-2
June 2011 saw the publication of the National Institute for Health and Clinical Excellence Clinical Guideline 144, Venous thromboembolic diseases: the management of venous thromboembolic diseases and the role of thrombophilia testing, which is sure to provoke considerable comment. The guidance provides 23 recommendations and ten key priorities. This is an extensive, evidence-based attempt to facilitate the diagnostic process that patients with suspected deep vein thrombosis (DVT) undergo and to rationalise the subsequent investigations for patients presenting with unprovoked DVT.
Olympics – clotting in sports
Patrick Kesteven
pp 5-5
In this Olympic year, the question is asked: does exercise prevent venous thromboembolism? There are two situations in which exercise can be implicated in the aetiology of such thromboses. The first is called ‘effort thrombosis’ by couch potatoes, ‘Paget-Schroetter’ syndrome by vascular surgeons of a certain age, and ‘subclavian vein thrombosis’ by everybody else. This involves thrombosis of the main vein in the upper arm, where it kinks around the armpit through various mysterious muscle groups around the shoulder, close to the first rib.
Developments and progress in VTE prevention
Karen Smith
pp 6-7
Venous thromboembolism (VTE) prevention continues to be an NHS priority. The National VTE Prevention Programme, and the work of exemplar centres across the NHS and private sectors, continue to promote implementation of best practice through the integrated approach of policy levers and adoption of clinical excellence.
VTE – can we identify a stopping rule for low-risk patients?
Trevor Baglin
pp 8-9
Prevention of recurrent venous thromboembolism (VTE) stops fatal incidences and reduces the burden of disease in survivors. Treatment with an oral vitamin K antagonist, such as warfarin, or a direct thrombin or factor Xa inhibitor, will prevent more than 95% of recurrent episodes of VTE. However, VTE is only prevented for as long as the anticoagulant therapy is continued. Therefore, anticoagulation must be continued indefinitely to prevent long-term recurrence.
FAQs: Should patients in lower limb plaster cast be offered LMWHs?
Tim Nokes
pp 10-10
There are six small randomised controlled trials, in a total of 1,536 patients, comparing low molecular weight heparin against controls (placebo or nothing) in patients with lower limb plaster casts. Furthermore, another recent review of 2,761 patients was undertaken to guide focused thromboprophylaxis to the highest risk groups.
Audit of telephone calls to an anticoagulation clinic
Sarah Bond and Amanda McMullon
pp 12-14
The anticoagulation service at Great Western Hospital, Swindon, monitors nearly 3,500 patients who require anticoagulant therapy for a range of conditions, including atrial fibrillation, venous thromboembolism and mechanical heart valve replacements. Due to the rural nature of the catchment area for the hospital, the service is provided mainly by post. The majority of patients have blood taken by the practice nurse at their GP surgery, and the samples are sent in to the hospital laboratory for analysis. International normalised ratio results are then passed to the anticoagulation service and dosed by an anticoagulant practitioner with the assistance of a computer dosing system.
Anticoagulation in Practice 2012
Tamara Ball
pp 15-15
Nicky Fleming, recently elected as Chair of the Anticoagulation in Practice (AiP) Society, and Professor David Fitzmaurice welcomed more than 150 delegates to the University of Birmingham for the AiP 2012 conference. The programme presented the changing face of anticoagulation therapy, particularly the introduction of new oral anticoagulants. This was the topic of the keynote speech delivered by Dr Patrick Kesteven, Consultant in Haematology at the Freeman Hospital, Newcastle-upon- Tyne.

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)