May 16, 2012Volume 7 - Issue 20 

DynaMed Weekly Update

For the week ending May 11, 2012

Last week 475 articles were evaluated via DynaMed's Systematic Literature Surveillance and 223 were added to DynaMed content.
 

Based on the editors' criteria of selecting "articles most likely to change clinical practice," one article of significant interest was selected for the DynaMed Weekly Update.

Feature Article

Adding Aspirin to Compression Therapy May Hasten Venous Ulcer Healing

 

Venous ulcers are a common complication of venous insufficiency and are usually treated with compression therapy.  Compression is usually effective for healing, but the recurrence rate can be high.  Aspirin was found to help with ulcer healing in a small trial with 20 patients in 1994, but there were no follow-up trials, and current guidelines conclude there is insufficient evidence to recommend aspirin use for venous ulcers.  Now,  a second randomized trial has investigated the effects of adding aspirin to compression on healing time and recurrence rates.  A total of 51 patients (mean age 60 years) with ulcers > 2 cm associated with chronic venous insufficiency were randomized to aspirin 300 mg/day vs. no aspirin.  All patients received wound care including cleaning, debridement, and hydrocolloid dressings followed by compression therapy with a 2-layer system providing cushioning and continuous pressure.  No topical corticosteroids or antiseptics were used.  Patients received antibiotics for infected lesions.  Exclusion criteria included diabetes, rheumatoid arthritis, peripheral arterial disease, neurological disease, and contraindications to aspirin.

 

The mean time to healing was 12 weeks for aspirin and 22 weeks for no aspirin (p = 0.04) (level 2 [mid-level] evidence).  The recurrence rates of 25% for aspirin and 33.3% for no aspirin were not significantly different.  The mean time to ulcer recurrence was significantly increased in the aspirin group (39 days vs. 16.3 days, p = 0.007) (Ann Vasc Surg 2012 Mar 19 early online).  While this trial is also small, the cost and risks associated with aspirin use are low.

 

For more information, see the Venous ulcer topic in DynaMed.

 

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Call for Peer Reviewers

We are currently seeking reviewers for:

Kaposi sarcoma

Renal vein thrombosis

Venous ulcer

 

Learn more about the DynaMed Contribution Opportunities:

DynaMed Peer Review 

Editorial Policies for Reviewers 

About DynaMed Weekly Update

Prepared by the clinician members of the DynaMed Editorial Team, DynaMed Weekly Update is a compilation of one to five articles selected from DynaMed's Systematic Literature Surveillance as articles most likely to change clinical practice.

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CME Information

CREDITS

Physicians:
0.25 AMA PRA Category I Credit(s)™
Family Physicians: 0.25 Prescribed credits
Nurse Practitioners: 0.25 Contact hours
 
Release Date: May 16, 2012
Expiration Date: May 16, 2013
Estimated Completion Time:
15 minutes
 
There is no fee for this activity.

To Receive Credit 
In order to receive your certificate of participation, you should read the information about this activity, including the disclosure statements, review the entire activity, take the post-test, and complete the evaluation form. You may then follow the directions to print your certificate of participation. To begin, click the CME icon at the end of the article.

Program Overview

Learning Objectives

Upon successful completion of this educational program, the reader should be able to:
1. Discuss the significance of this article as it relates to your clinical practice.
2. Be able to apply this knowledge to your patient's diagnosis, treatment and management.
 
Faculty Information
 
Alan Ehrlich, MD - Assistant Clinical Professor in Family Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA; Deputy Editor, DynaMed, Ipswich, Massachusetts, USA

Michael Fleming, MD, FAAFP - Assistant Clinical Professor of Family Medicine and Comprehensive Care, LSU Health Science Center School of Medicine, Shreveport, Louisiana, USA; Assistant Clinical Professor of Family Medicine, Department of Family and Community Medicine, Tulane University Medical School, New Orleans, Louisiana, USA; Chief Medical Officer, Amedisys, Inc. & Antidote Education Company

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Dr. Ehrlich, Dr. Fleming, DynaMed Editorial Team members, and the staff of Antidote Education Company have disclosed that they have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity.
 
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ACCME This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Antidote Education Company and EBSCO Publishing. Antidote is accredited by the ACCME to provide continuing medical education for physicians.  Antidote Education Company designates this educational activity for a maximum of 0.25 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

AAFP: This activity, DynaMed Weekly Update 2011, has been reviewed and is acceptable for up to 13 Prescribed credits by the American Academy of Family Physicians. AAFP accreditation begins March 2, 2011. Term of approval is for one year from this date. Each Weekly Update is approved for 0.25 Prescribed credits. Credit may be claimed for one year from the date of each Weekly Update.

  

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Program ID 1102072K.

 
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