The first ambulatory screening on thromboembolism: a multicentre, cross-sectional, observational study on risk factors for venous thromboembolism.

OBJECTIVES: To assess the prevalence of risk factors for venous thromboembolism (VTE) and the prevalence of recent (<1 year) VTE [including superficial vein thrombosis (SVT), deep vein thrombosis (DVT) and pulmonary embolism (PE)] amongst patients attending general practitioner (GP) surgeries. DESIGN: Multicentre, cross-sectional, observational study. SETTING: A total of 1536 GP surgeries. PARTICIPANTS: A total of 15 180 adult, co-operative subjects, who had consulted their GP for a health disorder and signed the informed consent form. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Prevalence of known VTE risk factors graded according to importance and prevalence of recent (<1 year) VTE events (including SVT), based on interviews. RESULTS: About 1:5 patients had at least one strong risk factor and about 1:20 had at least two risk factors, with no difference between sexes. The prevalence of strong risk factors increased with age. Most were related to medical conditions: history of SVT and/or DVT/PE, heart failure and malignancy. About 3:4 women and 2:3 men had at least one moderate to weak risk factor; nearly 1:2 women and 1:3 men had at least two moderate to weak risk factors. The most common were: history of VTE, smoking, history of miscarriage, estrogen therapy, obesity, and varicose veins. Overall, 80% women and 67% men had at least one risk factor, and 50% women and 35% men had at least two risk factors. The prevalence of recent (<1 year) VTE was 3.4% in women and 2.4% in men, and increased with age. The majority of cases were SVT in both sexes (2.5% in women and 1.5% in men). CONCLUSIONS: The prevalence of risk factors for VTE amongst patients attending GP surgeries is high. GPs should bear this in mind during their daily practice.

A randomized trial comparing ticlopidine hydrochloride with indobufen for the prevention of stroke in high-risk patients (TISS Study). Ticlopidine Indobufen Stroke Study.

Two treatments, based on either ticlopidine or indobufen at their optimal individual daily dose (median dose: 250 and 200 mg/day, respectively), were compared in an open randomized multicenter trial in patients at risk of cerebral ischemia (men and women, aged 39 to 80 years, who had experienced in the month before entry into the study transient ischemic attack or amaurosis fugax or minor stroke). The total number of patients screened was 4033; 1632 were enrolled, 821 randomized to ticlopidine, 811 to indobufen. The overall frequency of the composite primary end-point (stroke, myocardial infarction, and death from any cause) was 4.4%. The ticlopidine-based regimen proved significantly better than the indobufen one in preventing the composite of fatal and non fatal events (49.6% relative risk reduction), or death alone (54.4% relative risk reduction). The two groups had similar percentages of adverse events (5.5% and 6.4% for ticlopidine and indobufen group, respectively) with withdrawals because of adverse events in 3.4% and 2.5%; gastrointestinal disorders and bleeding were more frequent in the indobufen group, whereas rash and abnormal liver function were more frequent in the ticlopidine one.

Plasma thiobarbituric acid reactive substances a predictive marker of cerebral ischemia in patients at high risk?

The clinical meaning of high values of blood lipid peroxides, assessed as thiobarbituric acid reactive substances (TBA-RS), was investigated in 19 selected high risk patients with transient ischemic attacks (TIA). Patients were checked every 3-6 months and followed-up for 3 years. 8 patients experienced further vascular episodes, 4 having minor stroke and 4 TIA; one of the latter died from myocardial infarction. Unlike blood cholesterol and glucose. TBA-RS values discriminated patients with vascular episodes: they, indeed, showed significant higher values of TBA-RS. Discriminant analysis further indicated that TBA-RS levels differentiate patients with and without vascular accidents, suggesting that high blood values of lipid peroxides could represent a predictive sign of vascular ischemia.

Antiplatelet treatment with ticlopidine in unstable angina. A controlled multicenter clinical trial. The Studio della Ticlopidina nell'Angina Instabile Group.

We conducted a controlled multicenter trial with central randomization and evaluation of events under blind conditions involving 652 patients with unstable angina. Patients were treated either with conventional therapy alone (group C) (n = 338) or with conventional therapy combined with an inhibitor of platelet aggregation, ticlopidine 250 mg b.i.d. (group C + T) (n = 314). Patients were assigned randomly within 48 hours of admission and followed up for 6 months. With the "intention-to-treat" approach, the primary end points, vascular death and nonfatal myocardial infarction, were observed in 13.6% of the patients in group C and in 7.3% of the patients in group C + T, which is a reduction in risk of 46.3% (p = 0.009). Vascular mortality was 4.7% in patients in group C and 2.5% in patients in group C + T, which is a reduction in risk of 46.8% (p = 0.139). The risk of nonfatal myocardial infarction was reduced by 46.1% (p = 0.039), with a frequency of 8.9% in patients in group C and 4.8% in patients in group C + T. New Q wave myocardial infarction occurred with a frequency of 6.8% in patients in group C and 3.8% in patients in group C + T, which is a reduction in risk of 44.1% (p = 0.091). Fatal and nonfatal myocardial infarction was 10.9% in patients in group C and 5.1% in patients in group C + T, which is a reduction in risk of 53.2% (p = 0.006). These findings confirm the importance of platelets in the pathogenesis of unstable angina and the usefulness of antiplatelet treatment for the prevention of cardiovascular events.

A survey of patients acceptability of diabetes education programmes in Italy.

When planning diabetes education programmes it would be useful to know in advance the patients' demands and expectations. To this purpose, a questionnaire was circulated throughout Italy. Eight hundred and forty-five forms were returned from 487 men and 358 women of age 49 +/- 18 (SD) residing in all regions of Italy. Fifty percent were on insulin, 37% on oral agents and 13% on diet only. Forty-seven percent believed they had a satisfactory knowledge of diabetes, 49% thought it fair or poor and 4% judged it non-existent. Such knowledge derived from diabetic clinics, mass media, specialized publications and family doctors. Only 11% had previously attended education programmes. The vast majority (83%) believed that better information would help to improve their diabetes care and were willing to attend education courses. Printed material and group learning were preferred to audiovisual aids and individual education. Doctors were preferred as teachers (83%) to other patients or paramedical staff. Patients were mostly interested in learning about complications (84%), diet (74%), control (63%), intercurrent illnesses (61%) and inheritance (59%). The least requested subjects were CSII (20%), the artificial pancreas (22%), insulin preparations (22%), pancreatic transplant (26%) and oral agents (31%).