Bookshelf |

Thrombosis and Thromboembolism FREE TO VIEW

Alex C. Spyropoulos, MD
Chest. 2003;123(1):316. doi:10.1378/chest.123.1.316
Text Size: A A A
Published online


By Samuel Z. Goldhaber, MD, and Paul M. Ridker, MD, MPH, eds. New York: Marcel Dekker, 2002; 365 pp; $165

An updated book on the most recent advances in arterial and venous thrombotic and thromboembolic disease, especially from a clinical perspective, has been long overdue. The 44th volume of the acclaimed “Fundamental and Clinical Cardiology” series, Thrombosis and Thromboembolism by Goldhaber and Ridker provides a much needed overview, for the practicing physician and experienced clinical investigator alike, of this rapidly expanding and evolving field.

A cursory glance at the list of contributing authors and references for each chapter belies the fact that great care was taken by the editors in choosing selected topics within the field of vascular medicine that are timely, scientifically sound, clinically relevant, and based on an interdisciplinary approach to the field. As expected when rapid advances in the scientific, diagnostic, and therapeutic arena have yet to be fully translated at a patient practice level, controversial topics in thromboembolism are not overlooked. Integrated within their respective chapters are such “hot” topics as the following: the use inflammatory markers in assessing the risk of arterial thrombosis, emerging concepts in hyperhomocysteinemia and the antiphospholipid antibody syndrome in vascular disease risk, the role of hormone replacement therapy in cardiovascular disease prevention in women, the optimal role of antithrombotic therapy during coronary intervention, the emerging role of novel antiplatelet therapy in cardiovascular disease, the failure of the oral platelet glycoprotein IIb/IIIa antagonists in clinical trials, the optimal duration of anticoagulant therapy in venous thromboembolism, and the expanding use of thrombolytic agents to treat hemodynamically stable pulmonary embolism and iliofemoral deep vein thrombosis. In superb fashion, the editors adapted and condensed the mass of relevant clinical trials or observational study results within each section into a handful of easy-to-digest summary tables or illustrative figures, a task that would be herculean for most readers or practitioners with an interest in the field.

The book is arranged into five parts: Part I is dedicated to the emerging concepts of hypercoagulability and hypercoagulable states; Parts II and III are dedicated to advances in diagnostic and pharmacologic/interventional therapeutic approaches to acute coronary syndromes and peripheral arterial occlusive disease; Parts IV and V are dedicated to new diagnostic paradigms and antithrombotic, interventional, and surgical approaches to venous thromboembolism. By extensive review of recent landmark clinical trials, including the CURE, TIMI-14, and ISIS-2 studies, specific emphasis is made of clinical use of low-molecular-weight heparins (LMWH), direct thrombin inhibitors, glycoprotein IIb/IIIa inhibitors, and the novel thienopyridine adenosine diphosphate antagonists in the setting of acute coronary syndromes and (in the case of the thienopyridines) cerebrovascular/peripheral artery disease. In addition, the editors highlight the achievements made, in the catheterization and interventional laboratory, in both diagnosis and management of acute arterial and venous thromboembolic disease, especially in conjunction with the newer antithrombotic agents. Two whole sections and multiple chapters are devoted to this exciting field.

On the venous side of thromboembolic disease, the tables summarizing the use of validated, integrated, diagnostic algorithms for patients with suspected venous thromboembolic disease are invaluable, although the emphasis on the use of quantitative plasma d-dimer testing as first-line screening may be premature in US health-care systems, where this approach awaits external validation in routine care settings. The chapters on the management of pulmonary embolism, with special emphasis on the emerging role of patient risk stratification and the use of thrombolytic therapy in hemodynamically stable patients, truly represent the most current state of affairs in this area.

The shortcomings of the book stem from the editors’ selective emphasis on certain topics in this evolving field to the exclusion of others. Although heparin-induced thrombocytopenia and the prevention of venous thromboembolism have books dedicated to them within the “Fundamental and Clinical Cardiology” series, some mention would have been appropriate of the newly approved synthetic antifactor Xa agent, the pentassacharide fondaparinux. The chapters on the clinical implications of angiotensin-converting enzyme inhibition therapy and the role of interdisciplinary anticoagulation management services, though well written, seem out of place in a book devoted to the mostly clinical aspects of thromboembolic disease. A chapter reviewing the recent clinical trials and observational study experience of outpatient-based treatment of uncomplicated proximal deep vein thrombosis (DVT) using LMWH, including patient selection and risk stratification strategies, would have been more timely. Also, there is no mention of a very recent diagnostic tool in venous thromboembolic disease—magnetic resonance direct thrombin imaging. Lastly, no discussion of ambulatory therapy using compression stockings in the acute stage of DVT is considered, although positive randomized trial data in decreasing postphlebitic syndrome are accumulating.

Thrombosis and Thromboembolism delivers a “state-of-the-art” book on thromboembolic disease. By focusing on timely and scientifically sound clinical aspects and by highlighting current innovations and controversies in the field, the book represents a mini-encyclopedia of where we should be in current clinical practice and maps out the future directions in the management of thromboembolic disease.




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543