scholarly journals The CLEAR (Considering Leading Experts’ Antithrombotic Regimes around peripheral angioplasty) survey: an international perspective on antiplatelet and anticoagulant practice for peripheral arterial endovascular intervention

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Kitty H. F. Wong ◽  
◽  
Dave C. Bosanquet ◽  
Graeme K. Ambler ◽  
Mahim I. Qureshi ◽  
...  
Keyword(s):  
Antiplatelet Therapy ◽  
Randomised Trial ◽  
Dual Therapy ◽  
International Perspective ◽  
Endovascular Intervention ◽  
Anatomical Location ◽  
The European Union ◽  
Peripheral Arterial ◽  
The Uk ◽  
Collaborative Research Networks

Abstract Background Antiplatelet and anticoagulant therapy are commonly used before, during and after peripheral arterial endovascular intervention. This survey aimed to establish antiplatelet and anticoagulant choice for peripheral arterial endovascular intervention in contemporary clinical practice. Methods Pilot-tested questionnaire distributed via collaborative research networks. Results One hundred and sixty-two complete responses were collected from responders in 22 countries, predominantly the UK (48%) and the rest of the European Union (44%). Antiplatelet monotherapy was the most common choice pre-procedurally (62%). In the UK, there was no difference between dual and single antiplatelet therapy use post procedure (50% vs. 37% p = 0.107). However, a significant majority of EU respondents used dual therapy (68% vs. 20% p < 0.001). There was variation in choice of antiplatelet therapy by the device used and the anatomical location of the intervention artery. The majority (82%) of respondents believed there was insufficient evidence to guide antithrombotic therapy after peripheral endovascular intervention and most (92%) would support a randomised trial. Conclusions There is widespread variation in the use of antiplatelet therapy, especially post peripheral arterial endovascular intervention. Clinicians would support the development of a randomised trial comparing dual antiplatelet therapy with monotherapy.

scholarly journals P6: ANTIPLATELET AND ANTICOAGULANT USE IN RANDOMISED TRIALS OF PATIENTS UNDERGOING ENDOVASCULAR INTERVENTION FOR PERIPHERAL ARTERIAL DISEASE: SYSTEMATIC REVIEW

2021 ◽  
Vol 108 (Supplement_1) ◽  
Author(s):  
MI Qureshi ◽  
HL Li ◽  
GK Ambler ◽  
KHF Wong ◽  
S Dawson ◽  
...  
Keyword(s):  
Systematic Review ◽  
Peripheral Arterial Disease ◽  
Antiplatelet Therapy ◽  
Dual Antiplatelet Therapy ◽  
Arterial Intervention ◽  
Arterial Disease ◽  
Endovascular Intervention ◽  
Randomised Trials ◽  
Peripheral Arterial ◽  
High Level

Abstract Introduction Guideline recommendations for antithrombotic (antiplatelet and anticoagulant) therapy during and after endovascular intervention are patchy and conflicted, in part due to a lack of evidence. The aim of this systematic review was to examine the antithrombotic specifications in randomised trials for peripheral arterial endovascular intervention. Method This review was conducted according to PRISMA guidelines. Randomised trials including participants with peripheral arterial disease undergoing endovascular arterial intervention were included. Trial methods were assessed to determine whether an antithrombotic protocol had been specified, its completeness, and the agent(s) prescribed. Antithrombotic protocols were classed as periprocedural (preceding/during intervention), immediate postprocedural (up to 14 days following intervention) and maintenance postprocedural (therapy continuing beyond 14 days). Trials were stratified according to type of intervention. Result Ninety-four trials were included. Only 29% of trials had complete periprocedural antithrombotic protocols, and 34% had complete post-procedural protocols. In total, 64 different periprocedural protocols, and 51 separate postprocedural protocols were specified. Antiplatelet monotherapy and unfractionated heparin were the most common choices of regimen in the periprocedural setting, and dual antiplatelet therapy (55%) was most commonly utilised postprocedure. There is an increasing tendency to use dual antiplatelet therapy with time or for drug-coated technologies. Conclusion Randomised trials comparing different types of peripheral endovascular arterial intervention have a high level of heterogeneity in their antithrombotic regimens, and there has been an increasing tendency to use dual antiplatelet therapy over time. Antiplatelet regimes need to be standardised in trials comparing endovascular technologies. Take-home message To determine the benefits of any endovascular intervention within a randomised trial, antithrombotic regimens should be standardised to prevent confounding. This systematic review demonstrates a high level of heterogeneity of antithrombotic prescribing in randomised trials of endovascular intervention, and an increasing tendency to utilise dual antiplatelet therapy, despite a lack of evidence of benefit, but an increased risk of harm.

scholarly journals Correction to: The CLEAR (Considering Leading Experts’ Antithrombotic Regimes around peripheral angioplasty) survey: an international perspective on antiplatelet and anticoagulant practice for peripheral arterial endovascular intervention

2020 ◽  
Vol 3 (1) ◽  
Author(s):  
Kitty H. F. Wong ◽  
◽  
Dave C. Bosanquet ◽  
Graeme K. Ambler ◽  
Mahim I. Qureshi ◽  
...  
Keyword(s):  
International Perspective ◽  
Endovascular Intervention ◽  
Peripheral Angioplasty ◽  
Peripheral Arterial

An amendment to this paper has been published and can be accessed via the original article.

The Law & Politics of Brexit: Volume II

2020 ◽  
Keyword(s):  
Decision Making ◽  
European Union ◽  
Legal Framework ◽  
Comprehensive Analysis ◽  
The European Union ◽  
Trade Relations ◽  
The United Kingdom ◽  
The Uk ◽  
Financial Settlement ◽  
The Eu

This book provides the first comprehensive analysis of the withdrawal agreement concluded between the United Kingdom and the European Union to create the legal framework for Brexit. Building on a prior volume, it overviews the process of Brexit negotiations that took place between the UK and the EU from 2017 to 2019. It also examines the key provisions of the Brexit deal, including the protection of citizens’ rights, the Irish border, and the financial settlement. Moreover, the book assesses the governance provisions on transition, decision-making and adjudication, and the prospects for future EU–UK trade relations. Finally, it reflects on the longer-term challenges that the implementation of the 2016 Brexit referendum poses for the UK territorial system, for British–Irish relations, as well as for the future of the EU beyond Brexit.

scholarly journals Advancing UK Regulatory Science Strategy in the Context of Global Regulation: a Stakeholder Survey

2021 ◽  
Author(s):  
Samantha Cruz Rivera ◽  
Barbara Torlinska ◽  
Eliot Marston ◽  
Alastair K. Denniston ◽  
Kathy Oliver ◽  
...  
Keyword(s):  
Pay For Performance ◽  
Regulatory Science ◽  
International Strategy ◽  
Free Text ◽  
The European Union ◽  
Accurate Definition ◽  
Definition Of ◽  
Healthcare Innovation ◽  
The Uk ◽  
Medium Enterprises

Abstract Background The UK’s transition from the European Union creates both an urgent need and key opportunity for the UK and its global collaborators to consider new approaches to the regulation of emerging technologies, underpinned by regulatory science. This survey aimed to identify the most accurate definition of regulatory science, to define strategic areas of the regulation of healthcare innovation which can be informed through regulatory science and to explore the training and infrastructure needed to advance UK and international regulatory science. Methods A survey was distributed to UK healthcare professionals, academics, patients, health technology assessment agencies, ethicists and trade associations, as well as international regulators, pharmaceutical companies and small or medium enterprises which have expertise in regulatory science and in developing or applying regulation in healthcare. Subsequently, a descriptive quantitative analyses of survey results and directed thematic analysis of free-text comments were applied. Results Priority areas for UK regulatory science identified by 145 participants included the following: flexibility: the capability of regulations to adapt to novel products and target patient outcomes; co-development: collaboration across sectors, e.g. patients, manufacturers, regulators, and educators working together to develop appropriate training for novel product deployment; responsiveness: the preparation of frameworks which enable timely innovation required by emerging events; speed: the rate at which new products can reach the market; reimbursement: developing effective tools to track and evaluate outcomes for “pay for performance” products; and education and professional development. Conclusions The UK has a time-critical opportunity to establish its national and international strategy for regulatory science leadership by harnessing broader academic input, developing strategic cross-sector collaborations, incorporating patients’ experiences and perspectives, and investing in a skilled workforce.

scholarly journals “East” in Europe—Health Dimension through the Lens of the UK Daily Mail and Statistical Facts

2021 ◽  
Vol 18 (7) ◽  
pp. 3705
Author(s):  
Izabella Lecka ◽  
Viktoriya Pantyley ◽  
Liudmila Fakeyeva ◽  
Alexandrina Cruceanu
Keyword(s):  
Care Practice ◽  
The European Union ◽  
Daily Mail ◽  
Media Criticism ◽  
The United Kingdom ◽  
Health Dimension ◽  
European Immigrants ◽  
The Uk ◽  
Zero Sum ◽  
Eastern European Immigrants

The study concerns the relationship between health and geopolitics in the United Kingdom (UK). To demonstrate this relationship, we examined the subject and tone of articles published in the popular media (on the example of tabloid the Daily Mail) in 2006–2020 concerning health and medical care, and the health and health care practice of Eastern European immigrants belonging to and not belonging to the European Union (EU). There was an increase in media criticism of the behaviour of immigrants in the years 2014–2017, in the period around the referendum in favour of the UK leaving the EU (Brexit). Attention was drawn to the media’s use of a Belief in a Zero-Sum Game (BZSG) narrative at that time. On both sides, “hosts” and the “guests”, a progressive anomy process was observed, degrading the behaviour of individuals and social groups.

To bee or not to beet with neonicotinoids

2021 ◽  
Vol 23 (2) ◽  
pp. 103-109
Author(s):  
Lynda M. Warren
Keyword(s):  
Sugar Beet ◽  
Weather Conditions ◽  
The European Union ◽  
Environmental Standards ◽  
Economic Interests ◽  
Precautionary Approach ◽  
The United Kingdom ◽  
Commercial Sugar ◽  
The Uk ◽  
First Time

In January 2021 the UK government granted an application for authorisation to use thiamethoxam, a neonicotinoid pesticide, to protect commercial sugar beet crops from attack by viruses transmitted by aphids. This was the first time such an authorisation had been granted in the United Kingdom (UK) and there were concerns that it signalled a weakening of environmental standards now that the UK was no longer part of the European Union. In fact, similar authorisations had been granted by several European Member States in the last 2 years, despite the ban on the use of neonicotinoids introduced in 2018. Nevertheless, the reasons for granting the authorisation do suggest that the balance between adopting a precautionary approach to environmental protection and taking emergency action to protect economic interests may have shifted. It was acknowledged that the proposed mitigation to safeguard bees and other wildlife was not entirely satisfactory. In the end, due to unforeseen weather conditions it meant that the pesticide is not necessary, which in itself demonstrates that short-term emergency measures are unsuitable for dealing with the problem. If the sugar beet industry is to continue to prosper in the UK, it will need to be managed in a way that provides resistance to virus infection without the use of controversial chemicals.

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