Thrombus - 2007

Thromboprophylaxis after orthopaedic surgery
David Camilleri
pp 1-4
Major orthopaedic surgery carries a high risk of venous thromboembolism (VTE) due to vessel trauma, venous stasis, coagulation activation and the older age of most patients. Before routine thromboprophylaxis was introduced, deep vein thrombosis (DVT), usually clinically silent, occurred in 40–60% of these patients. Pulmonary embolism (PE) occurred in 5–10% of patients, resulting in death in 1–2% of cases.

Comment: Obesity and clots
Peter Rose
pp 2-2
When spring arrives, many feel the need to take more exercise and lower their calorie intake. This reflects the WHO’s concerns that obesity is now a major cause of morbidity and mortality, and that it has reached epidemic proportions in many countries around the world. Higher rates of thrombosis are well recognised in association with obesity; however, it is important to differentiate between arterial and venous thrombotic events, which have different risk factors and underlying pathogeneses.

Treating DVT patients in the community
Jennie Bailey, Sarah Bond and Sarah Green
pp 5-7
At the Great Western Hospital in Swindon, patients with suspected or proven deep vein thrombosis (DVT) have been treated as outpatients for the last ten years. Indeed, more than 95% of people presenting with DVT at the hospital are now managed as outpatients. Patients with suspected DVT may be sent to the acute assessment unit (AAU) by their GP for assessment. Alternatively, GPs have the option of direct access to the radiology department, where four Doppler ultrasound slots per day (Monday to Friday) are reserved for patients with suspected DVT.

The mechanisms and management of warfarin resistance
Andrew D Mumford, Dominic J Harrington and Martin J Shearer
pp 8-11
Warfarin is a highly effective anticoagulant and is prescribed widely for the treatment and prevention of thrombosis. However, significant difficulties remain with warfarin because a wide array of genetic and acquired factors influence the dose response in different individuals.Warfarin also has a narrow therapeutic index and excessive anticoagulation can lead to serious adverse events, such as bleeding. Safe and effective anticoagulation, therefore, requires warfarin treatment to be monitored closely and therapeutic doses individualised for each patient.