Use and abuse of TTR in the management of anticoagulation
Francesca Jones and Peter Rose
pp 1-4
Oral anticoagulants are an increasingly common therapy for a wide range of conditions. Therapeutic indications include the prevention and treatment of venous thromboembolism, and the prevention of thromboembolic complications in patients with prosthetic heart valves, valvular heart disease or atrial fibrillation. However, as with all treatments, there are associated risks – most notably, bleeding complications, which are closely related to the intensity of anticoagulation.
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Comment: Vigilance with the novel oral direct inhibitors
Peter Rose
pp 2-2
The novel oral direct inhibitors have all proven, in clinical trials, to be at least as safe as warfarin with respect to bleeding risk, and are associated with a lower risk of intracranial haemorrhage. In the non-trial setting of the real world, information is accruing to support these findings. However, a cause for concern is the cases of litigation associated with bleeding and use of the new agents in North America. These cases focus around the clinician’s failure to inform the patient of the fact that there is no immediate antidote to reverse bleeding associated with use of these agents. They act as a reminder, when starting a new agent, to inform the patient of this information from the onset. I would suggest this information is detailed in the patient correspondence when treatment is commenced, together with a direction that the patient is responsible for ensuring they are compliant with taking their medication.
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Diagnosis and management of HIT
Hannah Sims and Martin Besser
pp 5-7
Heparin-induced thrombocytopenia is a rare disorder, with a frequency of 0.2–5.0% in patients exposed to heparin for over four days. There is variation in incidence according to the clinical situation. The pathophysiology is well documented and tools to diagnose the clinical likelihood of the condition have been used since 2003. Here, we aim to review these data, and also the laboratory aspects of diagnosis, along with management.
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GRASP-AF: reducing the risk of stroke in atrial fibrillation
Richard Healicon
pp 8-10
Atrial fibrillation (AF) is the most common form of cardiac arrhythmia and is a major preventable cause of stroke. In 2006, the National Institute for Health and Care Excellenceestimated the prevalence of AF in England to be about 1.3%.The latest Quality and Outcomes Framework data for 2011/12 suggest this is nearer 1.5%.This indicates that, in England, around 816,000 people have AF, although this is likely to be an underestimate, as this is just recorded AF, and does not include patients whose AF is not recorded, or is as yet undiagnosed. The prevalence of AF increases markedly with age and, therefore, the forecast is for the prevalence to increase as the population ages.
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Superficial thrombophlebitis: a proposal for classification and management
Anand Lokare
pp 11-13
The management of superficial thrombophlebitis (ST) has changed significantly with the recognition that this entity overlaps with venous thromboembolism. A strategy to identify which patients need anticoagulation, the optimal drug to use, and the dose and duration of treatment remains undetermined, due to the lack of high-quality data. This article reviews the evidence available and proposes a classification of patients with ST and treatment options for each group.
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FAQs: Anticoagulation and vena cava filters
Angela Collins
pp 14-14
Vena cava (VC) filters, also referred to as inferior vena cava filters, are radiologically inserted wire devices designed to trap clots in patients with known venous thromboembolism to prevent pulmonary embolism. VC filters are not as effective at preventing PE as anticoagulation so they are reserved for situations where anticoagulation is contraindicated or insufficient, although the evidence that they reduce mortality is lacking.
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