title: Oral anticoagulation in peripheral vascular surgery: how intense, for how long, or at all?
abstract: To evaluate the influence of postoperative pharmacotherapy (antiplatelet therapy with acetylsalicylic acid (ASA) or oral anticoagulation) following various peripheral vascular surgical interventions (femoro-popliteal reconstruction, femoro-popliteotibial venous bypass;) two clinical series of patients were analysed (A1-2) and we made the hypothesis that adjuvant therapy may be beneficial. Thereafter two clinical trials were carried out (B1-2), to assess the value of postoperative antiaggregant and anticoagulant treatment. It was not possible to demonstrate any influence of ASA on improving patency at the iliaco-popliteal level or on patient survival. It was concluded that the ASA dosage of 1500 mg daily was too high, and produced severe side-effects, probably leading to insufficient patient compliance to therapy. In the B2 trial 130 patients received a femoro-popliteal above- or below-knee vein bypass, and were assigned to the therapy group (n = 66) and treated with anticoagulants or to the control group (n = 64) which received no therapy. During the follow-up, for a maximum of 10 years, the probability of bypass function, limb salvage and patient survival were significantly in favour of the treatment. The described single centre clinical trial B-2 produced in accordance with other trials a level II evidence in favour of postoperative pharmacotherapy. Level 1 trials assessing the direct comparison of antiaggregant versus anticoagulant therapy are underway, but results are unavailable yet, similarly the results of the Antithrombotic Trialist's Collaboration (ATT) are currently unknown.
authors.affiliation: Department of Vascular Surgery, University of Vienna, Medical School, Austria. a9408254@unet.univie.ac.at
authors.forename: G
authors.initials: G
authors.lastname: Kretschmer
authors.forename: T J
authors.initials: TJ
authors.lastname: Hölzenbein
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage*; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000601:surgery; D001241:Aspirin / Q000008:administration & dosage; D004334:Drug Administration Schedule; D006801:Humans; D013923:Thromboembolism / Q000209:etiology / Q000517:prevention & control*; D014656:Vascular Surgical Procedures / Q000009:adverse effects*
chemical_list: D000925:Anticoagulants; D001241:Aspirin