Roberto Bisacci

Guidelines for Venous Thromboembolism and Clinical Practice in Italy: A Nationwide Survey

Venous thromboembolism (VTE) is a common health problem for todays society, and considering the role that it plays in surgical patients (general surgery, gynecology, and orthopedics), new advances in our understanding of the procedures and trauma characteristics are relevant and necessary. The most important and recently published guidelines concerning this problem have been taken into consideration, leading to articulate investigations and data evaluation. This project has proposed a data-survey framework available as a questionnaire in order to investigate application of the guidelines for VTE throughout the national territory. Of the total 714 Italian centers, a random sample of 214 were contacted and asked to take part in this study; of these, 146 replied (20.4% of total and 68.2% of the sample): 48 departments of general surgery, 46 departments of gynecology, and 52 departments of orthopedics. About 70% of the centers has appropriate information about surgery as a risk factor for VTE. The answers have provided evidence of an adequate knowledge of the instrumental and laboratory diagnostic pathways, useful to confirm the diagnosis of TE (80%). Data waiting compared with morbidity and mortality rates related to deep vein thrombosis and pulmonary embolism showed an increase of mortality associated with the diagnostic data timing of supply, with an exponential trend linked to the data acquisition delay. Both risk stratification and adequate application of prophylaxis together with treatment devices represent a real tool to control morbidity and mortality for VTE. Moreover, diagnostic data waiting significantly influences adequate prophylaxis. In Italy, only 40% of the centers are ready to provide diagnostic data within 12 hr.

Elastic compression for varicose vein surgery* - An Italian survey

In daily clinical practice the elastic compression before and after varicose vein surgery is not standardized and there are no clear indications on techniques or materials to use, especially for uncomplicated varicose disease (i.e., absence of ulcers, lymphoedema). Aim of the study was to evaluate the current use of elastic compression for varicose vein in different vein surgical settings in Italy, and to compare Italian practice to the customary approaches used in other European countries. Methods: A national survey exploring pre-, intra and postoperative practice in varicose vein surgery was conducted among surgical departments throughout Italy. Results: The survey, involving practice patterns in 112 Italian venous Surgical departments (26,792 venous operations), showed that a large number of survey respondents ( 57/112), considered use of elastic compression as „non indispensable” in the preparation for varicose vein surgery, but all of them applied compression in the immediate post operative management and at discharge. However, techniques and materials employed for postoperative elastic compression were generally based on personal opinions and thereby, were largely dissimilar among centres. Conclusion: The use of elastic compression for varicose vein surgery is still applied with disparate modalities according with the individual’s experience. Efforts toward more uniformed and wide application of elastic compression need to be implemented. Standardization in the management for varicose venous surgery will reflect in better results also in terms of cost-effectiveness and patient care.

Effect of aspirin and dipyridamole treatment on prostacyclin production by human veins

Patients admitted for surgical removal of varicose veins were treated in a blinded manner for 48 hours prior to surgery with either placebo, low-dose aspirin (25 mg twice daily), dipyridamole (150 mg twice daily) or both. Segments of vein excised at surgery were incubated with or without sodium arachidonate and subsequent prostacyclin (PGI2) production was measured without knowledge of treatment given. During the first 5 minute period of incubation in the presence of arachidonate, veins from dipyridamole-treated patients demonstrated increased (by 75%) arachidonate-stimulated PGI2 production compared to placebo-treated patients. By contrast, PGI2 production was reduced by 64% by aspirin treatment and 67% by aspirin plus dipyridamole compared to placebo-treated patients (p = less than 0.05). In unstimulated vein segments incubated in the absence of arachidonate, spontaneous PGI2 production during the first 5 minute incubation period was increased 32% following dipyridamole treatment but was unchanged following aspirin treatment. By contrast, unstimulated (spontaneous) PGI2 production in patients treated with aspirin plus dipyridamole was reduced by 57% (p = less than 0.05), compared to both placebo- and aspirin-treated patients, and by 71% (p = less than 0.05) compared to dipyridamole-treated patients. With repeated change of incubation medium, the ability of vein walls to produce PGI2 declined. This exhaustion was not prevented by drug treatment. However, drug effects between patient treatment groups were consistent over successive incubation periods. These results suggest that certain therapeutic benefits that might be achieved by enhancement of PGI2 production from vascular endothelium following dipyridamole treatment may be reduced by simultaneous aspirin treatment.(ABSTRACT TRUNCATED AT 250 WORDS)