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Published on: November 19, 2019
Benefits of antithrombotic therapy after infrainguinal bypass grafting: a meta-analysis
Tracie C Collins1, Julianne Souchek, Rebecca J Beyth
1Department of Veterans Affairs, Baylor College of Medicine, Michael E. DeBakey VA Medical Center, Houston, Texas, USA. tcollins@bcm.tmc.edu
Insights
Antithrombotic therapy significantly reduces vascular graft occlusion by approximately 50% at 12 months after lower extremity bypass surgery. This protective effect is maintained at 24 months, improving graft patency rates.
Area of Science:
- Vascular Surgery
- Pharmacology
- Clinical Trials
Background:
- Maintaining vascular graft patency is crucial for successful lower extremity bypass operations.
- Graft occlusion remains a significant complication, leading to reoperation and limb loss.
Purpose of the Study:
- To evaluate the efficacy of antithrombotic therapy in preserving vascular graft patency.
- To quantify the benefits of antithrombotic agents in preventing graft occlusion post-bypass surgery.
Main Methods:
- A meta-analysis of randomized clinical trials was conducted.
- Studies were identified through MEDLINE and journal hand searches.
- Random-effects models assessed graft occlusion and secondary outcomes like mortality and bleeding.
Main Results:
- Ten studies involving 1000s of patients met inclusion criteria.
- Antithrombotic therapy halved the odds of graft occlusion (Odds Ratio: 0.46, 95% CI: 0.32-0.66) at 12 months.
- Protective effects persisted at 24 months (OR: 0.58, 95% CI: 0.39-0.88).
Conclusions:
- Antithrombotic therapy is highly effective in preventing vascular graft occlusion.
- A 50% reduction in occlusion risk at 12 months is observed.
- Therapy provides sustained protection against graft failure up to 24 months post-operation.
Purpose:
We performed a meta-analysis to ascertain the benefits of antithrombotic therapy for maintaining the patency of vascular grafts following lower extremity bypass operations.
Methods:
We identified articles using MEDLINE and hand searches of relevant journals for randomized clinical trials that compared the use of antithrombotic therapy with control or placebo therapy. Random-effects (DerSimonian and Laird) analyses were used to determine the risk of graft occlusion following lower extremity bypass operations. We also assessed the odds of secondary outcomes, such as myocardial infarction, cerebrovascular accident, all-cause mortality, and bleeding.
Results:
Sixteen articles met the inclusion criteria of a randomized trial of antithrombotic therapy for the patency of vascular grafts; six were excluded because the analyses involved repeat surgeries or lacked a control group. Of the 10 studies included in the final analysis, seven compared antiplatelet agents with placebo or control, and three compared anticoagulant agents with placebo or control. The 10 studies were homogeneous in spite of differing durations of follow-up. The odds of graft occlusion in the treated group was half that in the placebo or control group. The odds ratio was 0.46 (95% confidence interval [CI]: 0.32 to 0.66) for the 10 studies that reported outcomes at 12 months or longer, 0.50 (95% CI: 0.29 to 0.87) in the five studies with 12-month rates; and 0.58 (95% CI: 0.39 to 0.88) at 24 months.
Conclusion:
Antithrombotic therapy decreases the risk of graft occlusion after a vascular operation by about 50% at 12 months and is still protective at 24 months after the operation.
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