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Compression Stockings; Stroke Prevention; Stents and Meds

Clicks:Updated:2016-06-06 09:06:34

Stay the Course on Compression Stockings
After a symptomatic deep vein thrombosis of the leg, the full 2-years wearing elastic compression stockings helps prevent post-thrombotic syndrome, the randomized OCTAVIA trial affirmed.

Incidence of post-thrombotic syndrome at 24 months among the 518 initially-adherent patients randomized was 19.9% when patients stopped wearing the stockings at 12 months and 13.0% when continued to 24 months. The upper confidence interval of 12.3% for the difference between groups exceeded the predefined margin of 10% for non-inferiority.

While 2 years has been recommended in international guidelines and used in daily clinical practice, there had been debate over a possible placebo effect in the trials after the SOX trial failed to show any benefit over placebo stockings, the researchers noted in BMJ.

But that trial "had very poor adherence; only 56% of patients were using the study stockings for three days a week or more at the end of the study," whereas adherence 6 or more days a week in OCTAVIA was 85% from year 1 to 2. Even if uncomfortable or seemingly unattractive, keeping the stockings on the extra year was worthwhile and should be recommended, the researchers concluded.

Contraindicated Meds in Stenting
Few percutaneous coronary intervention (PCI) patients who shouldn't get antiplatelet medications still do, a study of veterans showed.

The overall rate of receipt of contraindicated antiplatelet medication was just 1.1% in the registry. However, among people with a contraindication, that rate was 6.5%.

The findings highlight the persistence of medication errors, "despite high-profile reports and electronic medical record built-in warnings," the researchers wrote in Circulation: Cardiovascular Quality and Outcomes. See MedPage Today's coverage here.

Real-World vs. Trial Setting in Afib
The stroke prevention trials with dabigatran (Pradaxa) or warfarin in atrial fibrillation might have underestimated the bleeding risk when applied in real-world practice, a healthcare claims database suggested.

Among more than 6,500 people initiating dabigatran and 15,400 starting on warfarin in the United Health databases from October 2009 through June 2013, the observed rate of thromboembolism in routine care was close to that predicted by the trials (1.7 per 100 patients annually).

However, the annual major bleeding event rate of 4.6 per 100 patients was consistently higher than the trial estimates, particularly in warfarin initiators with high HAS-BLED scores, for whom the difference was up to 4.0 per 100 patient-years.

"In situations where model based predictions can be demonstrated to be more accurate for patients treated as part of routine care, they may prefer to use these predicted event rates as one factor in the decision making process," the researchers noted in BMJ.

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