			Home About us Contact

Pharmacological Prophylaxis (pharmacological + prophylaxis)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Pharmacological prophylaxis of venous thromboembolism in contemporary radical retropubic prostatectomy: Does concomitant pelvic lymphadenectomy matter?

INTERNATIONAL JOURNAL OF UROLOGY, Issue 11 2008
Benjamin C Jessie
Abstract The prevention of venous thromboembolism is a major concern in cancer patients undergoing pelvic surgery. Radical retropubic prostatectomy is a common treatment for localized prostate cancer and has been identified as a high risk procedure for postoperative venous thromboembolism. However, most patients diagnosed with prostate cancer in the current era have clinically localized, low volume disease and the risk of venous thromboembolism is very low. Multiple guidelines exist for the prevention of venous thromboembolism in patients undergoing radical retropubic prostatectomy and pharmacological venous thromboembolism prophylaxis is recommended. Most urological surgeons in the USA however, do not routinely utilize pharmacological prophylaxis. A major concern arises when radical retropubic prostatectomy is performed with a concomitant pelvic lymphadenectomy. Pharmacological prophylaxis is known to increase the rate of lymph drainage and the rate of lymphocele formation. Evidence suggests that lymphocele may be an independent risk factor for venous thromboembolism in the postoperative period. These factors raise concern over current guidelines calling for routine use of pharmacological venous thromboembolism prophylaxis in radical retropubic prostatectomy especially when lymphadenectomy is performed simultaneously. [source]

Octreotide 24-h prophylaxis in patients at high risk for post-ERCP pancreatitis: results of a multicenter, randomized, controlled trial

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 7 2001
P. A. Testoni
Background: Pharmacological prophylaxis of post-ERCP pancreatitis is costly and not useful in most non-selected patients, in whom the incidence of pancreatitis is 5% or less. However, it could be useful and probably cost-effective, in patients at high risk for this complication, where the post-procedure pancreatitis rate is 10% and more. Aim: To assess the efficacy of octreotide in reducing the incidence and severity of post-ERCP pancreatitis and procedure-related hospital stay, in subjects with known patient-related risk factors. Methods: A total of 120 patients were randomly allocated to receive octreotide or not, in a multicentre, randomized, controlled trial. The drug was given subcutaneously, 200 ,g t.d.s., starting 24 h before the ERCP procedure, in patients with either sphincter of Oddi dysfunction, or a history of relapsing pancreatitis or post-ERCP pancreatitis, or who were aged under 35 years, or who had a small common bile duct diameter (< 8 mm). Results: A total of 114 patients (58 in the octreotide group and 56 in the control group) completed the trial. Post-procedure pancreatitis occurred in seven octreotide-treated patients (12.0%) and eight controls (14.3%). The two groups showed no significant differences in the incidence or severity of pancreatitis. Twenty-four hours after the procedure, severe hyperamylasemia (more than five times the upper normal limit) without pancreatic-like pain was recorded in three octreotide-treated patients (5.2%) and six controls (10.7%), the difference being not significant. Conclusion: Twenty-four-hour prophylaxis with octreotide proved ineffective in preventing post-ERCP pancreatitis and in avoiding 24-h severe hyperamylasemia in high-risk patients. [source]

Migraine Disability Awareness Campaign in Asia: Migraine Assessment for Prophylaxis

HEADACHE, Issue 9 2008
Shuu-Jiun Wang MD
Objectives., This study aimed to survey the headache diagnoses and consequences among outpatients attending neurological services in 8 Asian countries. Methods., This survey recruited patients who consulted neurologists for the first time with the chief complaint of headache. Patients suffering from headaches for 15 or more days per month were excluded. Patients answered a self-administered questionnaire, and their physicians independently completed a separate questionnaire. In this study, the migraine diagnosis given by the neurologists was used for analysis. The headache symptoms collected in the physician questionnaire were based on the diagnostic criteria of migraine proposed by the International Classification of Headache Disorders, second edition (ICHD-2). Results., A total of 2782 patients (72% females; mean age 38.1 ± 15.1 years) finished the study. Of them, 66.6% of patients were diagnosed by the neurologists to have migraine, ranging from 50.9% to 85.8% across different countries. Taken as a group, 41.4% of those patients diagnosed with migraine had not been previously diagnosed to have migraine prior to this consultation. On average, patients with migraine had 4.9 severe headaches per month with 65% of patients missing school, work, or household chores. Most (87.5%) patients with migraine took medications for acute treatment. Thirty-six percent of the patients had at least one emergency room consultation within one year. Only 29.2% were on prophylactic medications. Neurologists recommended pharmacological prophylaxis in 68.2% of patients not on preventive treatment. In comparison, migraine prevalence was the highest with ICHD-2 "any migraine" (ie, migraine with or without migraine and probable migraine) (73.3%) followed by neurologist-diagnosed migraine (66.6%) and ICHD-2 "strict migraine" (ie, migraine with or without aura only) (51.3%). About 88.6% patients with neurologist-diagnosed migraine fulfilled ICHD-2 any migraine but only 67.1% fulfilled the criteria of ICHD-2 strict migraine. Conclusions., Migraine is the most common headache diagnosis in neurological services in Asia. The prevalence of migraine was higher in countries with higher referral rates of patients to neurological services. Migraine remains under-diagnosed and under-treated in this region even though a high disability was found in patients with migraine. Probable migraine was adopted into the migraine diagnostic spectrum by neurologists in this study. [source]

Pharmacological prophylaxis of venous thromboembolism in contemporary radical retropubic prostatectomy: Does concomitant pelvic lymphadenectomy matter?

Use of preventive measures for air travel-related venous thrombosis in professionals who attend medical conferences

JOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 11 2006
S. KUIPERS
Summary.,Background:,Lack of guidelines for prevention of air travel-related venous thrombosis may lead to excessive use of potentially dangerous precautions. Objectives:,To assess the use of preventive measures for air travel-related thrombosis in professionals employed in the field of thrombosis and hemostasis and in other fields. Methods:,A survey amongst delegates of the XXth ISTH Congress, the 15th ISDB Congress and the 13th Cochrane Colloquium, which all took place in Australia 2005. Results:,Two thousand and eighty-nine questionnaires were completed (response 53%). Overall, 80% of the respondents had used preventive measures. Low-molecular-weight heparin and vitamin K antagonists were mostly used by ISTH delegates (10% vs. 1% at the other conferences). Medical doctors used more pharmacological prophylaxis (31%) than research fellows (11%) and non-clinical scientists (22%). Dutch (64%) and Asian respondents (67%) least used any prevention, whereas Israeli used most (94%). Subjects with risk factors for thrombosis more often used prophylaxis (90%) than those without (77%). In a multivariate analysis, conference, nationality, age, presence of risk factors and profession were determinants of prophylaxis use. Conclusion:,Major differences in the use of prophylactic measures for air travel-related thrombosis stress the need for studies of interventions and clear guidelines on prevention of air travel-related venous thrombosis. [source]

Thromboprophylaxis practice patterns in hip fracture surgery patients: experience in Perth, Western Australia

ANZ JOURNAL OF SURGERY, Issue 10 2003
Susan Wan
Background: International guidelines recommend that all patients undergoing hip fracture surgery receive specific thromboprophylaxis. The purpose of the present study was to examine current thromboprophylaxis practice patterns in patients undergoing hip fracture surgery at Royal Perth Hospital. Methods: A total of 129 consecutive patients admitted to Royal Perth Hospital between 4 February and 21 July 2002 for surgical repair of a fractured neck of femur, was studied. The primary outcome was the frequency, type, and duration of thromboprophylaxis use during hospitalization. Results: Mean patient age was 79.4 ± 13.4 years and 69.8% (90/129) were female. Seventy-four patients (57.8%; 95% confidence interval (CI): 48.8,66.8%) received specific thromboprophylaxis during hospitalization, including 50 patients (39.1%; 95%CI: 30.6,48.1%) who received pharmacological prophylaxis only, three (2.3%; 95%CI: 0.5,6.7%) who received mechanical prophylaxis only, and 21 (16.4%; 95%CI: 10.5,24.0%) who received both mechanical and pharmacological prophylaxis. Of those receiving pharmacological prophylaxis, 35 (49.3%; 95%CI: 37.2,61.4%) received low-molecular-weight heparin, 26 (36.6%; 95%CI: 25.5,48.9%) received low-dose unfractionated heparin, eight (11.3%; 95%CI: 5.0,21.0%) received warfarin, 35 (49.3%; 95%CI: 37.2,61.8%) received aspirin or clopidogrel, and 27 (38.0%; 95% CI: 26.8,50.3%) received combined anticoagulant and antiplatelet prophylaxis. The median duration of mechanical prophylaxis was 8 days (range: 6,12 days) and that of pharmacological prophylaxis was 12 days (range: 6,26 days). When the 32 patients already taking aspirin or warfarin at the time of admission were excluded, only 45 (46.9%; 95%CI: 36.6,57.3%) of the remaining 96 patients received specific thromboprophylaxis. Conclusion: Specific thromboprophylaxis remains under-utilized in patients undergoing surgery for hip fracture at Royal Perth Hospital. These data should prompt the implementation of effective strategies to improve thromboprophylaxis practice patterns in high-risk orthopaedic patients. [source]

Influence of disease features on adherence to prophylactic migraine medication

ACTA NEUROLOGICA SCANDINAVICA, Issue 6 2008
M. Linde
Objectives,,, Randomized controlled trials of prophylactic treatments for migraine focus on the effects in an ideal situation and underestimate the impact of non-adherence, which in this study was examined in a natural setting. Materials and methods,,, A sample of 174 adult migraineurs with a current prescription of pharmacological prophylaxis were consecutively recruited at a specialist clinic. Logistic regression analysis was performed to analyse the association between adherence (self-reported with the Medication Adherence Report Scale) and number of years with migraine, frequency of attacks, number of days with migraine per month, attack duration, presence of cardinal features, mean intensity of pain, and recovery between attacks. Results,,, One third (35%) were non-adherent. Neither demographic characteristics nor any of the disease specific variables were significantly associated with adherence. Conclusion,,, Characteristics of the disease per se did not predict non-adherence which was also observed among patients with severe migraine. The full benefit of drugs cannot be realized at currently achieved levels of adherence. [source]