Saturday, May 30, 2009

Surgical stockings ‘don’t prevent blood clots in stroke patients', but have nasty side-effects

Another instance of theory-based medicine doing more harm than good

Surgical stockings commonly given to stroke patients to prevent blood clots do not work, a new study suggests. Doctors have found that the compression stockings have no effect in preventing deep-vein thrombosis (DVT) — a life-threatening form of blood clot that can travel up into the heart or lungs — in people who have suffered a stroke. Research carried out by a team from the University of Edinburgh suggests that cutting the use of stockings in stroke units could save the NHS about £7 million and 320,000 hours of nursing time each year. More than 150,000 Britons a year suffer a stroke.

The stockings have been proven to reduce clots in surgery patients, so experts had long thought that the cheap solution might also help stroke patients. About two thirds of stroke patients are unable to walk on admission to hospital and approximately 15 per cent develop blood clots because of this lack of movement.

The Edinburgh team studied more than 2,500 stroke patients in Britain, Italy and Australia. All were treated with routine care, including aspirin and assisted exercise, and half were offered surgical stockings as well. After 30 days, there was no significant difference between the groups in the occurrence of DVT and the patients using stockings suffered more skin breaks, ulcers and blisters than those without. Compression stockings are still recommended for patients who have undergone surgery and for people travelling on long-haul flights.

The results were simultaneously published in The Lancet and presented at the European Stroke Conference in Stockholm on Wednesday. Martin Dennis, Professor of Stroke Medicine at the University of Edinburgh, said: “Until now, the guidelines on the use of these stockings have been based on evidence collected in surgical patients and not in stroke patients. “We have shown conclusively that compression stockings do not work for stroke patients. The national guidelines need to be revised and we need further research to establish effective treatments for these patients. Abandoning this ineffective and sometimes uncomfortable treatment will free up valuable resources in our health services.”

Charles Swainson, Medical Director of NHS Lothian, said: “This research underlines the huge importance of close collaboration between the NHS and universities. “Professor Dennis and his colleagues in Lothian and beyond could prove highly important in making sure that nursing time and NHS money are used more effectively for the benefit of patients in Scotland and throughout the world.”

Ralph Sacco, president-elect of the American Heart Association, who was not linked to the study, said: “We have used these stockings because we assume they work. But sometimes you’re surprised when you find out the truth with a randomised trial.”

The CLOTS (Clots in Legs or Stockings after Stroke) trials are funded by the Medical Research Council, Chest, Heart and Stroke Scotland, the Scottish Government Chief Scientist Office and the UK Stroke Research Network. They are also supported by NHS Lothian.

David Clark, chief executive of Chest, Heart & Stroke Scotland, which co-funded the study, said: “This important research shows conclusively that compression stockings do not prevent DVT for stroke patients and can often have unpleasant side effects. More research like this, which will make a practical and positive impact on the lives of stroke patients, is needed.”


Stem cells used to help cure sight loss

COATING a common contact lens with stem cells could help restore a person's sight, Australian scientists have found. University of New South Wales medical researchers used the technique to treat the damaged corneas of three patients, all of whose vision improved within weeks of the groundbreaking procedure. The results are published in the journal Transplant, indicating a further unique element of the world-first trial.

Stem cells were harvested from the eyes of each patient and then cultured inside a contact lens, which was then stuck onto a damaged cornea in a "transplant'' of regenerative cells. "The procedure is totally simple and cheap,'' said the university's Dr Nick Di Girolamo. "Unlike other techniques ... there's no suturing, there is no major operation, all that's involved is harvesting a minute amount - less than a millimetre - of tissue from the ocular surface.'' The lens stayed on for 10 days allowing stem cells to change their form, colonise and repair the cornea.

Two of the patients involved in the trial had suffered extensive corneal damage to one eye, caused by multiple surgeries to remove cancerous growths. Dr Girolamo said that in these cases the stem cells were taken from their healthy eye - but the third patient posed an additional challenge because of a congenital disorder which affected both eyes. "We took them from another part of the eye altogether - the conjunctiva which also harbours stem cells,'' Dr Di Girolamo said. "The stem cells were able to change from the conjunctival phenotype to a corneal phenotype after we put them onto the cornea ... that's the beauty of stem cells.''

The procedure could be replicated in third would countries by a surgeon with a laboratory for cell culture, Dr Di Girolamo said. It offered hope to people with a range of blinding eye conditions, he said, and there was also the possibility of adapting the technique to repair skin which behaved in a similar way to the eye.

The stem cell procedure was considered non-controversial, said former Deputy Chair of the Lockhart Committee on human cloning and embryo research Professor Loane Skene. "Provided that patients are told the new procedure is experimental ... and they then consent to have it, this use of a patient's own stem cells is no more ethically contentious than a skin transplant,'' Prof Skene said.


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