Thrombus - 2002


Investigation of thrombocytopenia
Tobias Menne and Gillian Evans
pp 1-3
Thrombocytopenia – the condition of having a platelet count below the lower limit of the normal laboratory range (usually around 150 x 109/l) – is a common incidental finding of a full blood count (FBC). The degree of thrombocytopenia that is identified and the related risk of haemorrhage will determine the need for further investigation – and the urgency with which this is required. The risk of spontaneous bleeding is low when the platelet count remains above 50 x 109/l; however, it increases significantly when the platelet count falls below 20 x 109/l.
Comment: Preventing recurrent strokes
Peter Rose
pp 2-2
It is certainly the case that patients with atrial fibrillation and a history of previous stroke or transient ischaemic attack benefit from long-term oral anticoagulation in terms of reducing their risk of recurrent stroke events. It is estimated that only 12 such patients need be treated with warfarin to prevent one further stroke event. Not only does this represent good clinical practice, but also good economic sense. The stroke recurrence rate in this patient group is significantly less for patients treated with warfarin, compared with antiplatelet agents. The value of anticoagulation to reduce recurrent strokes is a very different question for patients without atrial fibrillation.
Venous thromboembolism and acute medical illness
KK Hampton and Richard Hobbs
pp 4-6
Venous thromboembolism (VTE) remains a major cause of mortality and morbidity during acute medical illness. Despite clinical evidence indicating the substantial thromboembolic risk in general medical patients, particularly those with cardiorespiratory disease, management guidelines for thromboprophylaxis are not widely implemented. A greater awareness of the risks and effective risk stratification is essential – for both hospital physicians and GPs – to improve outcomes for acutely ill medical patients.
Long-haul flights: risk factors for VTE
Kirsty Sansum, E Sarah Green, Sarah Bond, Sue Rhodes and Michelle Taylor
pp 7-9
In recent months, there has been an increase in media reports about the risk of venous thromboembolism (VTE) in connection with long-haul flights. Here we examine the evidence for such an association and ask what advice travellers should be given. The relationship between longdistance air travel and VTE was first suggested in 1954 by Homans. However, the link between VTE and prolonged sitting had already been made in 1940 by Simpson.
Nomograms for warfarin initiation
Andrew Radley
pp 10-11
The initiation of anticoagulation has long been recognised as a particularly haphazard phase of treatment. Notably, there are many uncertainties as to how the patient will respond to starting doses and as to how quickly their dose can be adjusted to achieve an appropriate level of anticoagulation. Traditionally, warfarin therapy is commenced using a loading dose for three days, in an attempt to create a therapeutic response in a quicker time. In a hospital environment, where a shortage of beds creates pressure to keep patient stays to a minimum, there is an added incentive to get the dosage right first time.

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