Effects of Three Months of Low Molecular Weight Heparin (dalteparin) Treatment After Bypass Surgery for Lower Limb Ischemia—A Randomised Placebo-controlled Double Blind Multicentre Trial

Jivegård, Lennart; Drott, Christer; Gélin, J; Groth, O; Hensäter, M.; Jensen, Niels H.; Johansson, Gunnar; Konrad, Peter; Lindberg, Bo; Lindhagen, A; Lundqvist, B; Odén, Anders; Smith, Lisa M.; Stenberg, Björn; Thornell, E; Wingren, Urban; Örtenwall, Per

doi:10.1016/j.ejvs.2004.11.011

Cited by 22 publications

(6 citation statements)

References 26 publications

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“…Another trial randomized 284 patients with critical limb ischemia to 5,000 IU LMWH or placebo daily for 3 months. 130 All patients also received aspirin (75 mg/d). Three-month patency rates were 83% and 80% for LMWH vs control, and 59% for both treatments at 1 year.…”

Section: Postoperative Heparin Dextrans All Types Of Lower-extremitmentioning

confidence: 99%

Antithrombotic Therapy for Peripheral Artery Occlusive Disease

Sobel

Verhaeghe

2008

Chest

146

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Section: Postoperative Heparin Dextrans All Types Of Lower-extremitmentioning

confidence: 99%

Antithrombotic Therapy for Peripheral Artery Occlusive Disease

Sobel

Verhaeghe

2008

Chest

146

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“…Spinal cord stimulation treatment was associated with reduced care costs compared with usual care, and ER reduced mortality more than bypass surgery did . Both outcomes were reported to need higher quality evidence …”

Section: Resultsmentioning

confidence: 89%

Peripheral arterial disease: Scoping review of patient‐centred outcomes

Bolton

2019

International Wound Journal

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Peripheral arterial disease (PAD) impairs patients' quality of life (QOL), walking and ulcer healing, increasing patient pain, costs, and risks of amputation or mortality. A literature appraisal described PAD treatment capacity to improve validated patient-centred outcomes in controlled clinical studies. The PUBMED database was searched from 1 January 1970 to 21 June 2018, for original and derivative controlled clinical trial references addressing MeSH terms for 'ischemia' AND 'leg ulcer'. Non-ischemic ulcer treatment references were excluded. Frequencies of improved (P < .05) outcomes were reported. Eighty-eight studies on 4153 patients were summarized. Walking, pain or QOL improved mainly for interventions administered before PAD became severe. Amputation incidence, pain and ulcer healing were more frequently reported in those with severe PAD. Independent of PAD severity, patients experienced more likely improved walking, QOL, or pain reduction in response to structured walking interventions or those increasing calf muscle activity. Those with more severe PAD were more likely to report amputation reduction, mainly in response to invasive interventions. Those with PAD experienced more consistently improved patient-centred outcomes if they received multidisciplinary PAD management with supervised walking or calf muscle activity, with more likely amputation risk reduced for those with more severe PAD. Key Messages• Peripheral arterial disease (PAD) progresses in severity from impaired walking and quality of life (QOL) through increasing likelihood of pain, ulceration, gangrene, amputation, or death and magnifies clinical, economic, and patient burdens of venous insufficiency or diabetes • improving PAD-related patient-centred outcomes requires consistent early, effective PAD diagnosis and effective treatment to improve lower limb perfusionAbbreviations: ABI, ankle-to-brachial systolic blood pressure index (ratio), optimally performed using handheld Doppler ultrasound; ALU, arterial leg ulcers; CLI, critical limb ischaemia; DAPT, dual antiplatelet therapy, for example, aspirin plus low molecular weight heparin; DFU, diabetic foot ulcers; ER, endovascular revascularisation; HBO, hyperbaric oxygen; IC, intermittent claudication; IPC, intermittent pneumatic compression of the calf muscle; MLU, mixed aetiology leg ulcers complicated with peripheral arterial disease; NMES, neuromuscular electrical stimulation sufficient to cause contraction of the calf muscle; PAD, peripheral arterial disease; PPG, photoplethysmography a technique for measuring venous emptying; QOL, quality of life; RCT, randomised clinical trial; SET, structured exercise therapy supervised by a professional; SOC, standard of care; TcPO 2 , transcutaneous partial pressure of oxygen; VLU, venous leg ulcer.

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“…The benefit was not observed in patients with the bypass with 8 mm diameter [101]. Also, the use of dalteparin combined with ASA failed to benefit the patients who had undergone surgical revascularization due to LEAD [102]. The benefits from using warfarin and ASA compared to ASA alone were observed in a small study on patients with venous bypasses who were in the high bypass occlusion risk group (suboptimal bypass, poor reception of blood from the bypass, reoperation).…”

Section: Patients With Lower Extremity Artery Disease Who Underwent Imentioning

confidence: 98%

The position of Polish experts on conservative management in patients with artery diseases of lower limbs

Krasiński¹,

Gaciong

Szymański

et al. 2019

Acta Angiologica

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Peripheral artery disease (PAD) is a common disease, though not very well known and often diagnosed on a very late stage, causing not only typical complications such as intermittent claudication, critical limb ischemia or amputations, but also to cardiovascular mortality. The risk of cardiovascular death can be even 11 times higher in patients with symptomatic PAD than in healthy patients. The risk of heart attack, stroke or cardiovascular death is even higher, reaching almost 4% within one year, nearly equal to the risk for patients with coronary artery disease (CAD). In those patients, the 5-year mortality risk is estimated at 10-15%, with cardiovascular disorders being the most likely cause of death. In patients with critical limb ischemia, the risk of cardiovascular death within one year can be as high as 25% and the risk of amputation-30%. It is estimated that the global population of patients with PAD is over 120 million. The incidence of the diseases is 3-10%, but in patients aged 70 and more, the incidence increases to 14-29%. In Poland, around 4,000 people are hospitalized every year for PAD of lower limbs. The number of PAD-related amputations is over 9,000 per year. Although the methods of PAD diagnosis (e.g. ABI) are often easy and non-invasive, they are scarcely used in clinical practice. Also, optimal conservative management in the form of quitting smoking, modifying the cardiovascular risk factors and supervised exercise is often overlooked. PAD is a major issue not only for vascular surgery, but also for many other medical specializations, including angiology, general medicine, cardiology, or diabetology. As a result of long waiting times for the next visit and lack of access to patient programmes and reimbursed drugs, patients with PAD often report to the doctor when their condition is very serious. Despite the 2017 ESC guidelines on the diagnosis and treatment of peripheral artery disease, prepared together with ESVS, not all healthcare professionals have access to the latest knowledge on PAD diagnosis and treatment. Unfortunately, though published recently, the ESC's guidelines do not include some of the recent studies, among them the possibly breakthrough COMPASS trial which has the potential to change the paradigm of management of patients with PAD. We must bear in mind that the population with PAD is a difficult patient group who need new treatment methods and optimization of the existing ones in order to visibly improve diagnosis, treatment and prognosis.

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Effects of Three Months of Low Molecular Weight Heparin (dalteparin) Treatment After Bypass Surgery for Lower Limb Ischemia—A Randomised Placebo-controlled Double Blind Multicentre Trial

Abstract: In patients on ASA treatment, long-term postoperative dalteparin treatment did not improve patency after peripheral artery bypass grafting. Therefore, low molecular weight heparin treatment cannot be recommended for routine use after bypass surgery for critical lower limb ischemia.

Cited by 22 publications

References 26 publications

Antithrombotic Therapy for Peripheral Artery Occlusive Disease

Antithrombotic Therapy for Peripheral Artery Occlusive Disease

Peripheral arterial disease: Scoping review of patient‐centred outcomes

The position of Polish experts on conservative management in patients with artery diseases of lower limbs

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