title: Impact of long-term warfarin treatment on EVAR durability: a meta-analysis.
abstract: OBJECTIVE
  To evaluate whether postoperative long-term oral anticoagulation affects the durability of endovascular aneurysm repair (EVAR) and whether it is associated with an increased incidence of endoleak and subsequent need for reintervention.
  
  
  METHODS
  A literature search was performed to identify studies of abdominal aortic aneurysm patients undergoing EVAR including an arm receiving warfarin postoperatively and reporting the frequency of any endoleaks and/or persistent type II endoleaks and reinterventions. The search identified 81 articles, of which 5 observational cohort studies ultimately met the inclusion criteria.
  
  
  RESULTS
  Postoperative anticoagulation was required in 219 (14.6%) of the 1499 patients in the selected studies. The pooled effects analysis found that EVAR patients receiving long-term warfarin postoperatively had significantly more endoleaks of any type (OR 1.77, 95% CI 1.26 to 2.48, p=0.001) as well as persistent type II endoleaks (OR 1.58, 95% CI 1.05 to 2.37, p=0.03) compared with patients not on anticoagulation; however, there was no statistically significant difference in the reintervention rate between the groups.
  
  
  CONCLUSIONS
  Long-term anticoagulation in EVAR patients was associated with a statistically significant increase in any endoleak and persisting type II endoleaks, although it was not linked to an increased risk of reintervention. Close monitoring for EVAR patients who require long-term oral anticoagulation is advised.
authors: Department of Vascular Surgery, Democritus University Hospital, Alexandroupolis Greece.
authors: Miltos K
authors: MK
authors: Lazarides
authors: George S
authors: GS
authors: Georgiadis
authors: Dimitrios G
authors: DG
authors: Charalampidis
authors: George A
authors: GA
authors: Antoniou
authors: Efstratios I
authors: EI
authors: Georgakarakos
authors: George
authors: G
authors: Trellopoulos
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D016009:Chi-Square Distribution; D057867:Endoleak / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D057510:Endovascular Procedures / Q000009:adverse effects*; D006801:Humans; D016017:Odds Ratio; D019233:Retreatment; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014859:Warfarin / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D000925:Anticoagulants; D014859:Warfarin