Thrombus - 2002

Reversing the effects of warfarin therapy
Henry G Watson
pp 1-4
The increased use of oral anticoagulants demands, in addition to appropriate monitoring and dosing schemes, the availability of strategies for reversing the effects of warfarin. The possible options for this purpose are the withholding of warfarin, and the administration of vitamin K or vitamin K-dependent coagulation factors. To understand the magnitude of the problem that over-anticoagulation and anticoagulant-related bleeding poses, it is appropriate to consider the number of patients on anticoagulants, the percentage of time that patients spend outside the designated therapeutic range, and the risk of haemorrhage.

Comment: Anticoagulant issues in pregnancy
Peter Rose
pp 2-2
Anticoagulant management in pregnancy has been an ongoing concern ever since the first reports of warfarin-related embryopathy. Heparin, therefore, is considered to be the anticoagulant of choice in pregnancy, although it is not without its own inherent problems. Concerns relating to heparin-induced osteoporosis – resulting from prolonged administration of unfractionated heparin (UFH) – have promoted the increasing use of low molecular weight heparins (LMWHs) for anticoagulation during pregnancy.

Post-thrombotic syndrome: aetiology and prevention
Kevin Varty
pp 5-7
Post-thrombotic syndrome (PTS) is a condition that develops in a limb following an episode of deep vein thrombosis (DVT). It is characterised by pain and oedema, combined with venous and skin changes. The term ‘post-phlebitic limb’ is also used to describe this condition. However, since phlebitis is not a major cause of the symptoms, PTS is a more accurate term.

Oral anticoagulation management training: a review
Tricia Henley
pp 8-8
Following the success of its one-day course in oral anticoagulation management, the Department of Primary Care at the University of Birmingham has extended the duration of training to three days. The first three-day event was held in October 2001. Staff from both primary and secondary care attended the event; the mix of delegates ranged from GPs and practice nurses, to nurses from hospital anticoagulation and DVT clinics.

A pharmacist-led service for inpatient anticoagulation
Prayna Patel and John Luckit
pp 9-11
The first part of this article (Thrombus, Winter 2001) looked at the advantages of a pharmacist-led anticoagulation service for the management of deep vein thrombosis (DVT) in the community. The pharmacist-led service that was used to highlight this case has also been applied to the management of inpatients, and the outcome of monitoring inpatients on warfarin and intravenous heparin using the service has been evaluated.