Thrombus - 2014

Post-thrombotic syndrome, compression hosiery and the SOX trial
Cara Doyle
pp 1-4
Post-thrombotic syndrome (PTS) is a long-term complication of deep vein thrombosis (DVT), which is associated with chronic complaints, such as pain, swelling and skin changes in the affected leg. The prevention, development and treatment of PTS are widely debated topics. The uncertainty stems from the variability of symptoms, the difficulty in reaching a diagnosis and the dearth of clinical evidence on preventative methods. Research conducted by Kahn et al, published in The Lancet, aimed to establish the efficacy of compression hosiery in the prevention of PTS. Compression hosiery was originally suggested by Brandjes et al to be an effective method of inhibiting the development of PTS; however, Kahn et al rebuffs these claims. So, has salvation arrived for those patients struggling to apply their stockings each day in a bid to prevent the unpleasant symptoms of PTS?
Comment: Update from the American Society of Hematology
Peter Rose
pp 2-2
This issue of Thrombus highlights the debate around the clinical significance and management of incidental pulmonary embolism (IPE). What constitutes a symptomatic pulmonary embolism as compared to an IPE is highly subjective, particularly in the setting of cancer and other co-morbidities. With the advancement of imaging options available for staging cancer patients, the number of IPEs considered for anticoagulant therapy is also likely to increase.
Thrombophilia screening: clinical and laboratory considerations
Ian Jennings
pp 5-7
Thrombophilia testing has been in practice for over 40 years, since the development of assays to detect deficiencies in plasma, and the discovery of an antithrombin deficiency in a family prone to venous thromboembolism in 1965. Subsequently, more thrombophilia patients were tested and found to have deficiencies of natural anticoagulant proteins C and S, or defects in genes for Factor V and prothrombin. These findings led to the establishment of a standard panel of tests with which to investigate patients for thrombophilia.
Incidental pulmonary embolism in cancer patients: should we anticoagulate? Introduction
Azra Arif, Charles E Hutchinson, Annie Young, Tim Nokes
pp 8-9
Deep Vein Thrombosis and pulmonary embolism (PE) are collectively known as venous thromboembolism (VTE). PE has been described as one of the most commonly missed deadly diagnoses. It is the cause of more than 100,000 deaths each year in the US, and the primary diagnosis or complicating condition in more than 300,000 hospitalisations.
Incidental pulmonary embolism in cancer patients: should we anticoagulate? Yes
Azra Arif, Charles E Hutchinson, Annie Young
pp 10-11
Internationally published guidelines are based on rigorous literature searches by experts, and where there is insufficient evidence, the expert opinions of the advisory committee are enlisted. International clinical guidelines suggest, or recommend, the same initial and long-term treatment for cancer patients with incidental pulmonary embolism as is recommended for cancer patients with symptomatic PE – a low molecular weight heparin.
Incidental pulmonary embolism in cancer patients: should we anticoagulate? No
Tim Nokes
pp 12-15
Since the introduction of the multidetector CT pulmonary angiography (CTPA) in 1998, which has improved resolution and produced more definitive results, it has been increasingly used for PE diagnosis. The resolution of CTPA is 15 times that of ventilation/perfusion scanning (V/Q) and it is able to detect filling defects in sub-segmental arteries as narrow as 2–3 mm in diameter. Clinicians are reassured by the increased sensitivity of CTPA over V/Q scanning, its ability to identify other pathology and the lowered threshold for investigating a potentially life-threatening disease.

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)