Influence of coumarin treatment on patency and limb salvage after peripheral arterial reconstructive surgery.
The effect of coumarin on patency, limb salvage, and survival after primary femoro-popliteal and femoro-distal reconstructions was studied in 116 randomized patients (61 in the study group and 55 in the control group). All patients were treated postoperatively with heparin. Patients allocated to the study group received dicumarol (a coumarin derivative) orally postoperatively. The overall patency after 1 year was 75 +/- 6%, compared with 74 +/- 6%, after 2 years 65 +/- 9 compared with 57 +/- 8%, and after 3 years 46 +/- 11% compared with 42 +/- 9% (mean +/- SE) in the study and control groups, respectively. There were no statistically significant differences in limb salvage or survival rates between the two groups. In contrast, coumarin treatment was associated with serious bleeding complications in 4% to 5% of the study patients. As expected, limb salvage was lower in patients with critical ischemia (p less than 0.03), and this was also true for survival (p less than 0.04), which was also influenced by the level of the reconstruction; survival was lower in patients with femoro-distal reconstructions (p less than 0.001). Our results demonstrate that coumarin treatment does not improve outcome in routine femoro-popliteal and femoro-distal reconstructive surgery.
Arfvidsson
B
B
Department of Surgery, Sahlgren's Hospital, University of Gothenburg, Sweden.
Lundgren
F
F
Drott
C
C
Scherstén
T
T
Lundholm
K
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000401:mortality / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D003374:Coumarins / Q000627:therapeutic use*; D001728:Dicumarol / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D007383:Intermittent Claudication / Q000188:drug therapy; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D016032:Randomized Controlled Trials as Topic; D012501:Saphenous Vein / Q000637:transplantation; D013997:Time Factors
D003374:Coumarins; D001728:Dicumarol; D006493:Heparin