I read with interest the article by Langford et al in the recent edition of Acute Medicine, summarising the NICE guidance for the management of venous thromboembolic diseases.1 This highlights the recommendation that CTPA should be the investigation of choice for patients with suspected pulmonary embolism (PE), in view of its clinical and cost effectiveness.
In the latest edition of the journal, catheter-directed thrombolysis was reviewed (1), and does appear to be an attractive therapeutic option for treatment of deep venous thrombosis, both in prevention of postthrombotic syndrome and avoidance of anticoagulant therapy. I have one concern about the procedure with regards to the quoted bleeding rates. A systematic review reported high bleeding rates at 31% though major bleeding rates were low (2)
I read with interest the review article on the management of toxological emergencies , published in the last edition of the journal (E. Banham-Hall, R. Mallinson: Poisoning and toxological emergencies – acute trends and practice. Acute Medicine 2009 8(2) p17-21).