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Influence of coumarin treatment on patency and limb salvage after peripheral arterial reconstructive surgery
B Arfvidsson1, F Lundgren, C Drott
1Department of Surgery, Sahlgren's Hospital, University of Gothenburg, Sweden.
Insights
Coumarin (dicumarol) did not improve outcomes like patency, limb salvage, or survival in femoro-popliteal and femoro-distal reconstructions. This anticoagulant therapy also increased the risk of serious bleeding complications.
Area of Science:
- Vascular Surgery
- Pharmacology
- Clinical Trials
Background:
- Femoro-popliteal and femoro-distal reconstructions are critical procedures for limb salvage.
- The role of anticoagulation, specifically coumarin derivatives, in improving outcomes of these reconstructions requires further investigation.
Purpose of the Study:
- To evaluate the efficacy and safety of postoperative coumarin (dicumarol) administration.
- To determine the effect of coumarin on graft patency, limb salvage, and patient survival following femoro-popliteal and femoro-distal reconstructive surgery.
Main Methods:
- A randomized controlled trial involving 116 patients undergoing primary femoro-popliteal or femoro-distal reconstructions.
- Patients received either coumarin (study group) or no coumarin (control group) postoperatively, in addition to heparin.
- Outcomes including graft patency, limb salvage, and survival were assessed over a 3-year period.
Main Results:
- No statistically significant differences in overall patency rates were observed between the coumarin and control groups at 1, 2, or 3 years.
- Limb salvage and survival rates were comparable between the two groups.
- Coumarin treatment was associated with a 4-5% incidence of serious bleeding complications.
Conclusions:
- Postoperative coumarin administration does not enhance patency, limb salvage, or survival in patients undergoing routine femoro-popliteal and femoro-distal reconstructive surgery.
- The use of coumarin in this context is associated with an increased risk of bleeding complications.
- Factors such as critical ischemia and the level of reconstruction significantly impact patient survival.
Abstract:
The effect of coumarin on patency, limb salvage, and survival after primary femoro-popliteal and femoro-distal reconstructions was studied in 116 randomized patients (61 in the study group and 55 in the control group). All patients were treated postoperatively with heparin. Patients allocated to the study group received dicumarol (a coumarin derivative) orally postoperatively. The overall patency after 1 year was 75 +/- 6%, compared with 74 +/- 6%, after 2 years 65 +/- 9 compared with 57 +/- 8%, and after 3 years 46 +/- 11% compared with 42 +/- 9% (mean +/- SE) in the study and control groups, respectively. There were no statistically significant differences in limb salvage or survival rates between the two groups. In contrast, coumarin treatment was associated with serious bleeding complications in 4% to 5% of the study patients. As expected, limb salvage was lower in patients with critical ischemia (p less than 0.03), and this was also true for survival (p less than 0.04), which was also influenced by the level of the reconstruction; survival was lower in patients with femoro-distal reconstructions (p less than 0.001). Our results demonstrate that coumarin treatment does not improve outcome in routine femoro-popliteal and femoro-distal reconstructive surgery.