Thrombus - 2006

The commissioning of anticoagulation management services in primary care
Stephen Munday
pp 1-4
Venous thromboembolism (VTE) is the most common cause of maternal mortality in the developed world and now accounts for more maternal deaths than eclampsia and puerperal sepsis combined. Coumarins are contraindicated in the latter half of the first trimester due to teratogenic effects on nasal bridge development. Transplacental anticoagulant effect provides a relative contraindication to coumarin therapy in the second and third trimesters.

Comment: Lament for ximelagatran
David Fitzmaurice
pp 2-2
The search for a replacement drug for warfarin (and other coumarin derivatives) has been ongoing for some 50 years. There have been numerous variations of snake venoms and synthetic molecules, none of which have quite measured up in clinical trials. The past decade has seen increasing excitement about one particular molecule, melagatran (Exanta™, AstraZeneca, UK), which raised the prospect of a new oral anticoagulant preparation, given in a fixed daily dose and not requiring monitoring.

Low molecular weight heparin in pregnancy: is dose frequency relevant?
Mark P Smith
pp 5-7
Venous thromboembolism (VTE) is the most common cause of maternal mortality in the developed world and now accounts for more maternal deaths than eclampsia and puerperal sepsis combined. Coumarins are contraindicated in the latter half of the first trimester due to teratogenic effects on nasal bridge development. Transplacental anticoagulant effect provides a relative contraindication to coumarin therapy in the second and third trimesters.

The role of D-dimer assays in predicting the risk of recurrence of VTE
Farooq A Wandroo
pp 8-8
Patients who suffer from symptomatic venous thromboembolism (VTE) have a high risk of recurrent VTE that persists for many years. Knowledge of the risk of recurrence of a thrombotic event and its determinants is relevant for clinical policy regarding screening for thrombophilia, duration of anticoagulant treatment and prophylactic strategies.

What makes a good consultation?
Steve Johnson
pp 9-11
The clinical consultation is central to medical practice. It is the setting in which the doctor meets the patient and where clinical decisions are taken. The advice, investigation and treatment decisions that take place during the consultation have important implications for the patient and their family but also for the healthcare service and the wider economy of society. The nature of the consultation has been thoroughly examined in primary care but less so in hospital settings; nonetheless, many of the principles associated with good consultation practice have general applications to all doctor–patient interactions. If it is planned to impart important information about a patient’s diagnosis or treatment, this should clearly be done face to face rather than by telephone or letter.