Thrombus - 2015


Comparison of the current guidance around thrombolytic therapy for acute pulmonary embolism
Peter J Goodrem
pp 33-36
In April 2014, the National Institute for Health and Care Excellence published an evidence update relating to their 2012 guidance for the management of venous thromboembolic diseases (Clinical Guidelines 144 [CG144]). The update appraised the latest evidence relating to a number of topics within CG144. This article discusses the guidance and evidence relating to thrombolysis. It must be noted that the evidence update does not alter the current NICE guidance, but highlights areas where new evidence may impact on the current guidance when the full update is published.
Comment: Grey areas
Peter Rose
pp 34-34
There are many grey areas in medicine, where evidence-based practice is limited by a paucity of published trial data. In this edition of Thrombus, topics fall into this category, involving opinion from different clinical specialities, each with their own concern, nuances and priorities.
ISTH Congress 2015: CLOT scholarship winners’ experience
Sarah Bond and Kay Sumner
pp 37-37
CLOT scholarship winners, Sarah Bond and Kay Sumner, share their experiences from the ISTH Congress in Toronto, June 2015.
Pregnancy-related venous thromboembolism
Shalini Solanki and James Uprichard
pp 38-40
Natural haemostatic changes occur in pregnancy to minimise haemorrhage during miscarriage or childbirth. However, these physiological changes also increase the risk of venous thromboembolism (VTE) five-fold during pregnancy, and as much as 60-fold in the postpartum period. This translates into an incidence of VTE of 1 per 1,000 pregnancies making it one of the leading direct causes of maternal deaths. Fortunately, mortality is on the decline, largely due to improved risk assessment and appropriate use of thromboprophylaxis.
Review of the RCOG guidelines on the prevention of venous thromboembolism during pregnancy and the puerperium
Bethan Myers
pp 41-43
In April 2015, the Royal College of Obstetricians and Gynaecologists published the 3rd edition of the guidelines on the prevention of venous thromboembolism (VTE) during pregnancy and following delivery. Since the introduction of the first guideline in 2004, there has been a significant fall in maternal mortality from VTE. Despite this, pulmonary embolism remains a major direct cause of maternal death.
FAQ: What precautions should patients take before flying?
Jerome Durodie
pp 44-44
Unless there are recognised underlying medical or hereditary factors, the absolute risk of venous thromboembolism is generally extremely low, particularly for those undertaking short-haul flights. This does not negate, however, the possibility of a previously undetected condition being triggered by short- and/or longhaul flights.
‘The best thing since sliced bread’: patients’ perceptions of self-management of oral anticoagulation
Patricia N Apenteng, Deborah McCahon, Ellen T Murray, Sue Jowett, Kathryn A Murray, Dawn Swancutt, David A Fitzmaurice
pp 45-47
Current guidelines recommend self-monitoring, including patient self-management, of oral anticoagulation for suitable adults with atrial fibrillation and heart valve disease on long-term anticoagulation therapy (generally warfarin in the UK). Self monitoring involves the patient being responsible for the measurement of their own international normalised ratio (INR) using a finger prick blood sample and a portable point of care coagulometer device. Patients may either interpret their INR test result themselves and adjust their warfarin dose and test frequency accordingly (self-management) or contact a healthcare professional for dosing advice (self-testing). Despite evidence supporting this model of patient care, only around 1–2% of people receiving oral anti-coagulation engage in self-monitoring in the UK.

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)