New anticoagulants: major advances and patient needs
Patrick Kesteven and Brian Robinson
pp 1-4
Both unfractionated heparin (UFH) and warfarin have been in clinical use for over 50 years. Both are well, but not fully, understood, inexpensive and effective, with a reasonable safety profile. In most clinical situations, both require careful laboratory monitoring and dose adjustment.Warfarin effect is sensitive to changes in diet, liver function and drug interactions involving the P450 cytochromes. UFH must be administered parenterally and IV infusions monitored daily. In addition to their anticoagulant effects, heparins have other, poorly understood, effects involving growth factors and angiogenesis.
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Comment: The real cost of warfarin for patients with atrial fibrillation
Peter Rose
pp 2-2
In this issue, we read of the exciting development of new anticoagulant treatments. Ximelagatran, a reversible direct thrombin inhibitor, is set to be the first new oral anticoagulant since the introduction of warfarin nearly 60 years ago. This agent has received approval in France, acting as reference Member State for the European Union mutual recognition procedure, for use in orthopaedic thromboprophylaxis. Regulatory submissions for use in the prevention of stroke in atrial fibrillation (AF) have been filed in France, with Food and Drug Administration submissions in the United States. It is only a matter of time before this agent is available for use in the UK.
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Guidelines for patient self-testing and self-management of oral anticoagulation
Deborah McCahon, Ellen Murray and David Fitzmaurice
pp 5-6
Patient self-management (PSM) of warfarin therapy is comparable to home glucose monitoring using a portable glucometer, and may provide a robust model of service provision, with improvements in patients’ selfefficacy, closer treatment adherence and increased control of oral anticoagulant therapy.
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Thrombosis in children Part 1: incidence, risk factors and diagnosis
Elene Psiachou-Leonard and Denise O’Shaughnessy
pp 7-9
Thromboembolism (TE), venous or arterial, is rare in childhood and when present is associated with underlying acquired or hereditary disorders.1,2 Thromboembolism in children is an increasingly recognised entity – particularly within certain paediatric subspecialties such as neonatology, intensive care, cardiology, cardiac surgery and oncology.
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Informing patients about their drug sources – how far should you go?
Hayley Flavell
pp 10-11
Low molecular weight heparin (LMWH) is a form of anticoagulant that is derived from the intestines of pigs; it is a byproduct of the sausage industry.1 LMWHs are widely used in the prophylaxis and treatment of deep vein thrombosis (DVT) and pulmonary embolism.
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