Introducing extended venous thromboembolism prophylaxis
Lesley Hunt, Hannah Hardisty, Nick Quaife, Donna Oldfield and Rhona MacLean
pp 1-4
In 2002, the ENOXACAN II study demonstrated a significant reduction in venous thromboembolism when prophylactic enoxaparin was continued for four weeks postoperatively, compared with a control arm of one week, with a relative risk reduction of 60% and a number needed to treat, to prevent a thrombotic event, of 14. In 2010, this evidence found its way into the National Institute for Health and Clinical Excellence (NICE) guidelines. Venous thromboembolism – reducing the risk, clinical guideline 92, recommends that pharmacological prophylaxis should be extended for 28 days in patients undergoing major abdominal or pelvic surgery for cancer.
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Comment: Future perspectives
Peter Rose
pp 2-2
Thrombus is entering its 17th year, and continues to provide clinical and practical advice for management of patients with thrombotic disorders and those requiring anticoagulant treatment. For the year ahead, we hope to keep readers up-to-date with the rapid changes in the management of stroke reduction in non-valvular atrial fibrillation and in the management of venous thromboembolic disease. Currently, guidelines in these areas are out of date as soon as they are written, due to changes in the licensing and the National Institute for Health and Clinical Excellence approval process for use of the novel oral direct inhibitors. It is expected that the direct thrombin and direct factor Xa inhibitors will continue to be approved for wider clinical use and that this will impact on service delivery, both in primary and secondary care.
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FAQs: What should you do if someone has a bleed on an oral direct inhibitor?
Sarah Bond
pp 4-4
Dabigatran and rivaroxaban do not have a specific antidote, so managing bleeding events has to be based upon supportive measures. However, both drugs have a short half-life (dabigatran, 12–17 hours and rivaroxaban, 11–13 hours), so pharmacological effects will wear off more quickly than warfarin.
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Investigation and management of retinal vein thrombosis
Tristan McMullan
pp 5-8
Venous thrombosis in the retinal circulation can range from an asymptomatic incidental finding to a blinding problem resulting in rubeotic glaucoma and loss of the eye. It is also a marker for systemic disease, with some evidence of increased morbidity and mortality.There is an 11.9% risk of the fellow eye being affected by central retinal vein occlusion at four years.
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A quick guide to traveller’s thrombosis
Patrick Kesteven
pp 9-10
In March 2012, the International Air Transport Association reported that the number of annual air passengers worldwide had approached two billion. Travel is a relatively weak precipitant of venous thromboembolism, in the absence of other hazards, but nevertheless, this leaves an enormous number at risk.
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Thrombosis and sickle cell disease
Ben Bailiff and Peter Rose
pp 12-14
Sickle cell disease (SCD) is an inherited disorder that can present with clinical features of veno-occlusive disease, haemolysis and various thrombotic complications. SCD occurs in the presence of sickle haemoglobin, in patients homozygous for the substitution of glutamic acid by valine at the sixth position in the beta globin chain. This results in decreased red cell survival and sickling of red cells, which become polymerised under a variety of stresses, with loss of normal red cell shape and deformability. The clinical result is often chronic multi-organ disease.
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