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STUDY ON THE CHRONIC ANTITHROMBOTIC TREATMENT AFTER SURGICAL REVASCULARIZATIONS IN THE PERIPHERAL ARTERIAL DISEASE

MARIAN BROASCĂ^1*, DANA ELENA NEDELCU²

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The article presents a prospective controlled study of postoperative follow-up for 36 months, of the effect of the antithrombotic therapy on the arterial flux and vascular graft patency. The study included 231 patients with peripheral arterial disease, who underwent surgical interventions for lower limb revascularization during a 10-year period (1999- 2008), one month after surgery, the patients were divided into two groups: group #1 (174 patients) treated with antiplatelet therapy (AT), with a free interval after the first month or without treatment with vitamin K antagonist (VKA), and group #2 (57 patients) treated with continuous VKA, associated with the antiplatelet therapy (AT) treatment. The statistically homogeneous groups presented were compared in dynamics during the first 36 postoperative months with regard to the correlation between treatment and frequency of acute coronary events (ACE), stroke, hemorrhagic events, and significant hemodynamic modifications and graft patency in the operated lower limbs. There was no significant difference between the groups as far as ACE (p=0.59) or stroke (p=0.47) incidence was concerned. Group #1 presented a statistically higher significance of failing graft cases (43.8%) as compared to group #2 (34.5%) (r= 0.165, p<0.05) and graft occlusion (20.4%) as compared to group #2 (12.7%) (r=0.143, p<0.05). In group #2, the general incidence of hemorrhages is highly significant as compared to group #1. There were no deaths in the selected groups. Postoperative association treatment of VKA with AT in operated patients with chronic vascular conditions does not decrease the incidence of ACE or stroke in at-risk patients, it leads to a better graft patency (especially in case of low flows of distal discharge), but with significant increase of bleeding events.