Antithrombotic therapy has no beneficial effect in conservative treatment of spontaneous isolated superior mesenteric arterial dissection

Abstract

Purpose Initial conservative treatment with selective endovascular or surgical intervention has shown successful outcomes in the treatment of spontaneous isolated superior mesenteric artery dissection (SISMAD). However, the benefits of antithrombotic therapy as a part of conservative treatment have not been clarified. This study aimed to investigate the clinical course of SISMAD patients and determine differences in clinical outcomes between the antithrombotic and no-antithrombotic groups. Methods We retrospectively reviewed 79 cases of SISMAD that were treated conservatively from January 2004 to December 2019 at Chonnam National University Hospital. Clinical outcomes, including the length of hospital stay, pain resolution time, image remodeling, and maximal remodeling time, were compared between the antithrombotic and no-antithrombotic groups. Results There were 30 patients in the no-antithrombotic group and 49 patients in the antithrombotic group. There was no significant difference in clinical characteristics between the 2 groups, except for dyslipidemia (P = 0.011). The follow-up period (32.6 months vs. 14.6 months, P = 0.009) and imaging follow-up period (31.6 months vs. 13.9 months, P = 0.011) were longer in the antithrombotic group than in the no-antithrombotic group. The length of hospital stay (5.1 days vs. 7.7 days, P = 0.002) was significantly shorter in the no-antithrombotic group than in the antithrombotic group because patients in the antithrombotic group required longer hospitalization for warfarin titration. Conclusion In patients with SISMAD, conservative treatment without antithrombotic therapy may have clinical benefits such as decreased length of hospital stay compared with conservative treatment with antithrombotic therapy.

The Value of Rivaroxaban Combined with Ticagrelor in Antithrombotic Therapy after PCI in Patients with Nonvalvular Atrial Fibrillation with Acute Coronary Syndrome

“…At the same time, it will increase the risk of mural thrombosis and its disability and mortality. Several reports have found that among AF patients over 65 years old, 1/3 of patients are complicated with coronary heart disease [ 27 ]. In addition, atrial fibrillation has a higher risk of heart failure, thromboembolic events, and hospitalization [ 28 ].…”

Factors associated with false lumen changes in patients with superior mesenteric artery dissection

“…Owing to the fact that anticoagulants or antiplatelet therapy cannot prevent distal propagation and are likely to delay false lumen thrombosis, more and more evidence has appeared to support not using them as routine treatment methods during conservative treatment. [11][12][13][14][15][16] The failure of conservative treatment was defined as the persistence or aggravation of symptoms and signs, continuous expansion of the false lumen, or a newly appeared dissecting aneurysm during treatment. CTA (Core 128; Philips, Rotterdam, The Netherlands) and Doppler sonography (Philips Ultrasound, Inc., Rotterdam, The Netherlands) were performed within 1 week after the diagnosis of SMAD, and the status of SMAD was assessed and related data were recorded.…”