Should patients with venous thrombosis have cancer screening? Raj K Patel pp 1-4 Ten per cent of patients with idiopathic
venous thromboembolism (VTE) will have
underlying occult malignancy, and there is
a threefold increased risk of new cancer
diagnosis in the months following VTE
diagnosis.Where occult cancer is present,
it is metastatic in 40–60% of cases.7,9,10 The
issue of whether or not to screen patients
with acute VTE for occult cancer at diagnosis
is controversial, and there is no consensus
on how extensive any screening programme
should be. Few studies have addressed the
cost, safety, psychological stress and health
benefits associated with extensive screening
strategies
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Comment: Problems with implementing NPSA alert 18 Peter Rose pp 2-2 Anticoagulant management is ultimately predestined to fail.
Any system that requires correct sample analysis, reporting of
results, data interpretation, communication, patient understanding and
compliance will, on occasions, fail. The recent National Patient Safety
Agency (NPSA) alert, aims to minimise these failures (see Rosalind
Perrott’s article on page 14 of this issue for further insights).
Many of us are currently suffering from NPSA ‘alertitis’, with alerts
on numerous medications requiring treatment plans and rapid action.
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Orally active antithrombotic agents: a new era in the prevention of VTE Simon P Frostick pp 5-6 As warfarin was introduced as an oral
antithrombotic agent 60 or so years ago,
the arrival of new orally active
antithrombotic agents represents a
significant advance. So far, two agents
have been licensed for the prophylaxis of
orthopaedic patients undergoing total
hip replacement (THR) or total knee
replacement (TKR): dabigatran
(Pradaxa®,Boehringer Ingelheim, UK)
and rivaroxaban, (Xarelto®, Bayer AG,
UK). A third drug, apixaban (Pfizer, UK),
has completed a Phase III trial, but failed
to achieve non-inferiority (NI) in THR
patients. In a Phase II dose-ranging study
for TKR patients, there was reduction of
venous thromboembolism (VTE) events
in the apixaban groups, but also a
statistically significant increase in
bleeding associated with the drug.
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Developing a national risk assessment model to prevent VTE in hospital Trevor Baglin pp 7-9 VTE (venous thromboembolism) describes
deep vein thrombosis (DVT) with or
without symptomatic pulmonary
embolus. Recent hospitalisation for
surgery or medical illness is responsible
for approximately half of all cases of
VTE. In addition, approximately half of
all hospitalised patients are at risk of
VTE and one in ten hospital deaths are
due to pulmonary embolism (PE).
Among seven million patients
discharged from nearly 1,000 US acute
care hospitals, postoperative VTE was the
second most common complication, the
second most common cause of excess
length of stay, and the third most
common cause of excess mortality and
excess cost.
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Self-management of oral anticoagulation and quality assurance Ellen Murray, Ian Jennings and David Fitzmaurice pp 10-12 Patient self-management of oral
anticoagulant therapy using point-ofcare
(POC) devices has the potential to
become as routine as diabetes selfmonitoring.
However, there are concerns
that POC devices outside the laboratory
setting, particularly those used by
patients, can be inaccurate due to
analytical error (in part due to lack of
knowledge about quality assurance
procedures). Please note, this article is
based on a previously published report.
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Update on NPSA patient safety alert 18 Rosalind Perrott pp 14-15 The National Patient Safety Agency
(NPSA) published patient safety alert 18,
Actions that can make anticoagulation
therapy safer, in March 2007. The alert
was issued in response to a risk
assessment of UK anticoagulation
services, which highlighted many areas
of high risk. The target date for
implementation was 31 March 2008.
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