Surgery News - August 2007 - (Page 6)

VASCULAR SURGERY NEWS • A U G U S T 2 0 0 7 Venous Screening Program Gains Participants in Year 2 A nationwide free program aimed at older people is uncovering the risk factors for venous disease. data, up from 17 the year before. These 83 physicians were located in 40 states; a total of 2,234 individuals were screened. The demographic data obtained by the ncreased national interest in educating individuals about venous disease has physicians and provided to the NVSP coled to a dramatic rise in the number of ordinating center in Baltimore showed centers volunteering to participate in the that the mean age of the individuals second annual National Venous Screening screened was 60 years (ranging from 17 to Program, according to Dr. Robert B. 93), with 77% being female and 80% white; the mean body mass inMcLafferty, who presented an dex (kg/m2) was greater than update and detailed statistical analysis at the Vascular Annual 29. A total of 40% of individuMeeting. als screened were current or Dr. McLafferty, an ACS Felprevious smokers; 24% were low, cited statistics stating that taking antiplatelet therapy, and 10 times more people in the 4% were taking warfarin, reU.S. have venous disease comported Dr. McLafferty, a propared with arterial disease, fessor of vascular surgery at with 24 million having variSouthern Illinois University, cose veins, 6 million having re- Analysis revealed Springfield, and colleagues lated skin changes, and one- that 21% of those from other institutions. half million having stasis Dr. Marc A. Passman, an screened were at ulcers. Venous thromboem- high risk if placed ACS Fellow at the department bolism (VTE) affects 1 in 20 of surgery at the University of in a situation persons over a lifetime, ac- conducive to VTE. Alabama, Birmingham, and Dr. counting for 600,000 hospital McLafferty are cochairs of the DR. MCLAFFERTY admissions per year, and National Venous Screening 650,000 hospital patients die each year Program. Michele Lentz is the director of from pulmonary embolism. the coordinating center in Baltimore, The National Venous Screening Pro- which maintains a central database for gram (NVSP) was developed to provide “a the NVSP. free, comprehensive national screening The participants this year stated that the program” to the public that would “edu- most common reason for attending the cate, identify, and empower those individ- NVSP was that it was free (60%); the secuals at risk from VTE.” ond most common reason was the presOver 4,000 physicians from the Ameri- ence of varicose veins (42%). The quality can Venous Forum, the American College of life assessment indicated that 17% of of Phlebology, and the Society for Vascu- individuals had a combined total score for lar Surgery were invited to participate in all 11 questions of “very limited” or “imthe 2006-2007 screening. Of these, 164 possible to do.” physicians requested materials, with 83 fiScreening results in this analysis indinally completing screening and returning cated that 40% of participants were at low B Y M A R K S. L E S N E Y Else vier Global Medical Ne ws I risk, 22% were at moderate risk, 21% were at high risk, and 17% were at very high risk if placed in a situation conducive to VTE. The percent distribution of venous reflux in the 2,234 individuals analyzed showed that the 37% had reflux in one or more segments, and 5% had obstruction in one or more segments. The clinically relevant, significant analyses coming out of the 2006-2007 National Venous Screening Program results showed that obstruction was significantly higher in nonwhites (9%) vs. whites (4%); in diabetics (9%) vs. nondiabetics (5%); in those with hypertension (6%) vs. those without (2%); and in those taking warfarin (12%) vs. those not taking it (4%). Overall, 35% of those screened had a high or very high risk of VTE, and approximately 25% were rated as moderate to severe (“bothered/limited”) in venous QOL assessment, according to Dr. McLafferty and his colleagues. “By educating people about their potential risk, we empower them to impart this information to their physician who can then prescribe certain prophylactic measures to prevent potential death and serious disability. The importance of these findings cannot be overemphasized,” added Dr. McLafferty concerning the value of the NVSP. This is especially important, because “even as the population getting screened grows, venous disease prevalence continues to be high in this nonrandomized sampling of mostly older individuals,” according to Dr. McLafferty. Results from the pilot 2005-2006 program have already been published ( J. Vasc. Surg. 2007;45:142-8). ■ DATA WATCH National Venous Screening Program Screening in state No screening in state Note: Data from the 2006-2007 National Venous Screening Program. Source: Dr. Robert McLafferty of the American Venous Forum Clopidogrel Plus Aspirin Reduced Prosthetic Bypass Failure BY MITCHEL L. ZOLER Else vier Global Medical Ne ws B A LT I M O R E — Dual antiplatelet therapy with aspirin and clopidogrel significantly cut the failure rate of prosthetic, below-theknee bypass grafts compared with aspirin alone in a controlled study with more than 800 patients. But aspirin alone was just as good as aspirin plus clopidogrel for preventing graft failure in patients receiving a venous, peripheral bypass graft. The combination of aspirin and clopidogrel also led to significant increases in mild and moderate bleeding compared with aspirin alone, but the combined regimen did not produce a significant increase in the rate of severe bleeding episodes or bleeding fatalities, Dr. John Dormandy said at the Vascular Annual Meeting. It’s likely that adding clopidogrel to aspirin benefited patients getting a prosthetic bypass graft because these grafts are more thrombogenic than venous grafts, Dr. Dormandy said in an interview. “With dual antiplatelet therapy, the results from prosthetic grafts are almost as good as the results with vein grafts,” said Dr. Dormandy, professor of vascular sciences at St. George’s Hospital in London. The Clopidogrel and Aspirin in Bypass Surgery for Peripheral Arterial Disease (CASPAR) study was done in 13 European countries and Australia. The study was sponsored by Bristol-Myers Squibb and Sanofi-Aventis, the two companies that jointly market clopidogrel (Plavix). The study enrolled patients 24 days after they had successfully received a below-the-knee bypass graft. Patients underwent bypass surgery either for claudication or for critical limb ischemia. Bypass grafting was considered success- ful if the graft was patent and working before randomization. Patients had to be 40-80 years old, and had to have received a daily dose of aspirin for at least 4 weeks before their surgery. A vein graft was placed in about 70% of the enrolled patients, and the remaining 30% received a prosthetic graft. All patients were placed on a daily dosage of 75-100 mg aspirin, and were randomized to receive either 75 mg/day clopidogrel or placebo. Patients were treated and followed for a median of about 1 year; 19 patients were lost to follow-up. The study’s primary end point was the incidence of graft failure, defined as a complete occlusion, need for revascularization, or limb amputation. During follow-up, the rate of graft failure for the 425 patients in the dual-therapy group was virtually identical to the rate in 426 patients treated with aspirin only. But the trial also stratified patients so that roughly equal numbers getting a prosthetic graft were in each treatment arm, and the study’s design included a prespecified analysis of only patients treated with venous graft and only those who received prosthetic grafts. In the patients who received prosthetic grafts, those who were treated with aspirin plus clopidogrel were 35% less likely to have graft failure than were those treated with aspirin alone, a statistically significant difference. In addition, patients treated with the dual regimen were 37% less likely to have graft occlusion, also a significant difference. In contrast, among the patients who received venous grafts, those on the dual-drug regimen had a 25% increased risk of graft failure compared with those treated with aspirin only, but this difference was not statistically significant. The main safety parameter examined was bleeding risk, which used the bleeding definitions that were first established for the GUSTO (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries) trials. The overall rate of GUSTO bleeding episodes was 7% in the aspirin-only patients and 17% in those getting both drugs, a statistically significant difference, but most of the episodes fell into the mild or moderate categories. The incidence of severe GUSTO bleeds, either intracranial hemorrhages or episodes that required treatment with a blood transfusion, was 1.2% in the aspirin-only group and 2.1% in the clopidogrel plus aspirin group, a difference that was not statistically significant. A fatal bleeding episode occurred once in the aspirin-only group and twice in the dual-drug group, Dr. Dormandy said. ■ ELSEVIER GLOBAL MEDICAL NEWS

Table of Contents Feed for the Digital Edition of Surgery News - August 2007

Contents Drug Developments News From the College Thoracic Surgery Head & Neck Surgery

Surgery News - August 2007

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.