[Peripheral arterial revascularization: which antithrombotic agents?].
Thrombotic occlusion after vascular reconstructive surgery is a frequent complication, specially when low-flow arteries and arterial prostheses are involved. Heparin therapy is usually administered in acute arterial insufficiency, and also during the perioperative period, in order to limit thrombus formation or propagation at the surgical or the cross-clamp application sites. The overall benefit of antiplatelet agents, specially aspirin, during the pre, peri and postoperative periods has been clearly demonstrated for arterial prostheses, and is probably useful in venous bypasses. Aspirin therapy also prevents thrombotic complication in other vascular beds, and reduces long-term cardiovascular morbidity and mortality. Oral anticoagulation by vitamin K antagonists, alone or combined with aspirin is perhaps an appropriate choice in selected patients with high risk of graft thrombosis, but cannot be recommended for routine treatments because of an increased risk of hemorrhage.
Haulon
S
S
Service de chirurgie cardiovasculaire, hôpital cardiologique, centre hospitalier régional universitaire de Lille, 59037 Lille.
Susen
S
S
Koussa
M
M
Jude
B
B
D015110:4-Hydroxycoumarins; D000925:Anticoagulants / Q000627:therapeutic use; D001158:Arteries / Q000637:transplantation; D001241:Aspirin / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006470:Hemorrhage / Q000139:chemically induced; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D007192:Indenes; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000517:prevention & control; D013927:Thrombosis / Q000517:prevention & control*; D014656:Vascular Surgical Procedures / Q000009:adverse effects*; D014812:Vitamin K / Q000037:antagonists & inhibitors
D015110:4-Hydroxycoumarins; D000925:Anticoagulants; D005343:Fibrinolytic Agents; D007192:Indenes; D010975:Platelet Aggregation Inhibitors; C011664:antivitamins K; D014812:Vitamin K; D006493:Heparin; D001241:Aspirin