title: The role of oral vitamin K antagonists in the outcome of infrainguinal bypass procedures.
abstract: We investigated the role of oral vitamin K antagonists (VKAs) in graft patency, limb salvage, major and minor bleeding rates in patients undergoing infrainguinal bypass surgery. Five randomized-controlled trials (RCTs; n = 3746 patients) comparing VKA versus non-VKA treatment outcomes in patients undergoing infrainguinal bypass surgery were analyzed. The VKA treatment was associated with improved graft patency rates when a vein graft was used (risk ratio [RR]: 0.74; P = .0004), while there was no difference with prosthetic grafts (RR: 1.07; P = .39). The VKA treatment was also associated with improved limb salvage rates (RR: 0.33; P = .0008). Major and minor bleeding complications were higher in the VKA group. In conclusion, VKA treatment is associated with improved graft patency and limb salvage rates when a vein graft is used at the price of an increased risk of bleeding. Due to the inconsistent results, further well-designed RCTs are needed.
authors.affiliation: Department of Vascular Surgery, University Hospital of Larissa, University of Thessalia Medical School, Larissa, Greece giannouk@med.uth.gr.
authors.forename: Athanasios D
authors.initials: AD
authors.lastname: Giannoukas
authors.affiliation: Department of Vascular Surgery, University Hospital of Larissa, University of Thessalia Medical School, Larissa, Greece.
authors.forename: Kosmas I
authors.initials: KI
authors.lastname: Paraskevas
authors.affiliation: Department of Vascular Surgery, University Hospital of Larissa, University of Thessalia Medical School, Larissa, Greece.
authors.forename: Stylianos
authors.initials: S
authors.lastname: Koutsias
authors.affiliation: Department of Vascular Surgery, University Hospital of Larissa, University of Thessalia Medical School, Larissa, Greece.
authors.forename: Christos
authors.initials: C
authors.lastname: Argyriou
authors.affiliation: Department of Vascular Surgery, University Hospital of Larissa, University of Thessalia Medical School, Larissa, Greece.
authors.forename: Vasilios
authors.initials: V
authors.lastname: Saleptsis
authors.affiliation: Department of Vascular and Endovascular Surgery, "San Martino" University Hospital, University of Genoa, Genoa, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Palombo
mesh_terms: D000284:Administration, Oral; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D006083:Graft Occlusion, Vascular / Q000188:drug therapy; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D058017:Vascular Grafting; D014654:Vascular Patency / Q000187:drug effects*; D014812:Vitamin K / Q000037:antagonists & inhibitors*
chemical_list: D005343:Fibrinolytic Agents; D014812:Vitamin K
keywords: antiplatelet agents; coumadin; graft patency; infrainguinal bypass; peripheral arterial disease; vitamin K antagonists; warfarin