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NIHR Signal Significant risk of another thrombosis remains if anticoagulation is stopped
Unprovoked venous thromboembolism (VTE), including deep vein thrombosis in the leg and pulmonary embolism, are clots within veins that occur spontaneously in people without risk factors and are treated with anticoagulant drugs. If those drugs are stopped after three months or more, the risk of another clot appears to be on average 10% in the first year, 16% by two years, 25% by five years and 36% by 10 years. This systematic review and meta-analysis of 18 studies included a total of 7,515 patie...
NIHR Signal Short-term dual antiplatelet treatment may be best for most patients after receiving a drug-eluting stent
For patients who have had a drug-eluting stent inserted into the coronary arteries, there is no difference in mortality or cardiovascular outcomes between the standard 12-month dual antiplatelet therapy and shorter six-month courses. Longer courses above 12 months increased risk of bleeding and non-cardiac death compared with short courses. It has been debated whether longer treatment might decrease complications, but similarly, it is unclear if shorter treatment might be as effective while red...
NIHR Signal Transcatheter aortic valve implantation may be an option for patients with aortic stenosis at lower surgical risk
Transcatheter aortic valve implantation (TAVI), the less-invasive procedure, may be associated with a reduced risk of death and stroke for up to two years when compared with surgical aortic valve replacement for adults with severe narrowing of the aortic valve, irrespective of the level of surgical risk. TAVI is already an established procedure for those unsuitable for surgery or at high risk. This meta-analysis evaluated seven trials comparing 8,020 adults treated with one of these procedures ...
NIHR Signal Text message reminders increase attendance at NHS health checks
Sending text messages reminding people to book their NHS health check following their invitation letter increases attendance. There is little evidence to support pre-notification text messages telling people an invitation would soon be sent. NHS health checks are offered to adults aged 40 to 74 years. Identification and management of cardiovascular risk factors has been shown to save lives. Yet only half of adults attend a check when it is offered. This trial conducted across general practices ...
NIHR Signal On balance, antiplatelet drugs may be restarted for stroke survivors who have bled into the brain
Early research suggests that antiplatelet drugs, such as aspirin, can provide more benefit than harm if restarted at about 2 to 3 months after a brain bleed. The results seem to apply best to those patients with a good prognosis who survive with less disability. Antiplatelet drugs are of proven benefit to those with a high risk of vascular events; they reduce the risk of heart attacks and strokes because they prevent platelets from clumping together. However, after a type of a stroke caused by ...
NIHR Signal Cardiac rehabilitation for heart failure can improve quality of life and fitness
Exercise-based cardiac rehabilitation may improve the quality of life and physical fitness of people with heart failure but does not reduce their risk of being admitted to hospital or dying. This is irrespective of factors such as age and ethnicity. This NIHR study summarised the outcome data from trials assessing exercise programmes for over 4,000 people with heart failure. At an individual level, the review looked for any improvements in physical symptoms and the psychological impacts of livi...
NIHR Signal Reminders to assess clotting risk increase the use of preventive measures
Reminders to assess clotting risk result in more patients being given appropriate anti-clotting measures in hospital. Computer alerts, in particular, are linked to better choice of prophylaxis and fewer blood clots in veins. Clots in deep leg veins or the lungs are common when people are bedbound in hospital. This updated Cochrane review assessed interventions aiming to increase the use of appropriate preventive measures such as anti-clotting drugs or mechanical measures, including stockings, f...
NIHR Signal Routine engagement in end of life planning can improve health outcomes for people with heart failure
Interventions that encourage healthcare professionals to engage in advance care planning with heart failure patients can work more effectively than stand-alone training activities in improving health outcomes. Approaches that involve patients to change clinicians’ professional practice behaviours, the use of reminder systems and educational meetings may offer the best potential. There is no cure for heart failure, and palliative care is known to help this patient group. Advance care plann...
NIHR Signal Placental growth factor testing can speed up diagnosis of pre-eclampsia
Measuring the level of placental growth factor (PlGF) in women with suspected pre-eclampsia helps to reduce the time to diagnose pre-eclampsia from 4 days to 2 days. PlGF testing is also associated with fewer adverse outcomes for mothers. In this NIHR-funded trial, the test results were used alongside the NICE clinical management algorithm to help clinicians make a diagnosis. Pre-eclampsia can lead to serious complications for mothers and babies. Women with suspected pre-eclampsia require furt...
NIHR Signal Providing pressurised air through a mask may improve outcomes for people with deteriorating heart failure
Non-invasive positive pressure ventilation may help people with rapidly deteriorating heart failure who become short of breath due to fluid build-up in the lungs. For people not requiring immediate mechanical ventilation using an endotracheal tube, this approach may reduce the risk of death in hospital and the need for intubation. This review evaluated 24 trials of 2,664 adults comparing a group who received air under pressure through a mask, to a group receiving standard medical care. These ty...
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