Thrombus - 2013


Counselling for patients taking oral direct inhibitors as anticoagulant therapy
Caroline Baglin
pp 1-4
The Clinical Leaders of Thrombosis (CLOT) is a specialist interest group consisting of approximately 450 multidisciplinary healthcare professionals, who have direct patient contact, working in the field of haemostasis and thrombosis, mainly in the UK. The group’s aim is to share knowledge and experience, and facilitate learning to support members in the delivery of high-quality care. CLOT also aims to shape future services and advance the boundaries of healthcare delivery.
Comment: Always more to be learnt
Peter Rose
pp 2-2
This year’s International Society for Haemostasis and Thrombosis Congress was held in July in Amsterdam. Not surprisingly, there was a major emphasis on the oral direct inhibitors, particularly in the management of venous thromboembolic (VTE) disease. The overall message was that all the new agents, including apixaban, dabigatran, edoxaban and rivaroxaban, are effective treatments in the management of deep vein thrombosis, being at least as effective as warfarin and having a generally better safety profile. Therefore, the whole clinical approach to the management of VTE disease is set to change and it is likely that there will be increasing patient management in the primary care setting.
Impact of the new commissioning structure on anticoagulant services
Greg Fell
pp 5-7
Even the most disinterested observers cannot help but notice that the NHS is midway through another reorganisation. It might be argued that this reorganisation is more substantial than most, particularly in terms of the changes made to the commissioning structure; as noted by Sir David Nicholson, the reforms are so substantial they can be seen from space. These changes are happening at a time of great financial austerity. Furthermore, there are important new anticoagulant treatments now available that are substantially more expensive than existing treatments. This makes for very interesting times for anticoagulant services.
Benefits of bridging clinics – a case study
Juliane Kause, Tracy Graham and Judith Effeny
pp 8-11
Patients receiving long-term anticoagulation with oral vitamin K antagonists pose clinical challenges when therapy needs to be interrupted for surgical or interventional procedures. A balance between the risk of thromboembolism and bleeding complications needs to be achieved. This article explores these issues in further detail and outlines how a bridging service can overcome many of the barriers to optimal anticoagulation and safe surgery.
Laboratory testing and the novel oral direct inhibitors
Ian Jennings
pp 12-13
For more than 60 years, patients requiring long-term anticoagulation have primarily received treatment with vitamin K antagonists – most commonly warfarin. It is necessary to closely monitor the anticoagulant effect of these drugs due to a narrow therapeutic window, marked between-patient variation in drug sensitivity and interaction with many other treatments. With over 1% of the UK population receiving anticoagulant therapy, the workload for laboratories in monitoring international normalised ratios in these patients is significant and grows on an annual basis. Moves to control patients in primary care, through use of point-of-care devices, have alleviated this workload somewhat, but these bring their own problems and issues.

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