The field of anticoagulation has seen impressive progress over the last decade. The introduction of the Non Vitamin K Oral Anticoagulants (NOACs) has revolutionized practice surrounding thromboprophylaxis, treatment of thromboembolic disease and stroke prevention in atrial fibrillation (AF). However, the search for the 'holy grail' of anticoagulation, an agent that combines optimal efficacy with minimal bleeding diathesis, continues. Areas covered: In this paper we aim to summarize the current evidence from pre-clinical studies and early phase clinical trials, presenting the pharmacodynamic and pharmacokinetic properties as well as the safety and efficacy profiles of the most important antithrombotic agents in development. Expert opinion: Research focused on the development of new anticoagulation agents is rapidly expanding. Although the exploration of antithrombotic agents that act on well-established targets such factor Xa and thrombin remains the mainstay, attention has also shifted to other factors in the coagulation cascade. The evidence emerging from clinical research is growing, generating exciting possibilities in the field of anticoagulation.

PE can be quite difficult to diagnose. It is relatively common and can be fatal without adequate treatment. As per NICE guideline on the management of patients with suspected PE, where patients are considered to be of lower risks for PE based on the Wells score, D-dimer can be used to stratify patients. Positivity of D-dimer subsequently influences decision on radiological imaging (CTPA/VQ). In a real-life clinical setting, there appears to be a wide variation in clinicians' interpretation of D-dimer values in the context of PE. Apart from D-dimer, other biochemical variables including CRP, WCC, neutrophils:lymphocytes and CXR findings are often included as part of the initial investigations. This study aimed to assess the diagnostic value of these variables and its influence on predictability of PE.

Much of the work on basal cell carcinoma (BCC) in the literature mainly focused on the assessment of BCC excision completeness and comparing the performance of GPs, plastic surgeons and dermatologists. While most studies have consistently reported that GPs tended to do less well than the other specialists, little or no work was done to explore this even further.The study aimed: 1) to assess the performance of GPs, dermatologists and plastic surgeons in excision of basal cell carcinoma. 2) To identify factors or predictors of excision completeness. 3) To identify certain patterns of excision made by each specialty, including excision cut margin, size of lesion, confidence in diagnosing skin lesion, etc.

As its symptoms are non-specific and develop progressively, testosterone deficiency is often misdiagnosed and overlooked. Symptoms may be mild and accepted as normal manifestations of ageing. Some of these symptoms can indeed occur in ageing men who do not have testosterone deficiency. Diagnosis of testosterone deficiency in ageing men can be challenging, as symptoms of testosterone deficiency overlap with those of ’normal’ physiological ageing. GPs’ prescriptions of testosterone have increased significantly over the past decade. An increased awareness among GPs, when coupled with extra demand from patients, is likely to lead to increased prescribing of testosterone. Patient demand has increased with sophisticated drug marketing and guidelines promoting testing and treatment of testosterone deficiency. This article reviews the common clinical features and diagnosis of testosterone deficiency, identifies the risk and benefits of testosterone replacement therapy, and briefly discusses the associated controversies regarding prostate cancer and cardiovascular risk.