Antiplatelet therapy in endovascular surgery: the RENDOVASC study

Antiplatelet treatment prevents cardiovascular events and thrombosis during the endovascular surgery procedure. The aim of this study is to analyze the different antiplatelet treatment used in endovascular procedures in Spain.

In this investigation we included observational, retrospective, and multicenter study patients who underwent arterial endovascular therapy in 2006 or in the first 3 months of 2007, and follow-up of at least 1 year. The following data were collected: the usual epidemiologic variables, history of cardiovascular disease (coronary, cerebrovascular, or peripheral artery disease), risk factors, endovascular procedure performed, blood pressure, ethiology of arterial disease, the pre-operative antiaggregant treatment, and antiplatelet therapy used at 1 month and 1 year after the procedure.

A total of 1,557 patients were evaluated, of whom 84.3% were male. In addition 72.1% were hypertensive, 53.1% dyslipidemic, and 43.3% diabetic. From these patients, 32.6% presented with ischemic cardiomyopathy, 17.9% had a cerebral vascular history, and 35.3% had peripheral arterial disease. The most common etiology was occlusive disease (76.9%), the most commonly treated arterial sector was iliac (33.4%), and the most frequent procedure was stent angioplasty (46.9%). In the preoperative period, 75.1% of the patients were given antiplatelet therapy (89% simple antiplatelet treatment), 62.9% in the perioperative period, and 93.8% at 1 month after surgery (37.3% double antiaggregation). Antiplatelet treatment was administered previously to 86.2% of patients with history of cerebrovascular disease and to 88% of those with coronary disease. In the femoropopliteal sector 76.1% patients were receiving antiaggregation treatment before the procedure (11.1% double). However, 1 month later, double antiaggregation therapy was increased (45.3%), especially in the angioplasty and stent. In the iliac sector, 43.1% of patients with arterial stenosis and 38.2% of patients with complete arterial occlusion treated with angioplasty and stent continued receiving double antiaggregation 1 month after the procedure. In the carotid territory, 65.7% of patients treated with stent were receiving double antiplatelet treatment 1 month after the procedure.

We believe it is necessary to create consensus committees to perform clinical practice evidence-based guidelines to formalize antiaggregation treatment in endovascular procedures.