A Decade of Oral Anticoagulant Treatment to Maintain Autologous Vein Grafts for Femoropopliteal Atherosclerosis

Kretschmer, G.; Herbst, F.; Prager, Manfred; Sautner, Thomas; Wenzl, E.; Berlakovich, Gabriela; Zekert, F; Marosi, L; Schemper, M.

doi:10.1001/archsurg.1992.01420090120018

Cited by 88 publications

(39 citation statements)

References 13 publications

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“…Raros são os trabalhos que enfocaram esse tipo de paciente com relação ao tratamento anticoagulante 23 ; a maioria são estudos comparativos entre AVK e antiplaquetários em enxertos distais nos membros inferiores 5,[33][34][35] . Em trabalho anterior, em nosso ambulatório de anticoagulação, estudamos retrospectivamente 230 pacientes com doença arterial periférica, tratados com warfarina, num período de 17 anos.…”

Section: Discussionunclassified

Complicações da terapia anticoagulante com warfarina em pacientes com doença vascular periférica: estudo coorte prospectivo

et al. 2006

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194 ResumoObjetivo: Estudar prospectivamente a freqüência de complicações em pacientes tratados com warfarina e acompanhados no Ambulatório de Anticoagulação da Faculdade de Medicina de Botucatu da Universidade Estadual Paulista.Métodos: Pacientes sorteados entre os agendados para consulta de junho de 2002 a fevereiro de 2004. Na primeira consulta, foi preenchida ficha com dados de identificação e clínicos. A cada retorno, ou quando o paciente procurou o hospital por intercorrência, foi preenchida ficha com a razão normatizada internacional, existência e tipo de intercorrência e condições de uso dos antagonistas da vitamina K.Resultados: Foram acompanhados 136 pacientes (61 homens e 75 mulheres), 99 com tromboembolismo venoso e 37 com doença arterial; 59 pacientes eram de Botucatu, e 77, de outros municípios. Foram registradas 30 intercorrências: nove não relacionadas ao uso da warfarina e 21 complicações hemorrágicas (38,8 por 100 pacientes/ ano). Uma hematêmese foi considerada grave (1,9 por 100 pacientes/ ano). As demais foram consideradas moderadas ou leves. Não houve óbitos, hemorragia intracraniana ou necrose cutânea. A única associação significante foi da freqüência de hemorragia com nível médio de razão normatizada internacional.Conclusão: Nossos resultados mostram a viabilidade desse tratamento em pacientes vasculares em nosso meio, mesmo em população de baixo nível socioeconômico, quando tratados em ambulatório especializado.Palavras-chave: Anticoagulantes, warfarina, efeitos adversos, doenças vasculares, trombose venosa, embolia pulmonar. AbstractObjective: To prospectively study the frequency of complications in patients treated with warfarin followed at Botucatu Medical School.Methods: Patients randomly selected among those with appointments scheduled from June 2002 to February 2004. At the first appointment, a protocol was filled with identification and clinical data. At every return or when the patient went to the hospital due to clinical events, another form was filled with the international normalized ratio, existence and type of clinical event and the conditions of use of vitamin K antagonists.Results: A total of 136 patients (61 men and 75 women), were followed; 99 patients with venous thromboembolism and 37 with arterial disease; 59 were from Botucatu and 77 were from other municipalities. Thirty clinical events were registered: nine of them were not related to the use of warfarin and 21 were hemorrhagic complications (38.8 per 100 patients-year). One hematemesis was considered severe (1.9 per 100 patients-year). The others were considered moderate or mild. There were no deaths, intracranial hemorrhage or cutaneous necrosis. The only significant association was frequency of hemorrhage and average international normalized ratio level.Conclusion: Our results demonstrate the feasibility of this treatment in vascular patients in our country, even in socially and economically poor populations, when treated in specialized clinics.

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Section: Discussionunclassified

Complicações da terapia anticoagulante com warfarina em pacientes com doença vascular periférica: estudo coorte prospectivo

et al. 2006

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“…[13][14][15][16] The disappointing results of some of these trials, with respect to graft patency, emphasize the gaps in our understanding of how the antithrombotic surface of saphenous vein endothelium is altered when vein is implanted in the arterial circulation. Here, we show that the concentration of thrombomodulin on saphenous vein endothelium is downregulated rapidly in response to arterial flow conditions, whereas the changes in tissue factor expression are either slower or much more subtle.…”

Section: Discussionmentioning

confidence: 99%

Arterial Flow Conditions Downregulate Thrombomodulin on Saphenous Vein Endothelium

et al. 1999

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Background —The antithrombogenic properties of venous endothelium may be attenuated when vein is implanted in the arterial circulation. Such changes may facilitate thrombosis, which is the final common pathway for saphenous vein arterial bypass graft occlusion. Methods and Results —Using human saphenous vein in a validated ex vivo flow circuit, we investigated (1) the possibility that arterial flow conditions (mean pressure, 100 mm Hg, 90 cpm, ≈200 mL/min) alter the concentration of proteins involved in regulating thrombosis at the vessel wall and (2) the influence of ion channel blockade on such effects. Concentrations of thrombomodulin and tissue factor were quantified by Western blotting (ratio of von Willebrand factor staining) and immunohistochemistry (as a percentage of CD31-staining area). Thrombomodulin concentrations after 90 minutes of venous and arterial flow conditions were quantified by immunostaining (68.9±4.8% and 41.0±3.0% CD31, respectively; P <0.01) and by Western blotting (1.35±0.20 and 0.15±0.03 ratio of von Willebrand factor, respectively; P <0.01). The ability of endothelial cells to generate activated protein C also decreased from 62±14 to 19±10 ng · min −1 · 1000 cells −1 ( P =0.01). The significant reduction in thrombomodulin was attenuated if calcium was removed from the perfusate but not by external vein stenting. Inclusion in the vein perfusate of drugs that reduce calcium entry (including Gd 3+ , to block stretch-activated ion channels, and nifedipine) abolished the reduction in thrombomodulin concentration observed after arterial flow conditions. In freshly excised vein, negligible concentrations of tissue factor were detected on the endothelium and concentrations did not increase after 90 minutes of arterial flow conditions, although the inclusion of nifedipine caused the immunostaining to increase from 3.0±0.4% to 8.5±0.7% CD31 ( P <0.02). Conclusions —In saphenous vein endothelium exposed to arterial flow conditions, there is rapid downregulation of thrombomodulin, sufficient to limit protein C activation, by a calcium-dependent mechanism.

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“…Many of these studies focused on peripheral artery patency after vascular reconstruction and were not designed to assess the potential benefit of a VKA to reduce future cardiovascular outcomes [36,[48][49][50][51][52][53]. As the rate of CV events is 5 times higher in patients with PAD compared to patients without PAD and moderate intensity VKA is effective in reducing CV events in patients with CAD, there is a strong rationale for testing the efficacy of long-term moderate intensity VKA (target INR between 2 and 3) in addition to antiplatelet therapy to prevent major vascular events in patients with PAD.…”

Section: Peripheral Artery Disease (Pad)mentioning

confidence: 99%

Indications of combined vitamin K antagonists and aspirin therapy

Loualidi

Bredie

Janssen

2008

J Thromb Thrombolysis

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Based on their mode of action, it is reasonable to expect that the combination therapy of aspirin and a vitamin K antagonist (VKA) may be more beneficial in preventing (athero) thrombotic complications in high-risk patients for cardiovascular events. However, there is no consensus about additional aspirin use in the most common indications for VKA or the use of VKAs to be added to the most common aspirin indications. The variation in clinical outcomes and bleeding complications suggests that extrapolating from one indication to another may not be appropriate. So far, decisions about the combined use of aspirin and VKA are individualized in the absence of adequate data. Only in patients with mechanical heart valves the benefits and safety of combining aspirin with VKA therapy seems obvious. In patients with peripheral artery disease no beneficial effect was noted for the combination therapy, perhaps with an exception of those with graft failure. For all other clinical situations, this is unclear and should be avoided.

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A Decade of Oral Anticoagulant Treatment to Maintain Autologous Vein Grafts for Femoropopliteal Atherosclerosis

Cited by 88 publications

References 13 publications

Complicações da terapia anticoagulante com warfarina em pacientes com doença vascular periférica: estudo coorte prospectivo

Complicações da terapia anticoagulante com warfarina em pacientes com doença vascular periférica: estudo coorte prospectivo

Arterial Flow Conditions Downregulate Thrombomodulin on Saphenous Vein Endothelium

Indications of combined vitamin K antagonists and aspirin therapy

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