|
Recommendations for
Oral Anticoagulation |
|
COR |
LOE |
Recommendations |
|
IIb |
B-R |
The usefulness of anticoagulation
to improve patency after lower extremity autogenous vein or
prosthetic bypass is uncertain.193–195
|
|
See Online Data Supplements 23 and
24. |
Two RCTs evaluating the effectiveness
of oral anticoagulation (warfarin) in improving lower extremity
bypass patency demonstrated improved patency among the subgroup of
patients with autogenous vein bypass grafts.193,194 However, a Cochrane systematic review
showed no patency benefit with the use of anticoagulation compared
with antiplatelet therapy.195 All RCTs and observational studies
evaluating the effect of anticoagulants on bypass patency
demonstrated increased bleeding complications associated with
anticoagulant use. One RCT evaluating the effectiveness of oral
anticoagulation (warfarin) in addition to aspirin in improving lower
extremity bypass patency demonstrated improved patency in a subgroup
of patients with 6-mm polytetrafluoroethylene (known as PTFE) bypass
graft.196
Randomization to anticoagulation plus aspirin was associated with
increased risk of death and major hemorrhage versus aspirin
alone. |
|
III: Harm |
A |
Anticoagulation should not be
used to reduce the risk of cardiovascular ischemic events in
patients with PAD.194,196–198
|
|
See Online Data Supplements 23 and
24
|
RCTs and observational studies have
uniformly demonstrated that oral anticoagulation therapy aimed at
decreasing major cardiovascular ischemic events provided no benefit
and resulted in increased morbidity.194,196–198 In the WAVE (Warfarin Antiplatelet
Vascular Evaluation) trial of patients with atherosclerotic vascular
disease, including PAD, there was no difference in cardiovascular
ischemic events among patients randomized to oral anticoagulation
and antiplatelet therapy versus antiplatelet therapy
alone.198
In addition, there was an increase in bleeding endpoints including
life-threatening and intracranial bleeding.198 One RCT demonstrated
increased death rate among patients randomized to warfarin plus
aspirin versus aspirin alone after lower extremity bypass
grafting.196
|
|