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Subclavian site should be preferred for central venous access
Commentary on: Parienti JJ, Mongardon N, Mégarbane B, et al.., 3SITES Study Group. Intravascular Complications of Central Venous Catheterization by Insertion Site. N Engl J Med 2015;373:1220–9. Implications for practice and research Subclavian site should be preferred for central venous access (CVA) with a low risk of pneumothorax. Excluding patients before randomisation represents a selection bias. Post hoc sensitivity analysis may reduce the bias without fully balancing it. An adjudication committee, unaware of study-group assignments, may compensate for the absence of feasible blindness. Context Infection, ...
Source: Evidence-Based Nursing - September 21, 2016 Category: Nursing Authors: Mourvillier, B., Radjou, A., Timsit, J.-F. Tags: Health policy, Nursing issues, Drugs: infectious diseases, Drugs: cardiovascular system, Stroke, Ophthalmology, Venous thromboembolism, Health service research Source Type: research

Intermittent pneumatic compression is effective in reducing proximal DVT
Commentary on: Dennis M, Sandercock P, Graham C, et al.. The Clots in Legs Or sTockings after Stroke (CLOTS) 3 trial: a randomised controlled trial to determine whether or not intermittent pneumatic compression reduces the risk of post-stroke deep vein thrombosis and to estimate its cost-effectiveness. Health Technol Assess 2015;19:1–90. Implications for practice and research Intermittent pneumatic compression (IPC) is effective in reducing proximal deep vein thrombosis and should be used for all immobile patients with stroke, unless cost is a major concern. The cost-effectiveness of IPC in different types of medical...
Source: Evidence-Based Nursing - March 18, 2016 Category: Nursing Authors: Ho, K. M., Harahsheh, Y. Tags: Adult nursing, Stroke, Venous thromboembolism, Clinical diagnostic tests Source Type: research

In people with atrial fibrillation receiving antithrombotics, short-term non-steroidal anti-inflammatory drug exposure increases risk of serious bleeding
Commentary on: Lamberts M, Lip GYH, Hansen ML, et al. Relation of non-steroidal anti-inflammatory drugs to serious bleeding and thromboembolism risk in patients with atrial fibrillation receiving antithrombotic therapy Ann Intern Med 2014;161:690–8. Implications for practice and research Short courses of non-steroidal anti-inflammatory drugs (NSAIDs) should be used with caution in patients with atrial fibrillation (AF) already taking antithrombotic therapy for stroke prevention since there is an increased risk of serious bleeding and clot formation. Research needs to be carried out on whether combined NSAID and non-v...
Source: Evidence-Based Nursing - December 15, 2015 Category: Nursing Authors: Myat, A. Tags: GI bleeding, Adult nursing, Drugs: cardiovascular system, Pain (neurology), Stroke, Ischaemic heart disease, Pain (palliative care), Pain (anaesthesia), Drugs: musculoskeletal and joint diseases, Arrhythmias Source Type: research

Elastic compression stockings fail to prevent post-thrombotic syndrome after a first deep vein thrombosis
Commentary on: Kahn SR, Shapiro S, Wells PS, et al.. Compression stockings to prevent post-thrombotic syndrome: a randomised placebo-controlled trial. Lancet 2014;383:880–8. Implications for practice and research Elastic compression stockings should not be routinely used for the prevention of post-thrombotic syndrome (PTS) following a first deep vein thrombosis (DVT) episode. The role of elastic compression stockings in PTS prevention should be further examined. Context Post-thrombotic syndrome (PTS) is a chronic complication of deep venous thrombosis (DVT) characterised by clinical features ranging from minor limb s...
Source: Evidence-Based Nursing - December 10, 2014 Category: Nursing Authors: Kanaan, A. Tags: Adult nursing, Drugs: cardiovascular system, Stroke, Hypertension, Venous thromboembolism, Pulmonary embolism, Dermatology Source Type: research

Earlier thrombolytic treatment is associated with better outcomes following acute ischaemic stroke
Commentary on Saver JL, Fonarow GC, Smith EE, et al.. Time to treatment with intravenous tissue plasminogen activator and outcome from acute ischaemic stroke, JAMA 2013;309:2480–8. Implications for practice and research Optimisation is necessary in public education and hospital triage of the identification of factors such as arrival by ambulance and the importance of requesting emergency medical services (EMS) at scene of the stroke occurrence.1 The results of previous studies suggest that a disparity, observed between hospital-based outcomes for admissions that presented during regular hours and off hours, is not se...
Source: Evidence-Based Nursing - September 15, 2014 Category: Nursing Authors: Ullah, N., Thompson, M. J., Qureshi, A. I. Tags: Adult nursing, Drugs: cardiovascular system, Stroke Source Type: research

Aspirin given for up to 2 years after initial anticoagulant treatment reduces the risk of venous thromboembolism recurrence without increasing risk of major bleeding
Implications for practice and research The use of aspirin to prevent recurrent venous thromboembolism (VTE) after a first idiopathic event should not currently become a standard practice. Further studies are required before the use of aspirin following anticoagulation with warfarin for a first episode of venous thromboembolism becomes adopted as routine clinical practice. A direct comparison between low-dose aspirin and standard intensity warfarin is required. Context Venous thromboembolism, which encompasses deep vein thrombosis and pulmonary embolism, is a relatively common disorder with an incidence in western countries...
Source: Evidence-Based Nursing - June 6, 2013 Category: Nursing Authors: Watson, H. G. Tags: Editor's choice, Nursing issues, Drugs: cardiovascular system, Stroke, Venous thromboembolism, Pulmonary embolism Source Type: research

Overweight and obese middle-aged women have increased risk of venous thromboembolism, particularly following surgery
Commentary on Parkin L, Sweetland S, Balkwill A, et al.. for the Million Women Study Collaborators. Body mass index, surgery and risk of venous thromboembolism in middle-aged women: a cohort study. Circulation 2012;125:1897–904. Implications for practice and research Obesity is associated with an increased risk of venous thromboembolism (VTE) including both spontaneous and postoperative events. Further research is needed regarding factors responsible for the increase in postoperative VTE in overweight patients, and whether management should be altered (eg, increased focus on postoperative mobilisation, altered doses ...
Source: Evidence-Based Nursing - March 8, 2013 Category: Nursing Authors: McRae, S. Tags: Drugs: cardiovascular system, Stroke, Hypertension, Obesity (nutrition), Venous thromboembolism, Health education, Obesity (public health), Screening (public health), Smoking, Tobacco use Women ' s health Source Type: research