38 results found
Thapar A, Lawton R, Burgess L, et al., 2021, Compression hosiery to avoid post-thrombotic syndrome (CHAPS) protocol for a randomised controlled trial (ISRCTN73041168), BMJ Open, Vol: 11, ISSN: 2044-6055
Introduction: Up to 50% of patients develop post-thrombotic syndrome (PTS) after an above knee deep vein thrombosis (DVT). The aim of the study was to determine the effect of graduated compression stockings in preventing PTS after DVT.Methods and analysis: Pragmatic, UK multicentre randomised trial in adults with first above knee DVT. The standard of care arm is anticoagulation. The intervention arm will receive anticoagulation plus stockings (European class II, 23–32 mm Hg compression) worn for a median of 18 months. The primary endpoint is PTS using the Villalta score. Analysis of this will be through a time to event approach and cumulative incidence at median 6, 12 and 18 months. An ongoing process evaluation will examine factors contributing to adherence to stockings to understand if and how the behavioural interventions were effective.Ethics and dissemination: UK research ethics committee approval (reference 19/LO/1585). Dissemination though the charity Thrombosis UK, the Imperial College London website, peer-reviewed publications and international conferences.Trial registration number: ISRCTN registration number 73041168.
Thapar A, davies AH, 2017, Re: Endovascular Stroke Treatment of Acute Tandem Occlusion: A Single-Center Experience., JVIR: Journal of Vascular and Interventional Radiology, Vol: 28, Pages: 1288-1289, ISSN: 1051-0443
Milinis K, Thapar A, O'Neill K, et al., 2017, History of Aneurysmal Spontaneous Subarachnoid Hemorrhage, STROKE, Vol: 48, Pages: E280-E283, ISSN: 0039-2499
Varatharajan L, Thapar A, Lane T, et al., 2016, Pharmacological adjuncts for chronic venous ulcer healing: a systematic review, Phlebology, Vol: 31, Pages: 356-365, ISSN: 1433-3031
Background The aim of this study was to systematically review the current evidence and determine whether there is a clinical benefit for using pharmacological agents as adjunctive treatment for chronic venous ulcers.Method A systematic review of the MEDLINE and EMBASE (from 1 January 1947 through 15 August 2013) and Cochrane databases (from inception through 15 August 2013) was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria were all randomised controlled trials investigating pharmacological adjuncts for the treatment of venous ulcers with a minimum sample size of 20 patients for each treatment arm.Results Ten relevant articles were identified; one pilot randomised controlled trial and four Cochrane reviews were included. Pentoxifylline, aspirin, sulodexide, mesoglycan, flavonoids, thromboxane A2 antagonist (ifetroban), zinc, prostaglandin and prostacyclin analogues were the drugs reviewed. Pentoxifylline was found to be more effective than placebo in terms of complete ulcer healing or in causing a significant improvement (greater than 60% reduction in ulcer size) (RR 1.70, 95% CI 1.30 to 2.24). Aspirin and flavonoids show potential to be effective adjuncts but methodological shortcomings and issues with bias limit the validity of results from trials involving each of these drugs, respectively. There was no significant difference between placebo and Ifetroban and likewise pooled results from trials investigating sulodexide and zinc showed no benefit in comparison to placebo.Conclusion Many systemic pharmacological agents have been investigated as adjuncts to venous ulcer healing; however, pentoxifylline (400 mg, three times a day) is currently the only drug that has promising evidence to support its use. Other compounds are in early stage research.
Munster AB, Thapar A, Davies AH, 2016, History of Carotid Stroke, Stroke, Vol: 47, Pages: E66-E69, ISSN: 1524-4628
Munster AB, Franchini AJ, Qureshi MI, et al., 2015, Temporal trends in safety of carotid endarterectomy in asymptomatic patients, Neurology, Vol: 85, Pages: 365-372, ISSN: 0028-3878
Objective: To systematically review temporal changes in perioperative safety of carotid endarterectomy (CEA) in asymptomatic individuals in trial and registry studies.Methods: The MEDLINE and EMBASE databases were searched using the terms “carotid” and “endarterectomy” and “asymptomatic” from 1947 to August 23, 2014. Articles dealing with 50%–99% stenosis in asymptomatic individuals were included and low-volume studies were excluded. The primary endpoint was 30-day stroke or death and the secondary endpoint was 30-day all-cause mortality. Statistical analysis was performed using random-effects meta-regression for registry data and for trial data graphical interpretation alone was used.Results: Six trials (n = 4,431 procedures) and 47 community registries (n = 204,622 procedures) reported data between 1983 and 2013. Registry data showed a significant decrease in postoperative stroke or death incidence over the period 1991–2010, equivalent to a 6% average proportional annual reduction (95% credible interval [CrI] 4%–7%; p < 0.001). Considering postoperative all-cause mortality, registry data showed a significant 5% average proportional annual reduction (95% CrI 3%–9%; p < 0.001). Trial data showed a similar visual trend.Conclusions: CEA is safer than ever before and high-volume registry results closely mirror the results of trials. New benchmarks for CEA are a stroke or death risk of 1.2% and a mortality risk of 0.4%. This information will prove useful for quality improvement programs, for health care funders, and for those re-examining the long-term benefits of asymptomatic revascularization in future trials.
Thapar A, Dindyal S, Refson J, 2014, The 'two toe' technique for femorofemoral bypass., Ann R Coll Surg Engl, Vol: 96
Thapar A, Munster A, Shalhoub J, et al., 2013, Testing for asymptomatic carotid disease in patients with arterial disease elsewhere, Reviews in Vascular Medicine, Vol: 1, Pages: 81-84, ISSN: 2212-0211
Moderate to severe asymptomatic carotid atherosclerosis is found in 2-7% of the European population aged over 60 years; however the prevalence is highest in those with peripheral arterial disease (25%).The number of individuals needed to scan to prevent one extra stroke through referral for endarterectomy is 143 for claudicants, 250 for those with aortic aneurysmal disease and 333 for those with contralateral symptomatic carotid stenosis.The cost per stroke saved with surgery is approximately £76,000, through a policy of testing claudicants for asymptomatic carotid atherosclerosis, then offering carotid endarterectomy. Through implementing large scale testing of claudicants aged 60 years in England and Wales, 0.2% of the total number of strokes per year would be saved at a cost of £17 million. The main cost driver is the amount of unnecessary surgery performed (number needed to treat=20). © 2013 Elsevier GmbH.
Davies KJ, Thapar A, Kasivisvanathan V, et al., 2013, Review of Trans-Atlantic Cardiovascular Best Medical Therapy Guidelines - Recommendations for Asymptomatic Carotid Atherosclerosis, CURRENT VASCULAR PHARMACOLOGY, Vol: 11, Pages: 514-523, ISSN: 1570-1611
Thapar A, Shalhoub J, Dharmarajah B, et al., 2013, Should we stop testing for asymptomatic carotid atherosclerosis?, JOURNAL OF NEUROINTERVENTIONAL SURGERY, Vol: 5, Pages: 94-96, ISSN: 1759-8478
Thapar A, Garcia Mochon L, Epstein D, et al., 2013, Modelling the cost-effectiveness of carotid endarterectomy for asymptomatic stenosis, BRITISH JOURNAL OF SURGERY, Vol: 100, Pages: 231-239, ISSN: 0007-1323
Kasivisvanathan V, Thapar A, Oskrochi Y, et al., 2012, Irreversible Electroporation for Focal Ablation at the Porta Hepatis, CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY, Vol: 35, Pages: 1531-1534, ISSN: 0174-1551
Kasivisvanathan V, Thapar A, Davies KJ, et al., 2012, Periprocedural outcomes after surgical revascularization and stenting for postradiotherapy carotid stenosis, JOURNAL OF VASCULAR SURGERY, Vol: 56, Pages: 1143-+, ISSN: 0741-5214
Shalhoub J, Davies KJ, Hasan N, et al., 2012, The Utility of Collaborative Biobanks for Cardiovascular Research, ANGIOLOGY, Vol: 63, Pages: 367-377, ISSN: 0003-3197
Kasivisvanathan V, Thapar A, Davies AH, 2012, Letter by Kasivisvanathan et al Regarding Article, "Stenting Versus Surgery in Patients With Carotid Stenosis After Previous Cervical Radiation Therapy: Systematic Review and Meta-Analysis", STROKE, Vol: 43, Pages: E50-E50, ISSN: 0039-2499
Thapar A, Moore H, Golden D, et al., 2012, Peri-operative antithrombotic therapy: bridging the gap, ANNALS OF THE ROYAL COLLEGE OF SURGEONS OF ENGLAND, Vol: 94, Pages: 142-145, ISSN: 0035-8843
Abbott AL, Adelman MA, Alexandrov AV, et al., 2012, Why the United States Center for Medicare and Medicaid Services (CMS) Should not Extend Reimbursement Indications for Carotid Artery Angioplasty/Stenting, EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, Vol: 43, Pages: 247-251, ISSN: 1078-5884
Thapar A, Shalhoub J, Averkiou M, et al., 2012, Dose-Dependent Artifact in the Far Wall of the Carotid Artery at Dynamic Contrast-enhanced US, RADIOLOGY, Vol: 262, Pages: 672-679, ISSN: 0033-8419
Abbott AL, Adelman MA, Alexandrov AV, et al., 2012, Why the United States Center for Medicare and Medicaid Services (CMS) should not extend reimbursement indications for carotid artery angioplasty/stenting, INTERNATIONAL ANGIOLOGY, Vol: 31, Pages: 85-90, ISSN: 0392-9590
Abbott AL, Adelman MA, Alexandrov AV, et al., 2012, Why the United States Center for Medicare and Medicaid Services should not extend reimbursement indications for carotid artery angioplasty/stenting, VASCULAR, Vol: 20, Pages: 1-7, ISSN: 1708-5381
Thapar A, Mochon LG, Epstein D, et al., 2012, Cost-effectiveness of asymptomatic carotid surgery in the UK, International Surgical Congress of the Association-of-Surgeons-of-Great-Britain-and-Ireland (ASGBI), Publisher: WILEY-BLACKWELL, Pages: 54-54, ISSN: 0007-1323
Kasivisvanathan V, Thapar A, Dharmarajah B, et al., 2012, A systematic review of peri-procedural outcomes following surgical revascularization and stenting for post-radiotherapy carotid stenosis, International Surgical Congress of the Association-of-Surgeons-of-Great-Britain-and-Ireland (ASGBI), Publisher: WILEY-BLACKWELL, Pages: 215-216, ISSN: 0007-1323
Thapar A, Dharmarajah B, Sounderajah V, et al., 2012, Accuracy of manual and digital planimetry for measurement of simulated diabetic foot ulcers, International Surgical Congress of the Association-of-Surgeons-of-Great-Britain-and-Ireland (ASGBI), Publisher: WILEY-BLACKWELL, Pages: 22-22, ISSN: 0007-1323
Thapar A, Lane T, Nicholas R, et al., 2011, Systematic review of sonographic chronic cerebrospinal venous insufficiency findings in multiple sclerosis, PHLEBOLOGY, Vol: 26, Pages: 319-325, ISSN: 0268-3555
Shalhoub J, Monaco C, Owen DRJ, et al., 2011, Late-Phase Contrast-Enhanced Ultrasound Reflects Biological Features of Instability in Human Carotid Atherosclerosis, STROKE, Vol: 42, Pages: 3634-3636, ISSN: 0039-2499
Kasivisvanathan V, Thapar A, Shalhoub J, et al., 2011, Regarding "Outcomes of carotid artery stenting versus historical surgical controls for radiation-induced carotid stenosis", JOURNAL OF VASCULAR SURGERY, Vol: 54, Pages: 1868-1868, ISSN: 0741-5214
Thapar A, Lane TRA, Pandey V, et al., 2011, Internal jugular thrombosis post venoplasty for chronic cerebrospinal venous insufficiency, PHLEBOLOGY, Vol: 26, Pages: 254-256, ISSN: 0268-3555
Shalhoub J, Thapar A, Davies AH, 2011, The Use of Reverse Thermosensitive Polymer (LeGoo) for Temporary Vessel Occlusion in Clampless Peripheral Vascular Surgery, VASCULAR AND ENDOVASCULAR SURGERY, Vol: 45, Pages: 422-425, ISSN: 1538-5744
Jayasooriya G, Thapar A, Shalhoub J, et al., 2011, Silent cerebral events in asymptomatic carotid stenosis, JOURNAL OF VASCULAR SURGERY, Vol: 54, Pages: 227-236, ISSN: 0741-5214
Jayasooriya GS, Shalhoub J, Thapar A, et al., 2011, Patient preference survey in the management of asymptomatic carotid stenosis, JOURNAL OF VASCULAR SURGERY, Vol: 53, Pages: 1466-1472, ISSN: 0741-5214
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