scholarly journals EP.WE.690PPI Prescribing in Vascular Discharges

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Amy Hooper ◽  
Fang Yi Cheung ◽  
Anna Murray
Keyword(s):  
Critical Limb Ischaemia ◽  
Limb Ischaemia ◽  
Significant Morbidity ◽  
Diabetic Foot Infection ◽  
Nice Guideline ◽  
Period 2 ◽  
Anti Platelet Agent ◽  
Increased Risk ◽  
Upper Gastrointestinal

Abstract Aims Aspirin and clopidogrel are ubiquitously seen in prescriptions of most attendees to hospitals, especially those being admitted to a vascular unit. Most, if not all, are on at least one anti-platelet agent, and some are on dual antiplatelets (DAPA) or an anticoagulant. These increase the risk for upper gastrointestinal (UGI) bleeds, which lead to significant morbidity and mortality. In order to prevent this, proton pump inhibitors (PPIs) are recommended to be prescribed for patients with increased risk of UGI bleeds. Our aim for this audit was to evaluate the prescription of PPIs in vascular patients discharged from a major vascular hub. Methods Data was collected from a prospectively maintained database of consecutive primary vascular discharges between 01/09/2020 and 31/09/2020. Results 87 patients discharged in this period (71% Male, Median age 72 (22-92) yrs). 26% of admissions accounted for Diabetic foot infection management, 25% for Critical Limb Ischaemia management and 20% for Thoracic or Aortic Aneurysm management. 70% of patients were discharged with either a single or DAPA. 94% of patients met the NICE guideline for requirement for a PPI. 49% of those patients were not discharged with a PPI. Of the patients who should have been prescribed a PPI on discharge, 5% suffered UGI bleeds in the follow up period (2/42). Conclusions PPIs are often not prescribed when discharging vascular patients, most of whom are high risk for having UGI bleeds. We will re-audit this after education and protocols have been implemented.

scholarly journals Use of aspirin in Chinese after recovery from primary intracranial haemorrhage

2012 ◽  
Vol 107 (02) ◽  
pp. 241-247 ◽  
Author(s):  
Boon-Hor Chong ◽  
Koon-Ho Chan ◽  
Vincent Pong ◽  
Kui-Kai Lau ◽  
Yap-Hang Chan ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Ischaemic Stroke ◽  
Intracranial Haemorrhage ◽  
Chinese Patients ◽  
Vascular Events ◽  
Coronary Syndrome ◽  
Anti Platelet Therapy ◽  
Anti Platelet Agent ◽  
Increased Risk

SummaryIntracranial haemorrhage (ICH) accounts for ~35% of all strokes in Chinese. Anti-platelet agent is often avoided after an index event due to the possibility of recurrent ICH. This single-centered observational study included 440 consecutive Chinese patients with a first spontaneous ICH surviving the first month performed during 1996–2010. The subjects were identified, and their clinical characteristics, anti-platelet therapy after ICH, and outcomes including recurrent ICH, ischaemic stroke, and acute coronary syndrome were checked from hospital records. Of these 440 patients, 56 patients (12.7%) were prescribed aspirin (312 patient-aspirin years). After a follow-up of 62.2 ± 1.8 months, 47 patients had recurrent ICH (10.7%, 20.6 per 1,000 patient years). Patients prescribed aspirin did not have a higher risk of recurrent ICH compared with those not prescribed aspirin (22.7 per 1,000 patient-aspirin years vs. 22.4 per 1,000 patient years, p=0.70). Multivariate analysis identified age > 60 years (hazard ratio [HR]: 2.0, 95% confidence interval [CI]: 1.07–3.85, p=0.03) and hypertension (HR: 2.0, 95% CI: 1.06–3.75, p=0.03) as independent predictors for recurrent ICH. In a subgroup analysis including 127 patients with standard indications for aspirin of whom 56 were prescribed aspirin, the incidence of combined vascular events including recurrent ICH, ischaemic stroke, and acute coronary syndrome was statistically lower in patients prescribed aspirin than those not prescribed aspirin (52.4 per 1,000 patient-aspirin years, vs. 112.8 per 1,000 patient-years, p=0.04). In conclusion, we observed in a cohort of Chinese post-ICH patients that aspirin use was not associated with an increased risk for a recurrent ICH.

scholarly journals An observational study into the management of arteriomegaly: a call for a revised classification system

2012 ◽  
Vol 94 (4) ◽  
pp. 250-255 ◽  
Author(s):  
JV Barandiaran ◽  
TC Hall ◽  
I Glaves ◽  
N El-Barghouti ◽  
EP Perry
Keyword(s):  
Observational Study ◽  
Critical Limb Ischaemia ◽  
Limb Ischaemia ◽  
Type I ◽  
Type Ii ◽  
Type Iii ◽  
Cerebrovascular Events ◽  
Progression Of Disease ◽  
Artery Disease

INTRODUCTION Arteriomegaly is the diffuse ectasia of arteries with or without aneurysmal disease. Patients with arteriomegaly have a higher incidence of morbidity including limb loss compared to patients with other arteriopathies. The aim of this observational study was to review the management of these patients in our institution. METHODS Radiologists and surgeons prospectively reviewed aortofemoral angiography. Patients with arteriomegaly were identified. Data relating to demographics, mode of presentation, risk factors, type of arteriomegaly, management and progression of disease were analysed. RESULTS Arteriomegaly was identified in 1.3% of patients (n=69) undergoing lower limb angiography in the study period. Of these, the majority (n=67) were men. The mean age was 74 years (range: 60–89 years) and 76% were smokers. Co-morbidities included coronary artery disease (55%), diabetes mellitus (20%), hypertension (45%) and cerebrovascular events (6%). Fortynine patients presented with critical limb ischaemia and eighteen patients were seen electively in the outpatients department with symptoms of intermittent claudication. Data were incomplete for two male patients and were therefore not included. At presentation, 22 patients were classified as Hoi lier type I, 5 were type II and 9 were type III. Thirty-one patients had arteriomegalic vessels but no aneurysmal disease. After a median follow-up duration of 76 months (range: 6–146 months), 34 patients progressed to type I, 2 to type II and 18 to type III. Thirteen remained without aneurysmal disease. Twenty-nine patients required angioplasty and twenty-eight required bypass surgery during this time. In total, 102 procedures were required for complicated disease. The limb salvage rate was 92%. Although 8 patients in our series died, the remaining 59 are under regular follow up. CONCLUSIONS This study illustrates the progressive nature of arteriomegaly. Results of the management of these patients in our institution are similar to those in the literature. We suggest an additional fourth category to Hollier’s classification that describes arteriomegalic disease without aneurysmal degeneration as this, too, deserves special management. Regular follow-up visits and early intervention for patients with arteriomegaly is advocated to reduce the high incidence of morbidity.

Outcomes of covered expandable stents for the treatment of TASC D aorto-iliac occlusive lesions

Vascular ◽  
2015 ◽  
Vol 23 (6) ◽  
pp. 630-636 ◽  
Author(s):  
Robert Tewksbury ◽  
Lupe Taumoepeau ◽  
Andrew Cartmill ◽  
Anna Butcher ◽  
Toby Cohen
Keyword(s):  
Large Diameter ◽  
Clinical Signs ◽  
Primary Patency ◽  
Occlusive Disease ◽  
Critical Limb Ischaemia ◽  
Secondary Patency ◽  
Limb Ischaemia ◽  
Vascular Insufficiency ◽  
Good Patency

Introduction Aortoiliac arterial occlusive disease is frequently encountered in the management of lower limb vascular insufficiency. We report our experience with covered balloon-expandable stents for treatment of TASC D lesions of the abdominal aorta and common iliac arteries. Methods A retrospective study of 30 patients who underwent aortoiliac stenting with the Atrium Advanta V12 from March 2010 to September 2012 was conducted. Patient demographic data, clinical signs and symptoms and procedural details were recorded. Outcomes assessed were primary patency, secondary patency, technical success, complications, limb salvage and survival. Results Median age was 67 years (range 48–84) and 40% of patients underwent treatment for critical limb ischaemia. Median follow-up was 13 months (range 3–38 months). Stent configuration comprised of long iliac stents in 20 patients, a large diameter aortic stent with iliac stenting in six patients, and aortic stent alone in four patients. Radiological success was achieved in 100% and the complication rate was 6%. Primary patency at 6, 12 and 24 months was 97%, 90% and 79%, respectively. Four cases of in-stent stenosis were reported, with three of these undergoing re-interventions resulting in a secondary patency rate of 97% at the end of follow-up. One patient death occurred within the follow-up period. Discussion This case series demonstrates that treatment of complex aortoiliac occlusive disease with covered balloon-expandable stents can have acceptable results with good patency and good clinical outcome. Secondary patency rates are comparable to open surgical revascularisation, with lower morbidity.

scholarly journals A 5.5 years observational follow-up study of patients with critical limb ischaemia treated efficiently by endovascular approach

2020 ◽  
Vol 30 (2) ◽  
pp. 236-240
Author(s):  
Dan F. Filip ◽  
Gabriela Kozma ◽  
Calin F. Pop
Keyword(s):  
Endovascular Treatment ◽  
Critical Limb Ischaemia ◽  
Limb Ischaemia ◽  
Peripheral Artery ◽  
Arterial Segment ◽  
Final Treatment ◽  
Endovascular Approach ◽  
The Mean ◽  
Peripheral Artery Diseases

Objectives – The aim of this study was to describe our experience with endovascular treatment in critical limb ischaemia and to bring new follow-up data about these patients with initial successfully revascularization. Methods – A retrospective study of 181 patients with critical limb ischaemia, with successful endovascular treatment in our institution was performed. We followed death, reintervention and amputation rates during a mean period of 55.1 ± 8.2 months. Results – The mean age of the patients was 65.2±11.6 years. Of these patients, 66.3% were males, 38.1% diabetics, 51.4% active smokers, 21% with chronic kidney disease, 32.6% with other clinical forms of peripheral artery diseases. The final treatment was stenting in 31.5% of cases and balloon angioplasty alone in the rest of the cases. Treated arteries were in the femoral-popliteal segment – 55.6%, aorto-iliac segment – 31.4% and infrapopliteal segment – 13%. 27.6% of the patients underwent procedures on more than one arterial segment. During follow up 11 deaths occurred (6.1%), 27 patients (14.9%) underwent reinterventions for revascularization (endovascular or surgical) and 31 patients (17.1%) suffered further amputations. Conclusions – Despite a certain rate of death, amputation and reintervention, our results suggest that endovascular approach in critical limb ischaemia can be an effi cient and feasible treatment option if its results are optimal at the time of implementation.

Surveillance after Distal Revascularization for Critical Limb Ischaemia

2012 ◽  
Vol 101 (2) ◽  
pp. 119-124 ◽  
Author(s):  
E. Arvela ◽  
F. Dick
Keyword(s):  
Critical Limb Ischaemia ◽  
Limb Ischaemia ◽  
Compelling Evidence ◽  
Surgical Revascularization ◽  
Duplex Scan ◽  
European Guidelines ◽  
Distal Perfusion ◽  
Available Information

Patients with critical limb ischaemia (CLI) are usually elderly and suffer from several co-morbidities. The goal of surveillance after both endovascular and surgical revascularization for CLI is not only the protection of re-established distal perfusion and sustained ambulation but also the reduction of systemic atherothrombotic risk and mortality by ensuring continued best medical care. However, preferred format and rhythm of structured follow-up programs have remained controversial, mainly because of lack of compelling evidence. This review aims to summarize and to appraise available information critically. Thereby, it underlines the importance of systematic surveillance after both surgical and endovascular revascularization for CLI. Recent European guidelines are considered and areas of uncertainty are highlighted and discussed. According to currently available literature and recent guidelines, the early duplex scan is justified in all patients undergoing endovascular or surgical distal revascularization for CLI. There is no best level evidence supporting continued long term duplex surveillance of revascularizations with normal findings at early duplex scan, whereas those patients with abnormal early duplex scan or high risk revacularization are likely to benefit from continued duplex surveillance. Regular clinical follow-up is suggested and clinical deterioration should trigger duplex scanning to ensure revascularization patency.

scholarly journals ELEVATED ALANINE AMINOTRANSFERASE (ALT) IN BLOOD DONORS: AN ASSESSMENT OF THE MAIN ASSOCIATED CONDITIONS AND ITS RELATIONSHIP TO THE DEVELOPMENT OF HEPATITIS C

1998 ◽  
Vol 40 (4) ◽  
pp. 219-224 ◽  
Author(s):  
Fernando Lopes GONÇALES Jr. ◽  
Raquel Silveira Bello STUCCHI ◽  
Priscila Maria Oliveira PAPAIORDANOU ◽  
Maria Helena Postal PAVAN ◽  
Neiva Sellan Lopes GONÇALES ◽  
...  
Keyword(s):  
Hepatitis C ◽  
Blood Donors ◽  
Elevated Serum ◽  
Abdominal Ultrasound ◽  
Serum Levels ◽  
Gamma Glutamyl Transpeptidase ◽  
Period 2 ◽  
Increased Risk

The determination of aminotranferases levels is very useful in the diagnosis of hepatopathies. In recent years, an elevated serum ALT level in blood donors has been associated with an increased risk of post-transfusion hepatitis (PTH). The purpose of the study was to research the factors associated with elevated ALT levels in a cohort of voluntary blood donors and to evaluate the relationship between increased ALT levels and the development of hepatitis C (HCV) infection. 166 volunteer blood donors with elevated ALT at the time of their first donation were studied. All of the donors were questioned about previous hepatopathies, exposure to hepatitis, exposure to chemicals, use of medication or drugs, sexual behaviour, contact with blood or secretions and their intake of alcohol. Every three months, the serum levels of AST, ALT, alkaline phosphatase, gamma glutamyl transpeptidase, cholesterol, triglyceride and glycemia are assessed over a two year follow-up. The serum thyroid hormone levels as well as the presence of auto-antibodies were also measured. Abdominal ultrasound was performed in all patients with persistently elevated ALT or AST levels. A needle biopsy of liver was performed in 9 donors without definite diagnostic after medical investigation. The presence of anti-HCV antibodies in 116 donors were assayed again the first clinical evaluation. At the end of follow-up period (2 years later) 71 donors were tested again for the presence of anti-HCV antibodies. None of donors resulted positive for hepatitis B or hepatitis C markers during the follow-up. Of the 116 donors, 101 (87%) had persistently elevated ALT serum levels during the follow-up. Obesity and alcoholism were the principal conditions related to elevated ALT serum levels in 91/101 (90.1%) donors. Hypertriglyceridemia, hypercholesterolemia, hypothyroidism and diabetes mellitus also were associated with increased ALT levels. Only 1/101 (0.9%) had mild chronic active non A-G viral hepatitis and 3/101 (2.9%) had liver biopsy with non-specific reactive hepatitis. The determination of ALT levels was not useful to detect donors infected with HCV at donation in Brazil, including the initial seronegative anti-HCV phase.

Pyrophosphate Treatment in Pseudoxanthoma Elasticum (PXE)-Preventing ReOcclusion After Surgery for Critical Limb Ischaemia

2019 ◽  
pp. 1-3
Author(s):  
Suvi Väärämäk ◽  
Hannu Uusitalo ◽  
Natália Tőkési ◽  
Saku Pelttari ◽  
András Váradi ◽  
...  
Keyword(s):  
Limb Ischemia ◽  
Pseudoxanthoma Elasticum ◽  
Skin Lesions ◽  
Critical Limb Ischaemia ◽  
Limb Ischaemia ◽  
Tissue Calcification ◽  
Artery Disease ◽  
One Year ◽  
The One

Pseudoxanthoma elasticum (PXE) is a rare metabolic disease characterized by reduced plasma pyrophosphate (PPi) concentration, causing progressive soft tissue calcification represented by skin lesions, central vision lost and peripheral artery disease. PXE is currently incurable. Previous reports have shown early high failure after revascularization by unknown mechanism. Reports of oral PPi administration have shown to decrease tissue calcification in a murine model of PXE. We report the outcome of one patient treated with oral PPi and further operated for critical limb ischemia. During the one-year follow-up the operated area has not re-occluded and there have been no significant side effects.

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