Impact of Antithrombotic Therapy on Thrombotic and Bleeding Complications after Elective Endovascular Repair of Abdominal Aortic Aneurysms.

IF 2.8 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS CardioVascular and Interventional Radiology Pub Date : 2025-01-16 DOI:10.1007/s00270-024-03946-z

Josephine Kranendonk, Ad A Vermulst, Daphne van der Veen, Cornelis Kramers, Michiel C Warlé, Michel M P J Reijnen

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Abstract

Purpose: To investigate the influence of antithrombotic therapy on occurrence of thrombotic and bleeding complications after endovascular aneurysm repair (EVAR).

Methods: In this retrospective single-center cohort study, patients who underwent elective endovascular aneurysm repair for abdominal aortic aneurysm were categorized into three antithrombotic groups: single antiplatelet therapy (SAPT), anticoagulants, or dual antiplatelet therapy (DAPT). Outcome measures were the incidence of major adverse cardiovascular events (MACE), prosthetic limb occlusions, and bleeding complications during follow-up.

Results: Among 616 patients (SAPT: n = 450, anticoagulants: n = 84, and DAPT: n = 82), Kaplan-Meier analysis showed no significant difference (log-rank p = 0.37) in incidence of MACE between patients receiving SAPT (20.9%), anticoagulants (25.0%), and DAPT (14.6%) during a median follow-up of almost 4 years. In multivariable Cox regression analysis, only age (HR = 1.03; 95% CI 1.01-1.06, p = 0.01) and American Society of Anesthesiologists (ASA) classification (HR = 1.46; 95% CI 1.12-1.91; p = 0.01) were significant predictors for MACE. Prosthetic limb occlusion was observed in 38 patients during a median follow-up of 4 years; incidence between patients receiving SAPT (5.8%), anticoagulants (10.7%), and DAPT (3.7%) was not significantly different (log-rank p = 0.08). Age (HR = 0.96; 95% CI 0.92-1.00; p = 0.03) and use of anticoagulants (HR = 3.79, 95% CI 1.46-9.83; p < 0.01) were significant predictors for prosthetic limb occlusion. Bleeding complications occurred in 73 patients during median follow-up of almost 4 years, without significant difference (log rank p = 0.06) in incidence between patients receiving SAPT (10.7%), anticoagulants (19.0%), and DAPT (11.0%). ASA classification (HR = 1.74; 95% CI 1.23-2.46; p < 0.01) was a significant predictor for bleeding complications.

Conclusion: Use of anticoagulants after EVAR appears to be associated with a higher risk of prosthetic limb occlusion compared to the use of single or dual antiplatelet therapy.

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抗栓治疗对腹主动脉瘤择期血管内修复术后血栓和出血并发症的影响。

目的：探讨抗栓治疗对血管内动脉瘤修复术后血栓及出血并发症发生的影响。方法：在这项回顾性单中心队列研究中，接受选择性血管内动脉瘤修复术的腹主动脉瘤患者被分为三个抗血栓治疗组：单抗血小板治疗（SAPT）、抗凝剂治疗或双抗血小板治疗（DAPT）。结局指标为随访期间主要不良心血管事件（MACE）、假肢闭塞和出血并发症的发生率。结果：在616例患者中（SAPT: n = 450，抗凝剂：n = 84, DAPT: n = 82）， Kaplan-Meier分析显示，在中位随访近4年期间，接受SAPT（20.9%）、抗凝剂（25.0%）和DAPT（14.6%）的患者之间MACE发生率无显著差异（log-rank p = 0.37）。在多变量Cox回归分析中，只有年龄(HR = 1.03；95% CI 1.01-1.06, p = 0.01)和美国麻醉师学会（ASA）分类(HR = 1.46；95% ci 1.12-1.91；p = 0.01)是MACE的显著预测因子。在中位4年的随访期间，有38例患者观察到假肢闭塞；接受SAPT（5.8%）、抗凝剂（10.7%）和DAPT（3.7%）的患者发病率无显著差异（log-rank p = 0.08）。年龄(HR = 0.96；95% ci 0.92-1.00；p = 0.03)和抗凝剂的使用(HR = 3.79, 95% CI 1.46-9.83；结论：与使用单一或双重抗血小板治疗相比，EVAR后使用抗凝剂似乎与更高的假肢闭塞风险相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

CardioVascular and Interventional Radiology 医学-核医学

CiteScore

5.50

自引率

13.80%

发文量

306

审稿时长

3-8 weeks

期刊介绍： CardioVascular and Interventional Radiology (CVIR) is the official journal of the Cardiovascular and Interventional Radiological Society of Europe, and is also the official organ of a number of additional distinguished national and international interventional radiological societies. CVIR publishes double blinded peer-reviewed original research work including clinical and laboratory investigations, technical notes, case reports, works in progress, and letters to the editor, as well as review articles, pictorial essays, editorials, and special invited submissions in the field of vascular and interventional radiology. Beside the communication of the latest research results in this field, it is also the aim of CVIR to support continuous medical education. Articles that are accepted for publication are done so with the understanding that they, or their substantive contents, have not been and will not be submitted to any other publication.