Background
The use of warfarin for anticoagulation in thromboembolic disease has been the mainstay
of treatment. Direct oral anticoagulants (DOACs) have demonstrated equivalent anticoagulant
effects, without increased bleeding risks or need for frequent monitoring. However,
the role of DOACs remains unclear in the setting of replacing warfarin for high-risk
peripheral artery disease (PAD) interventions. The purpose of this study is to evaluate
the efficacy of DOACs compared to warfarin during the postoperative period in patients
that underwent a lower extremity high-risk bypass (HRB).
Methods
The study is a single institution, retrospective review of all lower extremity HRBs
between January 2012 and June 2021, who were previously placed on or started on anticoagulation
with a DOAC or warfarin. The HRB group included all patients undergoing femoral to
above or below knee bypass with an adjunct procedure, or below knee bypass with synthetic
or composite vein conduit. All demographics, preoperative factors, and complications
were evaluated with respect to DOAC versus warfarin.
Results
A total of 44 patients (28 males; average age 68.8 ± 10.9) underwent an HRB during
the study period. There were no significant differences in demographics and preoperative
characteristics between the 2 groups. Among patient comorbidities, coronary artery
disease was found to be significantly higher in patients on DOACs (P = 0.03). The 12-month primary patency rate was 83.3% versus 57.1%, for DOAC versus
warfarin respectively (P = 0.03). Multivariate analyses revealed that <30-day reinterventions contribute to
12-month patency (P = 0.02).
Conclusions
Patients who underwent lower extremity HRB with postoperative DOAC appeared to exhibit
higher graft patency rates than those who were placed on warfarin. Due to their low
incidence of undesirable side effects and the lack of frequent monitoring, DOACs could
be considered a safe alternative to warfarin in the postoperative period for patients
with HRB.
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Article Info
Publication History
Published online: July 07, 2022
Accepted:
June 6,
2022
Received:
February 14,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Conflict of interests: None.
Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
