Published 11/1/2007

Second Look: Clinical

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Studies examine treatments for VTE
A study in the Sept. 13 edition of the New England Journal of Medicine examined the use of idraparinux as a treatment for venous thromboembolic (VTE) disease. Investigators found that in patients with deep venous thrombosis (DVT), a once-weekly dose of subcutaneous idraparinux (2.5 mg) for 3 or 6 months had an efficacy similar to that of heparin plus an adjusted-dose vitamin K antagonist (standard therapy). However, in patients with pulmonary embolism (PE), idraparinux was less efficacious than standard therapy. The randomized trials involved 2,904 patients with DVT and 2,215 patients with PE.

In the DVT cohort, the incidence of recurrence among patients treated with idraparinux was 2.9 percent at day 92, compared to a 3.0 percent incidence rate for patients who were given standard therapy. The rates of clinically relevant bleeding at day 92 were 4.5 percent in the idraparinux group and 7.0 percent in the standard-therapy group (P=0.004). At 6 months, bleeding rates were similar.

In the pulmonary embolism cohort, incidence of recurrence with idraparinux at day 92 was 3.4 percent, compared to 1.6 percent with standard therapy.

Connection between prostate cancer and hip fracture risk
A study published in the October issue of the journal BJU International finds a possible link between prostate cancer and the likelihood of hip fracture. Researchers reviewed the cases of 62,865 men aged 50 and older; 15,716 patients suffered a fracture of some description and 47,149 were in a nonfracture control group. Overall, men with prostate cancer were 1.8 times more likely to sustain a fracture, and 3.7 times more likely to sustain a fracture of the hip. In men aged 50 to 65, the risk of hip fracture was 8 times higher among prostate cancer patients than among the control group. The risk remained elevated even if the patient recovered from the disease. The researchers found no increased risk of vertebral fractures.

Hip fractures riskier than breast cancer for women
A review of the racial and ethnic differences in the risk and incidence of osteoporosis, published in a supplement to the September Journal of the AAOS, finds that a hip fracture may be a greater morbidity risk for female patients than breast cancer. A woman’s risk of hip fracture is equal to her combined risk of breast, uterine, and ovarian cancer. Within one year of suffering a hip fracture, 20 percent of women die, and 20 percent become permanently disabled. Prior to a fracture’s occurring, osteoporosis often remains silent and undiagnosed—particularly among women in racial and ethnic minority groups, who tend to have a lower awareness level of the disease.

Survey finds low compliance with HAI recommendations
A survey conducted by the Leapfrog Group finds that 87 percent of U.S. hospitals may not have instituted all of the recommended policies to prevent common hospital-acquired infections (HAIs). Researchers surveyed 1,256 hospitals about their policies on various preventive practices. Only 32.3 percent of respondents reported full compliance with recommendations regarding surgical site infection and only 35.6 percent of hospitals reported full compliance with hand hygiene practices.