PMID- 21678330
OWN - NLM
STAT- MEDLINE
DCOM- 20110824
LR  - 20231017
IS  - 1469-493X (Electronic)
IS  - 1361-6137 (Linking)
VI  - 2011
IP  - 6
DP  - 2011 Jun 15
TI  - Antithrombotic agents for preventing thrombosis after infrainguinal arterial 
      bypass surgery.
PG  - CD000536
LID - 10.1002/14651858.CD000536.pub2 [doi]
LID - CD000536
AB  - BACKGROUND: Peripheral arterial disease (PAD) is frequently treated by either an 
      infrainguinal autologous (using the patient's own veins) or synthetic graft 
      bypass. The rate of occlusion of the graft after one year is between 12% and 60%. 
      To prevent occlusion, patients are treated with an antiplatelet or antithrombotic 
      drug, or a combination of both. Little is known about which drug is optimal to 
      prevent infrainguinal graft occlusion. This is an update of a Cochrane review 
      first published in 2003. OBJECTIVES: To evaluate whether antithrombotic treatment 
      improves graft patency, limb salvage and survival in patients with chronic PAD 
      undergoing infrainguinal bypass surgery. SEARCH STRATEGY: The Cochrane Peripheral 
      Vascular Diseases Group searched their Specialised Register (last searched August 
      2010) and the Cochrane Central Register of Controlled Trials (CENTRAL) (The 
      Cochrane Library 2010, Issue 3). SELECTION CRITERIA: Randomised, controlled 
      trials; two review authors independently assessed the methodological quality of 
      each trial using a standardised checklist. DATA COLLECTION AND ANALYSIS: Data 
      collected included patient details, inclusion and exclusion criteria, type of 
      graft, antithrombotic therapy, outcomes, and side effects. MAIN RESULTS: A total 
      of 14 trials were included in this review; 4970 patient results were analysed. 
      Four trials evaluating vitamin K antagonists (VKA) versus no VKA suggested that 
      oral anticoagulation may favour autologous venous, but not artificial, graft 
      patency as well as limb salvage and survival. Two other studies comparing VKA 
      with aspirin (ASA) or aspirin and dipyridamole provided evidence to support a 
      positive effect of VKA on the patency of venous but not artificial grafts. Three 
      trials comparing low molecular weight heparin (LMWH) to unfractionated heparin 
      (UFH) failed to demonstrate a significant difference on patency. One trial 
      comparing LMWH with placebo found no significant improvement in graft patency 
      over the first postoperative year in a population receiving aspirin. One trial 
      showed an advantage for LMWH versus aspirin and dipyridamol at one year for 
      patients undergoing limb salvage procedures. Perioperative administration of 
      ancrod showed no greater benefit when compared to unfractionated heparin. Dextran 
      70 showed similar graft patency rates to LMWH but a significantly higher 
      proportion of patients developed heart failure with dextran. AUTHORS' 
      CONCLUSIONS: Patients undergoing infrainguinal venous graft are more likely to 
      benefit from treatment with VKA than platelet inhibitors. Patients receiving an 
      artificial graft benefit from platelet inhibitors (aspirin). However, the 
      evidence is not conclusive. Randomised controlled trials with larger patient 
      numbers are needed in the future to compare antithrombotic therapies with either 
      placebo or antiplatelet therapies.
FAU - Geraghty, Alistair J
AU  - Geraghty AJ
AD  - Vascular Surgery Unit, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, UK, AB25 
      2ZN.
FAU - Welch, Karen
AU  - Welch K
LA  - eng
GR  - CZB/4/788/CSO_/Chief Scientist Office/United Kingdom
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20110615
PL  - England
TA  - Cochrane Database Syst Rev
JT  - The Cochrane database of systematic reviews
JID - 100909747
RN  - 0 (Fibrinolytic Agents)
RN  - 12001-79-5 (Vitamin K)
SB  - IM
UOF - Cochrane Database Syst Rev. 2003;(4):CD000536. PMID: 14583924
CIN - Sao Paulo Med J. 2021 Aug 13;139(6):675-684. PMID: 34406310
MH  - Arteriosclerosis/surgery
MH  - Fibrinolytic Agents/*therapeutic use
MH  - Graft Occlusion, Vascular/*prevention & control
MH  - Humans
MH  - Intermittent Claudication/surgery
MH  - Ischemia/surgery
MH  - Leg/blood supply
MH  - Peripheral Vascular Diseases/*surgery
MH  - Randomized Controlled Trials as Topic
MH  - Thrombosis/*prevention & control
MH  - Vitamin K/*antagonists & inhibitors
PMC - PMC7047373
COIS- None known
EDAT- 2011/06/17 06:00
MHDA- 2011/08/25 06:00
PMCR- 2012/06/15
CRDT- 2011/06/17 06:00
PHST- 2011/06/17 06:00 [entrez]
PHST- 2011/06/17 06:00 [pubmed]
PHST- 2011/08/25 06:00 [medline]
PHST- 2012/06/15 00:00 [pmc-release]
AID - CD000536.pub2 [pii]
AID - 10.1002/14651858.CD000536.pub2 [doi]
PST - epublish
SO  - Cochrane Database Syst Rev. 2011 Jun 15;2011(6):CD000536. doi: 
      10.1002/14651858.CD000536.pub2.