Journal of the New Zealand Medical Association, 18-June-2004, Vol 117 No 1196
ABC of antithrombotic therapy
Gregory Lip and Andrew Blann, editors. Published by BMJ Books.
ISBN 0-7279-17714. Contains 67pages. Price GBP16.95
This short text delivers informative reviews on thrombotic issues pertaining to a diverse range of medical and surgical specialties. The book’s concise style, typical of the ABC series in the British Medical Journal, offers a mix of relevant research and clinical data, focusing on patient management. Included are useful references to North American and British antithrombotic guidelines, and each chapter provides a "further reading" list for enthusiastic readers. The text is mainly written by staff at the Haemostasis, Thrombosis and Vascular Biology Unit at the University Department of Medicine, City Hospital, Birmingham.
Chapters 1 and 2 offer useful overviews of antithrombotic drugs and bleeding risk; covering antiplatelet agents, anticoagulants and thrombolytics. There are clear tables, bullet point fact lists, and explanatory diagrams. Safety criteria for prescribing these drugs are reviewed.
The chapter on diagnosis and prevention of venous thromboembolism covers the important principles of pre-test probability assessment for DVT and clinical probability criteria for PE. Prevention strategies are classified according to risk assessment. A very good evidence-based guide on thromboprophylactic strategies is presented for various risk settings and for various anticoagulant products, adapted from ACCP guidelines.
The chapter on atrial fibrillation tackles the challenge of ‘who to treat’, based on risk stratification schemes. The cardiology section covers anticoagulation guidelines for cardioversion and acute coronary syndromes. Sub-specialised areas of thrombosis in pregnancy, and in the paediatric setting, are covered conservatively—while not forgetting to address useful recent developments, such as appropriate strategies for managing LMWHs, the anti-phospholipid syndrome, and prosthetic cardiac valve thromboprophylaxis during pregnancy. Finally, the perennial issue of chronic oral anticoagulant management is reviewed for the UK setting, which is equally applicable to the New Zealand environment.
That such a diverse range of topics is covered in a 67-page text underscores its concise layout. I would recommend this book to generalists seeking an update, and to students as a concise learning tool covering antithrombotic interventions across a spectrum of clinical settings.
Canterbury Health Laboratories
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