Is long-term anticoagulation after acute thromboembolic limb ischemia always necessary?
OBJECTIVE
After thromboembolectomy, patients with acute limb ischemia often receive anticoagulant therapy to prevent recurrent events. Patients with atrial fibrillation or cardiac thrombus have a higher risk of recurrent emboli than those without these risk factors. This study examines the importance of long-term anticoagulation in these 2 groups.


METHODS
A review of patients presenting with acute limb ischemia over a 5-year period (1994-1999).


METHODS
A university-affiliated medical centre.


METHODS
Fifty patients divided into 2 groups: 19 (38%) patients with atrial fibrillation (group 1) and 31 (62%) patients with no atrial fibrillation or cardiac thrombus (group 2) as confirmed by transthoracic echocardiography.


METHODS
All patients underwent surgical thromboembolectomy and received postoperative anticoagulant therapy.


METHODS
Mortality, limb loss, further thromboembolic events and bleeding complications as determined by telephone survey.


RESULTS
There was a significant difference in 5-year survival (group 1, 84%; group 2, 64%) and early limb loss (group 1, 0%; group 2, 13%). Further thromboembolic events and bleeding complications were rare but were more common in group 1. In group 2 there were no instances of recurrent thromboemboli and no bleeding complications although only 39% of patients in this group were taking angicoagulants at the end of the study period.


CONCLUSIONS
Patients with extremity thromboemboli without atrial fibrillation or cardiac thrombus may not be at the same risk for recurrent events as those with these risk factors, and long-term anticoagulant therapy may not be as necessary in this group.
Forbes
Thomas L
TL
Division of Vascular Surgery, London Health Sciences Centre, University of Western Ontario. Tom.Forbes@lhsc.on.ca
DeRose
Guy
G
Harris
Kenneth A
KA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications; D005121:Extremities / Q000098:blood supply*; D005260:Female; D006331:Heart Diseases / Q000150:complications; D006801:Humans; D007511:Ischemia / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D017131:Thrombectomy / Q000379:methods; D013923:Thromboembolism / Q000150:complications / Q000517:prevention & control / Q000628:therapy*; D013927:Thrombosis / Q000150:complications; D013997:Time Factors; D016896:Treatment Outcome; D014859:Warfarin / Q000627:therapeutic use*
D000925:Anticoagulants; D014859:Warfarin