Contraception and hormone replacement therapy in thrombophilia
Niamh M O'Connell and David J Perry
pp 1-5
Appreciation of the role of inherited risk factors in the development of venous thromboembolism (VTE) has revolutionised the approach to the management of thromboembolic conditions. In addition, it has long been known that exogenous factors – such as immobility, surgery, malignancy and pregnancy – can influence the development of VTE, both in the presence and absence of thrombophilia. However, the relative contributions of inherited and acquired risk factors for the development of VTE are difficult to elucidate, and it is clear that the development of VTE in younger patients often requires the presence of more than one risk factor.
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Comment: Verotoxin unmasked
Peter Rose
pp 2-2
Haemolytic uraemic syndrome (HUS) is characterised by a micro-angiopathic haemolytic anaemia, thrombocytopenia and renal failure. The disease usually presents with a prodromal period of bloody diarrhoea and is most likely to produce illness in young children and the elderly. In recent years, infection with verotoxin (VT)-producing organisms, in particlular Escherichia coli O157:H7, has been reported to account for the vast majority of cases of HUS. Most recently, an outbreak in Eccleston, Lancashire, has been causing considerable concern. Currently, over 1,200 cases of E coli O157:H7 are reported annually in Britain.
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An anticoagulation service in evolution
Michelle Taylor, Sue Rhodes, Sarah Bond, Kirsty Sansum and E Sarah Green
pp 6-7
An anticoagulant practitioner service was established at the Princess Margaret Hospital, Swindon, in 1996. Initially, this service comprised a pharmacist and a clinical nurse specialist (as one whole time equivalent), who provided an outpatient deep vein thrombosis (DVT) service and ran the hospital’s outpatient anticoagulant clinics. Five years on, the service has evolved to include discharge planning, the management of over-anticoagulated patients, the supervision of pregnant patients requiring anticoagulation, community anticoagulant care and, most recently, the management of inpatients receiving oral anticoagulant therapy.
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Near-patient testing in oral anticoagulation therapy
Barry Hill
pp 8-9
Near-patient testing (NPT) is by no means a new phenomenon. It dates back to well over one hundred years ago, when clinicians would taste patients’ urine at the bedside to help diagnose diabetes mellitus. Fortunately, such crude methods are no longer required today. However, the demand for accurate, simple-to-use NPT equipment to aid the control and treatment of a variety of conditions is increasing.
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A pharmacist-led service for community DVT management
Prayna Patel and John Luckit
pp 10-11
An anticoagulant audit carried out at North Middlesex Hospital (NMH) in 1996 showed that there was a clear need for improvement in the quality of the service. In response, a pharmacist-co-ordinated anticoagulation service was set up. This, the first in a two-part article, looks at the outpatient protocol introduced as a feature of the new service. The second part of the article will describe the use of the new service to monitor inpatients on warfarin and intravenous heparin.
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