PMID- 23443603
OWN - NLM
STAT- MEDLINE
DCOM- 20130418
LR  - 20161026
IS  - 1827-191X (Electronic)
IS  - 0021-9509 (Linking)
VI  - 54
IP  - 1 Suppl 1
DP  - 2013 Feb
TI  - Risk-adjusted strategies in the prevention of early arterial thrombosis following 
      lower extremity arterial reconstruction: a comparison of unfractionated versus 
      low molecular weight heparin.
PG  - 183-92
AB  - AIM: In vascular surgery postoperative thrombosis prophylaxis must sufficiently 
      prevent arterial thrombosis. This cohort study examines different therapeutic 
      approaches of unfractionated heparin (UFH) or low molecular weight heparin (LMWH) 
      after vascular reconstruction. METHODS: Four hundred seventy-five patients 
      entered the study between 2005 and 2008. Our clinical routine made a 
      differentiation between low-risk patients (N.=375) and patients with peripheral 
      bypass, which were grouped as high-risk (N.=148). We changed our postoperative 
      anticoagulation management after 24 months in the low-risk and after each 16 
      months in the high-risk group. The anticoagulation of low-risk patients consisted 
      of either two applications of 7.500 IU UFH subcutaneously (N.=158) or one daily 
      application of 40 mg LMWH each up to discharge (N.=169). High-risk patients 
      received either 25.000 IU UFH i.v. over 24 hours and 4 days (N.=48), 2-times 
      (N.=51) or one-time weight-adjusted LMWH (N.=49) up to discharge (1 mg/kg body 
      weight). Minor complications (bleedings) were differentiated from major early 
      graft occlusion during the postoperative course. Further follow-up was not done 
      for this study. RESULTS: Low risk: under LMWH, complications could be 
      significantly reduced (P=0.001). Under LMWH significantly fewer occlusion 
      complications occurred (P=0.01) and operation-induced hemorrhages were less 
      frequently observed (P=0.05), this was significant in the complete low-risk 
      group. High-risk: the one-time weight-adjusted LMWH group similarly exhibited 
      many occlusions, like the unfractionated group (NS). The two-time LMWH treatment 
      was significantly superior to the one-time application with respect to occlusion 
      followed by amputations (P=0.03). Minor complications could be minimized overall 
      by administration of LMWH and its dose reduction (NS). CONCLUSION: The 
      differentiation between patients with high and low risk seems reasonable. An 
      improvement could be achieved by differentiated LMWH application. Synthetic 
      specific antifactor Xa substances (fondaparinux) or other medications could lead 
      in future to other changes in the management of vascular surgery patients and 
      should be further evaluated.
FAU - Winkler, M S
AU  - Winkler MS
AD  - Department for Vascular Medicine, University Heart Center at University Medical 
      Center, Hamburg-Eppendorf, Germany.
FAU - Larena-Avellaneda, A
AU  - Larena-Avellaneda A
FAU - Diener, H
AU  - Diener H
FAU - Kolbel, T
AU  - Kolbel T
FAU - Debus, E S
AU  - Debus ES
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - Italy
TA  - J Cardiovasc Surg (Torino)
JT  - The Journal of cardiovascular surgery
JID - 0066127
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - *Blood Vessel Prosthesis Implantation/adverse effects
MH  - Dose-Response Relationship, Drug
MH  - Drug Administration Schedule
MH  - Female
MH  - Fibrinolytic Agents/administration & dosage/adverse effects/*therapeutic use
MH  - Graft Occlusion, Vascular/etiology/physiopathology/*prevention & control
MH  - Hemorrhage/chemically induced
MH  - Heparin/administration & dosage/adverse effects/*therapeutic use
MH  - Heparin, Low-Molecular-Weight/administration & dosage/adverse 
      effects/*therapeutic use
MH  - Humans
MH  - Lower Extremity/*blood supply
MH  - Male
MH  - Middle Aged
MH  - Patient Selection
MH  - Peripheral Arterial Disease/*surgery
MH  - Risk Factors
MH  - Thrombosis/etiology/physiopathology/*prevention & control
MH  - Time Factors
MH  - Treatment Outcome
MH  - Vascular Patency
EDAT- 2013/03/06 06:00
MHDA- 2013/04/20 06:00
CRDT- 2013/02/28 06:00
PHST- 2013/02/28 06:00 [entrez]
PHST- 2013/03/06 06:00 [pubmed]
PHST- 2013/04/20 06:00 [medline]
AID - R37137553 [pii]
PST - ppublish
SO  - J Cardiovasc Surg (Torino). 2013 Feb;54(1 Suppl 1):183-92.