Long-term risk of vascular events after peripheral bypass surgery

2012 ◽  
Vol 108 (09) ◽  
pp. 543-553 ◽  
Author(s):  
Marco J. D. Tangelder ◽  
James A. Lawson ◽  
Frans L. Moll ◽  
Ale Algra ◽  
Eline S. Van Hattum
Keyword(s):  
Bypass Surgery ◽  
Primary Outcome ◽  
Oral Anticoagulants ◽  
Critical Limb Ischaemia ◽  
Individual Risk ◽  
Vascular Events ◽  
Peripheral Bypass ◽  
Vascular Death ◽  
Outcome Event

SummaryPatients with peripheral arterial disease (PAD) are at high risk of major ischaemic events. Long-term data of all major ischaemic events in PAD patients are scarce and outdated, especially for patients with severe PAD requiring bypass surgery. Our objective was to define their longterm prognosis and develop a prediction model which quantifies this risk up to a decade after surgery. We conducted a retrospective cohort study in patients from the Dutch Bypass Oral anticoagulants or Aspirin (BOA) Study; a multicentre randomised trial comparing oral anticoagulants with aspirin after infrainguinal bypass surgery. The primary outcome was the composite event of nonfatal myocardial infarction, non-fatal ischaemic stroke, major amputation, and vascular death. Cumulative risks were assessed by Kaplan-Meier analysis and independent determinants by multivariable Cox regression models. From 1995 until 2009, 482 patients were followed for a median period of 7.8 years. Follow-up was complete in 94%. Overall 60% of patients experienced a primary outcome event, of which the majority was a vascular death (30%), followed by major amputations (12%). The primary cause of vascular death was a cardiovascular event (29%), whereas the minority was due to complications directly related to PAD (6%). Within five years after bypass surgery vascular death occurred in about a quarter of patients and within 10 years in nearly half of patients. This was double the rate as for non-vascular death. The primary outcome event occurred in over a third and over half of patients in 5 and 10 years after bypass surgery, respectively. From four independent determinants for the primary outcome event: age, diabetes, critical limb ischaemia, and prior vascular interventions, we developed a risk chart, which systematically classifies the 10-year risks of the primary outcome event, ranging from 25% to 85%. This study provided a detailed insight in the course of PAD long after peripheral bypass surgery and enables individual risk assessment of major fatal and non-fatal ischaemic events by means of cumulative incidences and a risk chart.

scholarly journals THE LONG-TERM QUALITY OF LIFE IN PATIENTS WITH PERIPHERAL ARTERIAL DISEASE AFTER PERIPHERAL BYPASS SURGERY

2010 ◽  
Vol 55 (10) ◽  
pp. A156.E1458 ◽  
Author(s):  
Eline S. Van Hattum ◽  
Marco J. Tangelder ◽  
James A. Lawson ◽  
Frans L. Moll ◽  
Ale Algra
Keyword(s):  
Quality Of Life ◽  
Peripheral Arterial Disease ◽  
Bypass Surgery ◽  
Arterial Disease ◽  
Peripheral Bypass ◽  
Peripheral Arterial

Abstract 3164: Combined Antithrombotic Therapy in Atrial Fibrillation. Role of different Antiplatelet Strategies

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Francisco Pérez-Gómez ◽  
Ramón Bover ◽  
Antonio Salvador ◽  
María Paz Maluenda ◽  
Susana Asenjo ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Antithrombotic Therapy ◽  
Primary Outcome ◽  
Combined Therapy ◽  
Severe Bleeding ◽  
Vascular Events ◽  
Long Term Follow Up ◽  
Ischemic Events

The NASPEAF trial showed that combined anticoagulant plus antiplatelet therapy was more effective than anticoagulant alone at reducing vascular events in atrial fibrillation (AF) patients. We planned both to validate this benefit during a longer follow-up of patients included in that trial and to assess the hypothesis that combination of anticoagulation plus different antiplatelets could be differently effective and/or safe in patients from that trial and new ones followed-up for at least one year. Methods: Five hundred and seventy-four AF patients were included. Anticoagulation alone therapy (INR 2.0 –3.0) was used as control group (g) 1 to compare with anticoagulation (1.9 –2.5) plus either trifusal 600 mg/d (g2), trifusal 300 mg/d (g3) or aspirin 100 mg/d (g4). Median follow-up was 50, 32, 50 and 37 months respectively. The primary outcome was a composite of ischemic/haemorrhagic stroke, systemic/coronary ischemic events and cardiovascular death. The incidence of severe bleeding was also collected. Anticoagulation was regularly controlled in dedicated units. Results: Long-term follow-up showed benefit of combined anticoagulant plus trifusal 600 mg/d vs anticoagulant alone (primary outcome 2.86% pt/years in g1 vs 1.36% in g2, P=0.014). Combined therapy using other antiplatelet strategies was less effective or safe due to higher incidence of ischemic events when using trifusal 300 mg/d (2.44% pt/years in g3 vs 0.61% in g2, P=0.031) as well as more severe bleeding events with aspirin 100 mg/d (6.60% pt/years in g4 vs 1.51% in g2, P=0.008). Groups g1, g3 and g4 had similar primary outcome (2.86% pt/years, 2.67% and 2.83% respectively). Mean INR and other anticoagulation parameters were similar in the three combined therapy groups. Non-gastric severe bleeding incidence during combined therapy with trifusal 600 mg/d (0.3% pt/years) was lower than that observed in either anticoagulant alone therapy (2.1%, P=0.012) or combined with aspirin (6.60%, P=0.008). In conclusion, long-term follow-up of the NASPEAF trial confirmed the benefit of combined antithrombotic therapy over anticoagulant alone therapy. Combined therapy with aspirin 100 mg/d instead of trifusal 600 mg/d caused higher incidence of severe bleeding.

scholarly journals Breadth of complications of long-term oral anticoagulant care

Hematology ◽  
2018 ◽  
Vol 2018 (1) ◽  
pp. 432-438 ◽  
Author(s):  
Walter Ageno ◽  
Marco Donadini
Keyword(s):  
Oral Anticoagulants ◽  
Case Fatality ◽  
Bleeding Risk ◽  
Medical Intervention ◽  
Individual Risk ◽  
Anticoagulant Treatment ◽  
Risk Of Recurrence ◽  
Recurrent Vte ◽  
The Individual

Abstract The majority of patients with venous thromboembolism (VTE) have a considerable long-term risk of recurrence and may require extended duration of anticoagulant treatment after the initial 3 to 6 months. The decision to extend treatment is based not only on the individual risk of recurrence, but should also consider the potential complications associated with anticoagulation, taking into account that anticoagulant drugs are among the drugs most frequently associated with hospital admission due to adverse drug reactions. The most feared complication of oral anticoagulants is bleeding, which in some cases may be fatal or may affect critical organs. Case-fatality rates of bleeding have been reported to be ∼3 times higher than case-fatality rates of recurrent VTE. Even when nonserious, bleeding may require medical intervention and/or may impact on patient quality of life or working activity. Factors associated with bleeding during anticoagulant treatment include, among others, advanced age, cancer, renal or liver insufficiency, or concomitant antithrombotic drugs, but no bleeding risk score is sufficiently accurate for use in clinical practice. Not uncommonly, bleeding occurs as a complication of trauma or medically invasive procedures. Nonbleeding complications associated with oral anticoagulants are unusual, and their relevance is extremely uncertain, and include vascular calcification, anticoagulation-related nephropathy, and osteoporosis. Finally, because VTE not uncommonly affects young individuals and the mean age of the population is ∼60 years, the costs associated with extended anticoagulation should not be forgotten. The costs of the drugs need to be balanced against health outcome costs associated with both recurrent VTE and bleeding.

scholarly journals The quality of life in patients after peripheral bypass surgery deteriorates at long-term follow-up

2011 ◽  
Vol 53 (3) ◽  
pp. 643-650 ◽  
Author(s):  
Eline S. van Hattum ◽  
Marco J.D. Tangelder ◽  
James A. Lawson ◽  
Frans L. Moll ◽  
Ale Algra
Keyword(s):  
Quality Of Life ◽  
Bypass Surgery ◽  
Peripheral Bypass ◽  
Long Term Follow Up

scholarly journals CHA2DS2-VASc score in acute ischemic stroke with atrial fibrillation: results from the Clinical Research Collaboration for Stroke in Korea

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hak-Loh Lee ◽  
Joon-Tae Kim ◽  
Ji Sung Lee ◽  
Beom Joon Kim ◽  
Jong-Moo Park ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Primary Outcome ◽  
Research Collaboration ◽  
Recurrent Stroke ◽  
Oral Anticoagulants ◽  
Vascular Events ◽  
Stroke Registry ◽  
One Year

AbstractWe investigated a multicenter registry to identify estimated event rates according to CHA2DS2-VASc scores in patients with acute ischemic stroke (AIS) and atrial fibrillation (AF). The additional effectiveness of antiplatelets (APs) plus oral anticoagulants (OACs) compared with OACs alone considering the CHA2DS2-VASc scores was also explored. This study retrospectively analyzed a multicenter stroke registry between Jan 2011 and Nov 2017, identifying patients with acute ischemic stroke with AF. The primary outcome event was a composite of recurrent stroke, myocardial infarction, and all-cause mortality within 1 year. A total of 7395 patients (age, 73 ± 10 years; men, 54.2%) were analyzed. The primary outcome events at one year ranged from 5.99% (95% CI 3.21–8.77) for a CHA2DS2-VASc score of 0 points to 30.45% (95% CI 24.93–35.97) for 7 or more points. After adjustments for covariates, 1-point increases in the CHA2DS2-VASc score consistently increased the risk of primary outcome events (aHR 1.10 [1.06–1.15]) at 1-year. Among OAC-treated patients at discharge (n = 5500), those treated with OAC + AP (vs. OAC alone) were more likely to experience vascular events, though among patients with a CHA2DS2-VASc score of 5 or higher, the risk of primary outcome in the OAC + AP group was comparable to that in the OAC alone group (Pint = 0.01). Our study found that there were significant associations of increasing CHA2DS2-VASc scores with the increasing risk of vascular events at 1-year in AIS with AF. Further study would be warranted.

scholarly journals Clopidogrel with aspirin versus aspirin alone in prevention of stroke following transient ischemic attack or acute minor stroke

CJEM ◽  
2015 ◽  
Vol 17 (3) ◽  
pp. 315-317
Author(s):  
Scott Seadon ◽  
Eddy Lang
Keyword(s):  
Transient Ischemic Attack ◽  
Primary Outcome ◽  
Hemorrhagic Stroke ◽  
Minor Stroke ◽  
Clinical Question ◽  
Vascular Events ◽  
Vascular Death ◽  
Secondary Outcomes ◽  
Ischemic Attack

Clinical questionFollowing transient ischemic attack or acute minor stroke, does the combination of clopidogrel and aspirin reduce the risk of stroke greater than aspirin alone?Article chosenWang Y, Wang Y, Zhao X, et al. Clopidogrel with aspirin in acute minor stroke or transient ischemic attack. N Engl J Med 2013;369:11-9.ObjectiveThe primary outcome measured in this study was ischemic or hemorrhagic stroke at 90 days of follow-up in groups assigned to treatment with a combination of aspirin and clopidogrel or aspirin alone following transient ischemic attack or acute minor stroke. The secondary outcomes were new clinical vascular events, including vascular death.

Die Auswirkung begleitender antithrombotischer Therapie auf die Durchgängigkeit peripherer Bypasses

VASA ◽  
2000 ◽  
Vol 29 (3) ◽  
pp. 163-167 ◽  
Author(s):  
Robert Bucek ◽  
Schnürer ◽  
Ahmadi ◽  
Polterauer ◽  
Kretschmer ◽  
...  
Keyword(s):  
Bypass Surgery ◽  
Randomized Study ◽  
Low Molecular Weight ◽  
Antithrombotic Treatment ◽  
Cardiovascular Risk Reduction ◽  
Venous Bypass ◽  
Positive Effects ◽  
Peripheral Bypass ◽  
Few Data

Peripheral bypass surgery is a well-established treatment for symptomatic atherosclerotic disease of the legs. To improve the long-term patency antithrombotic drugs and other adjuvant treatment are applied. In this review we summarize the results of randomized studies concerning antithrombotic treatment for prophylaxis after peripheral bypass surgery. Heparin is used routinely intra- and perioperatively without strong data, and according to few data low molecular weight heparin may be superior in this situation. Aspirin had positive effects in placebo-controlled studies after infrainguinal PTFE-bypasses, furthermore it is recommended due to its general cardiovascular risk reduction. Ticlopidine improved long-term patency in one randomized study after venous bypass surgery. Otherwise there are some data that long-term oral anticoagulation may be preferable in patients after venous bypass surgery.

scholarly journals Rivaroxaban in patients with ischaemic chronic cardiomyopathy and obstructive peripheral arterial disease: rationale for treatment and results

2020 ◽  
Vol 22 (Supplement_E) ◽  
pp. E137-E141
Author(s):  
Stefano Savonitto ◽  
Silvia Pelizzoli ◽  
Antonia Maria Selva
Keyword(s):  
Combined Treatment ◽  
Factor Xa ◽  
Bleeding Risk ◽  
Arterial Disease ◽  
Critical Limb Ischaemia ◽  
Individual Risk ◽  
Limb Ischaemia ◽  
Vascular Events ◽  
Peripheral Arterial ◽  
The Individual

Abstract Patients with overt clinical atherosclerosis (ATS) or with previous peripheral vascular events have a high risk of ischaemic complications. A careful control of cardiovascular (CV) risk factors has been shown to improve prognosis, likely driven by a decrease progression of ATS. Prevention of occlusive complications is, on the other hand, based on antithrombotic therapy. So far, this therapeutic goal has been pursued through antiplatelet therapy with aspirin and P2Y12 receptor inhibitors. Anticoagulant therapy with full-dose vitamin K inhibitors, although effective in some arterial conditions, is burdened by high bleeding risk, and by low long-term compliance. In the COMPASS study, the association of aspirin with the factor Xa inhibitor, rivaroxaban, in a dose of one-fourth of the dose used in atrial fibrillation, decreased by more than 20% the incidence of CV events in patients with multi-district ATS. The positive effect was also observed as far as major peripheral complications, the like of critical limb ischaemia or limb amputations. This positive preventive effect was in addition to the effect of other preventive measures, such as the use of statins, ACE inhibitors, and aspirin itself. As compared to the aspirin-only treatment, the association with low-dose rivaroxaban had a significantly higher bleeding risk, which should be carefully considered when evaluating the individual risk/benefit ratio of the combined treatment.

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