It is interesting that in the UK the government are pushing the management of this type of disease into primary care. Will this eventually be reversed?

The science of thrombotic disorders is reaching a revolutionary phase in its development with new paradigms of diagnosis, prophylaxis, acute treatment and chronic management. In addition a deeper understanding of the genotypic and phenotypic mechanisms in thrombophilic states is increasing.

Anticoagulation is rapidly becoming a ‘glamour’ topic!

Improved diagnostic decision modeling, including the use of newer diagnostic modalities such as plasma quantitative d-dimer testing [1-3], spiral computerized tomography scanning [4,5], and magnetic resonance direct thrombin imaging (MRDTI) [6] may approach the sensitivities and specificities of the venographic "gold standard" and ultimately obviate the need for invasive testing.

New randomized controlled data supporting in-patient thromboprophylaxis for well-defined medical at-risk patient groups and extended thromboprophylaxis in high risk surgical groups such as cancer and orthopedic patients are providing complex disease management guideline approaches in the area of VTE prophylaxis.

Lastly, the field of antithrombotic therapy has reached explosive levels within the pharmaceutical industry's drug pipeline, with ever increasing numbers of agents undergoing Phase Il and III clinical trials.

They argue the case for the need and the formation of a specialist service to sit along side the current anticoagulation clinics headed by a clinical thrombologist!

For more information see the Journal of Thrombosis and Thrombolysis 15(3), 227-232, 2003