title: Acute lower limb ischemia: failure of anticoagulant treatment to improve one-month results of arterial thromboembolectomy. A prospective randomized multi-center study.
abstract: The value of short-term anticoagulant treatment in improving the early outcome in patients operated on for acute lower-limb ischemia has been debated and so far unproven. In this prospective randomized multi-center study, 188 such patients were randomized on admission, either to preoperative and postoperative anticoagulant medication (AC group, n = 94) or no anticoagulant treatment during the first month after surgery (O group, n = 94). Background factors were evenly distributed in the two groups, and 89% of the cases were considered as embolic. Analysis on an intention-to-treat basis showed no differences in outcome after 30 days. Good results, survivors who had amputation, and patients who died in the two groups are given respectively: AC group, 61%, 9%, 30%; O group, 65%, 11%, 24%. The results were similar in the two treatment groups also if only patients with a cardiac source of embolism were analyzed. Local bleeding complications were more common in the AC group (17% vs 2%, p less than 0.01). It is concluded that preoperative and early postoperative anticoagulant medication should not be routinely administered since such treatment is unlikely to improve the short-term results of lower-limb arterial thromboembolectomy while bleeding complications increase. The possible value of late (beyond 1 month) long-term anticoagulant treatment remains to be studied.
authors.affiliation: Department of Surgery, Sahlgrenska Hospital, Göteborg, Sweden.
authors.forename: L
authors.initials: L
authors.lastname: Jivegård
authors.forename: J
authors.initials: J
authors.lastname: Holm
authors.forename: D
authors.initials: D
authors.lastname: Bergqvist
authors.forename: C G
authors.initials: CG
authors.lastname: Björck
authors.forename: H
authors.initials: H
authors.lastname: Björkman
authors.forename: U
authors.initials: U
authors.lastname: Brunius
authors.forename: G
authors.initials: G
authors.lastname: Claes
authors.forename: J
authors.initials: J
authors.lastname: Hammarsten
authors.forename: B
authors.initials: B
authors.lastname: Jernby
authors.forename: P
authors.initials: P
authors.lastname: Konrad
mesh_terms: D000671:Amputation, Surgical; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D001157:Arterial Occlusive Diseases / Q000188:drug therapy* / Q000601:surgery; D005734:Gangrene / Q000209:etiology; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D007511:Ischemia / Q000188:drug therapy* / Q000601:surgery; D007866:Leg / Q000098:blood supply* / Q000601:surgery; D011446:Prospective Studies; D013923:Thromboembolism / Q000188:drug therapy* / Q000601:surgery
chemical_list: D000925:Anticoagulants