Medical treatment after peripheral bypass surgery over the past decade
E S van Hattum1, M J D Tangelder, M A Huis in 't Veld
1Department of Vascular Surgery (G.04.129), University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands. evhattum@tsz.nl
Insights
The Dutch Bypass and Oral anticoagulants or Aspirin (BOA) Study
Area of Science:
- Vascular Surgery
- Pharmacology
- Clinical Practice Research
Background:
- The Dutch Bypass and Oral anticoagulants or Aspirin (BOA) Study established differential efficacy of oral anticoagulants versus aspirin for preventing graft occlusion in peripheral arterial disease patients.
- Post-surgery management of peripheral arterial disease (PAD) involves optimizing anti-thrombotic, anti-hypertensive, and lipid-lowering therapies.
Purpose of the Study:
- To assess the long-term clinical implementation of BOA Study findings in former participants.
- To track trends in anti-thrombotic, anti-hypertensive, and lipid-lowering drug use over a decade.
Main Methods:
- Retrospective and prospective drug use data collected from 482 patients across six centers.
- Drug use assessed at baseline, up to two years post-BOA, and prospectively between 2005-2009.
- Analysis included anti-thrombotic, anti-hypertensive, and lipid-lowering medications.
Main Results:
- Anti-thrombotic use increased significantly from 54% at baseline to 96% at follow-up.
- Lipid-lowering drug use rose from 15% to 65%, and anti-hypertensive use from 49% to 76% over time.
- Despite increases, drug use remained suboptimal in some patient groups.
Conclusions:
- BOA Study recommendations were marginally adopted into clinical practice.
- While drug use improved, lipid-lowering and anti-hypertensive therapy levels were suboptimal.
- Trend analyses require cautious interpretation due to potential bias in survivor data.
Objective:
The Dutch Bypass and Oral anticoagulants or Aspirin (BOA) Study demonstrated that in patients with peripheral arterial disease after bypass surgery oral anticoagulants were more effective in preventing venous graft occlusions than aspirin, while aspirin was more effective in non-venous grafts. We evaluated if this finding was implemented in the clinical practice of former BOA participants by reconstructing a 10-year overview of their applied various drug treatments including anti-hypertensive and lipid-lowering drugs.
Methods:
In 482 patients from six centers that contributed most patients anti-thrombotic, anti-hypertensive, and lipid-lowering drug use was recorded at baseline (n = 478), retrospectively up to two years after BOA (n = 388), and prospectively for patients still alive between 2005 and 2009 (n = 209).
Results:
At baseline, 54% of patients received anti-thrombotics which increased to 96% at follow-up. At baseline 15% of patients were treated with lipid-lowering drugs and 49% with anti-hypertensives. This increased over time to 65% and 76%, respectively.
Conclusion:
After the BOA Study its recommendations were applied marginally. Despite improvements over time, current lipid-lowering and anti-hypertensive drug use remained suboptimal. Our trend analyses, however, should be interpreted with caution, because drug use and compliance in survivors might be better than average.
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