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Thrombosis and its treatment | ||||||
What is thrombosis? Thrombosis is one of the major causes of cardiovascular morbidity and mortality in the developed world, with nearly four million people experiencing thrombosis worldwide each year. It is caused by the formation of a thrombus - or blood clot - which can lead to the obstruction of blood vessels and prevent the circulation of blood to the heart (myocardial infarction) or brain (stroke). When blood clots break away from their original location (for example, a deep vein thrombosis, DVT), they can block blood vessels (venous thromboembolism, VTE) in other parts of the body, such as the lungs (pulmonary embolism). Those at greatest risk of thrombosis include patients with atrial fibrillation (AF: erratic heartbeat), patients following orthopaedic surgery, and those who have experienced a previous thromboembolic or cardiac event.
Patients often require long-term anticoagulant treatment, and subsequently its efficacy, safety and impact on quality of life are of great importance. Currently available treatments for the management of thrombosis, although effective, are associated with a number of drawbacks. Vitamin K antagonists (VKAs) - for example, warfarin - have been the standard long-term anticoagulant therapy for almost 60 years. However, drawbacks associated with warfarin include drug and food interactions and the need for routine coagulation monitoring. People receiving VKAs therefore have to go to their doctor or to the lab at least once a month, and sometimes even more frequently, to have their blood tested and dose adjusted. Taking the wrong dose will lead to an increased risk of bleeding or stroke. Low molecular weight heparins (LMWHs) require subcutaneous or intravenous administration, and so are inconvenient to use outside the hospital environment and are unsuitable for long-term treatment. Subsequently, many patients at risk of thrombosis do not receive the anticoagulant therapy they need because of the complications associated with these treatments. Anticoagulants in action AF occurs in around one in 25 adults over 60 years and more than one in 10 adults over 80 years old. Patients with AF experience a five-fold increased risk of stroke compared to those with a normal heartbeat and as a result, across 22 European countries with a combined population of 500 million, there are almost one million strokes each year, making it the second leading cause of death worldwide. Anticoagulant therapy is an effective means of lowering the risk of stroke in patients with AF. A study conducted by the Stroke Council of the American Heart Association highlights that treatment with VKAs can reduce the risk of stroke for patients with AF by an average of 68%.However, only half of patients with AF currently receive appropriate anticoagulant treatment. An explanation for eligible patients not receiving treatment is potentially that the limitations associated with VKAs and the variability in response of treatment can have an impact on a patient’s quality of life and lead to a reluctance on the part of the physicians to prescribe therapy for patients whom they consider incapable of managing such a complicated treatment regime. For patients already receiving VKA therapy to protect them long-term from stroke, these limitations can cause a lack of compliance with an associated increase in the potential for bleeding or stroke. However, the incidence of AF continues to increase, in line with an ageing population throughout the developed world, and the high economic cost of treating stroke means there is a clear rationale for addressing the under-utilisation of anticoagulant therapy and to improve the management of patients’ treatment to protect them from stroke. | ||||||
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IMPORTANT: The following suggestions apply for any long journey, such as coach, train or car, and also when sitting for any lengthy period.
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