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Antiplatelet agents for preventing thrombosis after peripheral arterial bypass surgery

  • Review
  • Intervention

Authors

  • J Dörffler-Melly,

  • HR Büller,

  • MM Koopman,

  • MH Prins


Dr Janine Dörffler-Melly, Consultant of Vascular Medicine, Division of Angiology, Swiss Cardiovascular Center, University Hospital Berne, Berne, CH 3010, SWITZERLAND. janine.doerffler@insel.ch.

Abstract

Background

Peripheral arterial disease (PAD) may cause occlusions (blockages) in the main arteries of the lower limbs. It is frequently treated by implantation of either an infrainguinal autologous (using the patient's own tissue) venous or artificial graft. A number of factors influence occlusion rates, including the material used. To prevent graft occlusion, patients are usually treated with either an antiplatelet or antithrombotic drug, or a combination of both.

Objectives

To evaluate whether antiplatelet treatment in patients with symptomatic PAD undergoing infrainguinal bypass surgery improves graft patency, limb salvage and survival.

Search strategy

The reviewers searched the Cochrane Peripheral Vascular Diseases Group Specialised Register, (last searched April 2003), and the Cochrane Central Register of Controlled Trials (CENTRAL) (last searched Issue 1, 2003). Additional trials were sought through reference lists of papers and by reviewing proceedings from the vascular surgical society meetings.

Selection criteria

The methodological quality of each trial was assessed independently by two reviewers (JD, MMK), with emphasis on concealment of randomisation.

Data collection and analysis

Details of the studies selected were extracted independently by two reviewers (JD, MMK), and an 'intention-to-treat' analysis performed. The treatment and control groups were compared for important prognostic factors and differences described. If any data were not available, further information was sought from the author. Data were synthesized by comparing group results.

Main results

The administration of a variety of platelet-inhibitors resulted in improved venous and artificial graft patency compared to no treatment. However, analysing patients for graft-type indicated that patients receiving a prosthetic graft were more likely to profit from administration of platelet-inhibitors than those treated with a venous graft.

Authors' conclusions

Antiplatelet therapy with aspirin had a slight beneficial effect on the patency of peripheral bypasses, but seemed to have an inferior effect on venous graft patency compared with artificial grafts. The effect of aspirin on cardiovascular outcomes and survival was mild and not statistically significant; this might be due to the fact that the majority of patients receiving a peripheral graft have an advanced stage of PAD with critical ischaemia. These patients are usually seriously ill with respect to cardiovascular diseases with high mortality rates of 20% per year. Additionally, the number of patients included in this analysis might still be too small to reach a statistically significant effect for mortality and cardiovascular morbidity.

Plain language summary

Plain language summary

Aspirin might help prevent blood clots blocking arteries after bypass graft surgery in the legs, but more research is needed

Peripheral arterial disease is narrowing or blockage of the arteries (major blood vessels) in the legs. This can cause intermittent claudication (pain on walking). It can worsen and lead to ischaemia, with poor circulation causing ongoing pain, ulcers (sores) and/or gangrene. Bypass graft surgery may be an option, where a graft keeps the artery open by bypassing the blockage. A possible complication is thrombosis (the formation of blood clots which might block the artery). The review of trials found some evidence that aspirin can sometimes prevent thrombosis after artery bypass graft surgery in the legs, but more research is needed.