BENEFIT OF HYPOCOAGULATION AFTER LOWER LIMB BYPASS - A SYSTEMATIC REVIEW

  • Vitor Ferreira Serviço de Angiologia e Cirurgia Vascular, Hospital de Santo António — Centro Hospitalar do Porto
  • Cristiana Freixo Laboratório de Farmacologia Clínica da Faculdade de Medicina da Universidade de Lisboa
  • Joana Martins Serviço de Angiologia e Cirurgia Vascular, Hospital de Santo António — Centro Hospitalar do Porto
  • Duarte Rego Serviço de Angiologia e Cirurgia Vascular, Hospital de Santo António — Centro Hospitalar do Porto
  • João Gonçalves Serviço de Angiologia e Cirurgia Vascular, Hospital de Santo António — Centro Hospitalar do Porto
  • Gabriela Teixeira Serviço de Angiologia e Cirurgia Vascular, Hospital de Santo António — Centro Hospitalar do Porto
  • Inês Antunes Serviço de Angiologia e Cirurgia Vascular, Hospital de Santo António — Centro Hospitalar do Porto
  • Carlos Veiga Serviço de Angiologia e Cirurgia Vascular, Hospital de Santo António — Centro Hospitalar do Porto
  • Daniel Mendes Serviço de Angiologia e Cirurgia Vascular, Hospital de Santo António — Centro Hospitalar do Porto
  • Rui Almeida Serviço de Angiologia e Cirurgia Vascular, Hospital de Santo António — Centro Hospitalar do Porto; Instituto de Ciências Biomédicas Abel Salazar — Universidade do Porto
Keywords: Anticoagulants, peripheral arterial disease, primary patency

Abstract

Introduction: After surgical revascularization of the lower limb, antiplatelet agents are usually prescribed and anticoagulation is considered in cases of high risk of thrombosis. We conducted a systematic literature review of the existing evidence on long term prescription of anticoagulants in the postoperative.

Material and methods: Systematic review of the literature available in the Pubmed database.

Results: The studies selected for the final review consisted of: 6 randomized controlled trials (and 4 post-hoc analyzes), 1 prospective study with historical controls and 3 retrospective studies.

Conclusion: The efficacy of hypocoagulation depends on the conduit used and its intrinsic factors. There is benefit of hypocoagulation in the autologous venous lower limb bypasses, but the INR range and risk factors for thrombosis may influence the results. In the non-venous grafts there may be benefit in those with reduced caliber and low average flow. The incidence of major bleeding is significant, and a careful evaluation of the risk-benefit ratio in the prescription of chronic hypocoagulation is essential.

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References

1. Antithrombotic Trialists’ Collaboration. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ 2002; 324:71
2. Norgren, L. et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). Journal of Vascular Surgery , Volume 45 , Issue 1 , S5 – S
3. Monaco M, Di Tommaso L, Pinna GB, Lillo S, Schiavone V, Stassano P. Combination therapy with warfarin plus clopidogrel improves outcomes in femoropopliteal bypass surgery patients. J Vasc Surg. 2012 Jul;56(1):96-105
4. Jivegård L, Drott C, Gelin J, Groth O, Hensäter M, Jensen N, Johansson G. Effects of three months of low molecular weight heparin (dalteparin) treatment after bypass surgery for lower limb ischemia--a randomised placebo-controlled double blind multicentre trial. Eur J Vasc Endovasc Surg. 2005 Feb;29(2):190-8.
5. Dutch Bypass Oral Anticoagulants or Aspirin (BOA) Study Group. Efficacy of oral anticoagulants compared with aspirin after infrainguinal bypass surgery (The Dutch Bypass Oral Anticoagulants or Aspirin Study): a randomized trial. Lancet 2000; 355:346–351
6. Ariesen MJ, Tangelder MJ, Lawson JA, Eikelboom BC, Grobbee DE, Algra A; Dutch Bypass Oral Anticoagulants or Aspirin Study Group. Risk of major haemorrhage in patients after infrainguinal venous bypass surgery: therapeutic consequences? The Dutch BOA (Bypass Oral Anticoagulants or Aspirin) Study. Eur J Vasc Endovasc Surg. 2005 Aug;30(2):154-9. Epub 2005 Apr 25.
7. Oostenbrink JB, Tangelder MJ, Busschbach JJ, van Hout BA, Buskens E, Algra A, Lawson JA, Eikelboom BC; Dutch Bypass Oral anticoagulants or Aspirin (BOA) Study Group. Cost-effectiveness of oral anticoagulants versus aspirin in patients after infrainguinal bypass grafting surgery. J Vasc Surg. 2001 Aug;34(2):254-62.
8. Tangelder MJ, Algra A, Lawson JA, Hennekes S, Eikelboom BC. Optimal oral anticoagulant intensity to prevent secondary ischemic and hemorrhagic events in patients after infrainguinal bypass graft surgery. Dutch BOA Study Group. J Vasc Surg. 2001 Mar;33(3):522-7.
9. Johnson WC, Williford WO; Department of Veterans Affairs Cooperative Study. Benefits, morbidity, and mortality associated with long-term administration of oral anticoagulant therapy to patients with peripheral arterial bypass procedures: a prospective randomized study. J Vasc Surg. 2002 Mar;35(3):413-21.
10. Johnson WC, Williford WO, Corson JD, Padberg Hemorrhagic complications during long-term postoperative warfarin administration in patients undergoing lower extremity arterial bypass surgery. Vascular. 2004 Nov-Dec;12(6):362-8.
11. Kretschmer G, Hölzenbein TJ. Oral anticoagulation in peripheral vascular surgery: how intense, for how long, or at all? J Intern Med. 1999 Apr;245(4):389-97.
12. Kretschmer G, Wenzl E, Schemper M, Polterauer P, Ehringer H, Marçosi L, Minar. Influence of postoperative anticoagulant treatment on patient survival after femoropopliteal vein bypass surgery. Lancet. 1988 Apr 9;1(8589):797-9.
13. Sarac TP(1), Huber TS, Back MR, Ozaki CK, Carlton LM, Flynn TC, Seeger JM. Warfarin improves the outcome of infrainguinal vein bypass grafting at high risk for failure. J Vasc Surg. 1998 Sep;28(3):446-57.
14. Pappas PJ, Hobson RW 2nd, Meyers MG, Jamil Z, Lee BC, Silva MB Jr, Goldberg MC, Padberg FT. Patency of infrainguinal polytetrafluoroethylene bypass grafts with distal interposition vein cuffs. Cardiovasc Surg. 1998 Feb;6(1):19-26.
15. Suckow BD, Kraiss LW, Stone DH, Schanzer A, Bertges DJ, Baril DT, Cronenwett JL, Goodney PP; Vascular Study Group of New England. Comparison of graft patency, limb salvage, and antithrombotic therapy between prosthetic and autogenous below-knee bypass for critical limb ischemia. Ann Vasc Surg. 2013 Nov;27(8):1134-45.
16. Brumberg RS(1), Back MR, Armstrong PA, Cuthbertson D, Shames ML, Johnson BL, Bandyk DF. The relative importance of graft surveillance and warfarin therapy in infrainguinal prosthetic bypass failure. J Vasc Surg. 2007 Dec;46(6):1160-6.
17. Hamdan AD, Rayan SS, Hook SC, Campbell DR, Akbari CM, LoGerfo FW, Pomposelli FB Jr. Bypasses to tibial vessels using polytetrafluoroethylene as the solo conduit in a predominantly diabetic population. Vasc Endovascular Surg. 2002 Jan-Feb;36(1):59-63
18. Pisters R, Lane DA, Nieuwlaat R, et al. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. Chest 2010;138:1093–1100.
19. Frederic Baumann, MD, Marc Husmann, MD, James F. Benenati, MD, Barry T. Katzen, MD, Ian Del Conde, MD. Bleeding Risk Profile in Patients With Symptomatic Peripheral Artery Disease. Journal of Endovascular Therapy Vol 23, Issue 3, pp. 468 - 471
Published
2018-12-02
Section
Review Article