Association of Anticoagulation and Major Adverse Limb Events After Index Peripheral Endovascular Intervention
Dual-antiplatelet therapy is commonly prescribed after endovascular intervention for peripheral artery disease. However, it is not known whether therapeutic anticoagulation affects outcomes after peripheral endovascular intervention. We sought to investigate whether therapeutic anticoagulation after...
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| Veröffentlicht in: | The American journal of cardiology 2023-04, Vol.192, p.124-131 |
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| creator | Ramkumar, Niveditta Goodney, Philip P. Creager, Mark A. Henkin, Stanislav |
| description | Dual-antiplatelet therapy is commonly prescribed after endovascular intervention for peripheral artery disease. However, it is not known whether therapeutic anticoagulation affects outcomes after peripheral endovascular intervention. We sought to investigate whether therapeutic anticoagulation after peripheral endovascular intervention is associated with lower risk of major adverse limb events (MALEs) and all-cause mortality. We studied patients who underwent index endovascular intervention for peripheral artery disease in the Vascular Study Group of New England (2010 to 2018). The main exposure was anticoagulation at the time of discharge. Outcomes included patency loss (occlusion or target lesion reintervention), MALE (any major amputation or reintervention), and all-cause mortality. We compared outcomes between patients who received anticoagulation on discharge versus those who did not receive anticoagulation using Kaplan–Meier survival analysis and Cox regression. In the cohort of 6,809 patients, 15% were discharged on an anticoagulant (mostly warfarin). These patients had a higher prevalence of acute or chronic limb ischemia than those not receiving an anticoagulant (74% vs 47%, p < 0.001) and were less likely to receive any antiplatelet agent after peripheral endovascular intervention (5% vs 14%, p < 0.001). After risk adjustment, compared with patients not on an anticoagulant, patients receiving therapeutic anticoagulation had a higher risk of 2-year patency loss (hazard ratio [HR] 1.41, 95% confidence interval [CI] 1.05 to 1.89), MALE (HR 1.39, 95% CI 1.09 to 1.76), and all-cause mortality (HR 1.24, 95% CI 1.05 to 1.47). In conclusion, anticoagulation after peripheral endovascular intervention was associated with higher risk of adverse events, including patency loss, MALE, and all-cause mortality. |
| doi_str_mv | 10.1016/j.amjcard.2023.01.030 |
| format | Article |
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However, it is not known whether therapeutic anticoagulation affects outcomes after peripheral endovascular intervention. We sought to investigate whether therapeutic anticoagulation after peripheral endovascular intervention is associated with lower risk of major adverse limb events (MALEs) and all-cause mortality. We studied patients who underwent index endovascular intervention for peripheral artery disease in the Vascular Study Group of New England (2010 to 2018). The main exposure was anticoagulation at the time of discharge. Outcomes included patency loss (occlusion or target lesion reintervention), MALE (any major amputation or reintervention), and all-cause mortality. We compared outcomes between patients who received anticoagulation on discharge versus those who did not receive anticoagulation using Kaplan–Meier survival analysis and Cox regression. In the cohort of 6,809 patients, 15% were discharged on an anticoagulant (mostly warfarin). These patients had a higher prevalence of acute or chronic limb ischemia than those not receiving an anticoagulant (74% vs 47%, p < 0.001) and were less likely to receive any antiplatelet agent after peripheral endovascular intervention (5% vs 14%, p < 0.001). After risk adjustment, compared with patients not on an anticoagulant, patients receiving therapeutic anticoagulation had a higher risk of 2-year patency loss (hazard ratio [HR] 1.41, 95% confidence interval [CI] 1.05 to 1.89), MALE (HR 1.39, 95% CI 1.09 to 1.76), and all-cause mortality (HR 1.24, 95% CI 1.05 to 1.47). In conclusion, anticoagulation after peripheral endovascular intervention was associated with higher risk of adverse events, including patency loss, MALE, and all-cause mortality.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/j.amjcard.2023.01.030</identifier><identifier>PMID: 36787683</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Amputation ; Angioplasty ; Anticoagulants ; Anticoagulants - adverse effects ; Cardiac arrhythmia ; Cardiovascular disease ; Cardiovascular system ; Endovascular Procedures ; Humans ; Intervention ; Ischemia ; Male ; Males ; Mortality ; Occlusion ; Patients ; Peripheral Arterial Disease ; Retrospective Studies ; Risk ; Risk Factors ; Statistical analysis ; Treatment Outcome ; Vascular diseases ; Vascular Patency ; Vein & artery diseases</subject><ispartof>The American journal of cardiology, 2023-04, Vol.192, p.124-131</ispartof><rights>2023 Elsevier Inc.</rights><rights>Copyright © 2023 Elsevier Inc. All rights reserved.</rights><rights>2023. Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c393t-252febcd87c0beced951bfaa2d42f2476722ec1ae7536087606a0ac0da3ff93f3</citedby><cites>FETCH-LOGICAL-c393t-252febcd87c0beced951bfaa2d42f2476722ec1ae7536087606a0ac0da3ff93f3</cites><orcidid>0000-0001-5968-1216</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/2785188580?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,776,780,3536,27903,27904,64361,64363,64365,65309,72215</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36787683$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ramkumar, Niveditta</creatorcontrib><creatorcontrib>Goodney, Philip P.</creatorcontrib><creatorcontrib>Creager, Mark A.</creatorcontrib><creatorcontrib>Henkin, Stanislav</creatorcontrib><title>Association of Anticoagulation and Major Adverse Limb Events After Index Peripheral Endovascular Intervention</title><title>The American journal of cardiology</title><addtitle>Am J Cardiol</addtitle><description>Dual-antiplatelet therapy is commonly prescribed after endovascular intervention for peripheral artery disease. However, it is not known whether therapeutic anticoagulation affects outcomes after peripheral endovascular intervention. We sought to investigate whether therapeutic anticoagulation after peripheral endovascular intervention is associated with lower risk of major adverse limb events (MALEs) and all-cause mortality. We studied patients who underwent index endovascular intervention for peripheral artery disease in the Vascular Study Group of New England (2010 to 2018). The main exposure was anticoagulation at the time of discharge. Outcomes included patency loss (occlusion or target lesion reintervention), MALE (any major amputation or reintervention), and all-cause mortality. We compared outcomes between patients who received anticoagulation on discharge versus those who did not receive anticoagulation using Kaplan–Meier survival analysis and Cox regression. In the cohort of 6,809 patients, 15% were discharged on an anticoagulant (mostly warfarin). These patients had a higher prevalence of acute or chronic limb ischemia than those not receiving an anticoagulant (74% vs 47%, p < 0.001) and were less likely to receive any antiplatelet agent after peripheral endovascular intervention (5% vs 14%, p < 0.001). After risk adjustment, compared with patients not on an anticoagulant, patients receiving therapeutic anticoagulation had a higher risk of 2-year patency loss (hazard ratio [HR] 1.41, 95% confidence interval [CI] 1.05 to 1.89), MALE (HR 1.39, 95% CI 1.09 to 1.76), and all-cause mortality (HR 1.24, 95% CI 1.05 to 1.47). In conclusion, anticoagulation after peripheral endovascular intervention was associated with higher risk of adverse events, including patency loss, MALE, and all-cause mortality.</description><subject>Amputation</subject><subject>Angioplasty</subject><subject>Anticoagulants</subject><subject>Anticoagulants - adverse effects</subject><subject>Cardiac arrhythmia</subject><subject>Cardiovascular disease</subject><subject>Cardiovascular system</subject><subject>Endovascular Procedures</subject><subject>Humans</subject><subject>Intervention</subject><subject>Ischemia</subject><subject>Male</subject><subject>Males</subject><subject>Mortality</subject><subject>Occlusion</subject><subject>Patients</subject><subject>Peripheral Arterial Disease</subject><subject>Retrospective Studies</subject><subject>Risk</subject><subject>Risk Factors</subject><subject>Statistical analysis</subject><subject>Treatment Outcome</subject><subject>Vascular diseases</subject><subject>Vascular Patency</subject><subject>Vein & artery diseases</subject><issn>0002-9149</issn><issn>1879-1913</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkc1u3CAURlHVqJkmfYRWSN1kY4efsbFXkRVN2kgTtYtmjTBcWiwbJmCPkrcvo5l2kU1WCDj3g3sPQp8pKSmh9fVQqmnQKpqSEcZLQkvCyTu0oo1oC9pS_h6tCCGsaOm6PUcfUxryltKq_oDOeS0aUTd8haYupaCdml3wOFjc-dnpoH4v4_FIeYMf1BAi7sweYgK8dVOPN3vwc8KdnSHie2_gGf-E6HZ_IKoRb7wJe5V0DjncZuaA57hLdGbVmODTab1Aj3ebX7ffi-2Pb_e33bbQvOVzwSpmodemEZr0oMG0Fe2tUsysmWVrUQvGQFMFouI1yZ2QWhGliVHc2pZbfoGujrm7GJ4WSLOcXNIwjspDWJJkQog8izVlGf36Ch3CEn3-XaaaijZN1ZBMVUdKx5BSBCt30U0qvkhK5MGHHOTJhzz4kITK7CPXfTmlL_0E5n_VPwEZuDkCkMexdxBl0g587tlF0LM0wb3xxF8RKZ-o</recordid><startdate>20230401</startdate><enddate>20230401</enddate><creator>Ramkumar, Niveditta</creator><creator>Goodney, Philip P.</creator><creator>Creager, Mark A.</creator><creator>Henkin, Stanislav</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>M7Z</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-5968-1216</orcidid></search><sort><creationdate>20230401</creationdate><title>Association of Anticoagulation and Major Adverse Limb Events After Index Peripheral Endovascular Intervention</title><author>Ramkumar, Niveditta ; Goodney, Philip P. ; Creager, Mark A. ; Henkin, Stanislav</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c393t-252febcd87c0beced951bfaa2d42f2476722ec1ae7536087606a0ac0da3ff93f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Amputation</topic><topic>Angioplasty</topic><topic>Anticoagulants</topic><topic>Anticoagulants - adverse effects</topic><topic>Cardiac arrhythmia</topic><topic>Cardiovascular disease</topic><topic>Cardiovascular system</topic><topic>Endovascular Procedures</topic><topic>Humans</topic><topic>Intervention</topic><topic>Ischemia</topic><topic>Male</topic><topic>Males</topic><topic>Mortality</topic><topic>Occlusion</topic><topic>Patients</topic><topic>Peripheral Arterial Disease</topic><topic>Retrospective Studies</topic><topic>Risk</topic><topic>Risk Factors</topic><topic>Statistical analysis</topic><topic>Treatment Outcome</topic><topic>Vascular diseases</topic><topic>Vascular Patency</topic><topic>Vein & artery diseases</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ramkumar, Niveditta</creatorcontrib><creatorcontrib>Goodney, Philip P.</creatorcontrib><creatorcontrib>Creager, Mark A.</creatorcontrib><creatorcontrib>Henkin, Stanislav</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Biochemistry Abstracts 1</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ramkumar, Niveditta</au><au>Goodney, Philip P.</au><au>Creager, Mark A.</au><au>Henkin, Stanislav</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Association of Anticoagulation and Major Adverse Limb Events After Index Peripheral Endovascular Intervention</atitle><jtitle>The American journal of cardiology</jtitle><addtitle>Am J Cardiol</addtitle><date>2023-04-01</date><risdate>2023</risdate><volume>192</volume><spage>124</spage><epage>131</epage><pages>124-131</pages><issn>0002-9149</issn><eissn>1879-1913</eissn><abstract>Dual-antiplatelet therapy is commonly prescribed after endovascular intervention for peripheral artery disease. However, it is not known whether therapeutic anticoagulation affects outcomes after peripheral endovascular intervention. We sought to investigate whether therapeutic anticoagulation after peripheral endovascular intervention is associated with lower risk of major adverse limb events (MALEs) and all-cause mortality. We studied patients who underwent index endovascular intervention for peripheral artery disease in the Vascular Study Group of New England (2010 to 2018). The main exposure was anticoagulation at the time of discharge. Outcomes included patency loss (occlusion or target lesion reintervention), MALE (any major amputation or reintervention), and all-cause mortality. We compared outcomes between patients who received anticoagulation on discharge versus those who did not receive anticoagulation using Kaplan–Meier survival analysis and Cox regression. In the cohort of 6,809 patients, 15% were discharged on an anticoagulant (mostly warfarin). These patients had a higher prevalence of acute or chronic limb ischemia than those not receiving an anticoagulant (74% vs 47%, p < 0.001) and were less likely to receive any antiplatelet agent after peripheral endovascular intervention (5% vs 14%, p < 0.001). After risk adjustment, compared with patients not on an anticoagulant, patients receiving therapeutic anticoagulation had a higher risk of 2-year patency loss (hazard ratio [HR] 1.41, 95% confidence interval [CI] 1.05 to 1.89), MALE (HR 1.39, 95% CI 1.09 to 1.76), and all-cause mortality (HR 1.24, 95% CI 1.05 to 1.47). In conclusion, anticoagulation after peripheral endovascular intervention was associated with higher risk of adverse events, including patency loss, MALE, and all-cause mortality.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>36787683</pmid><doi>10.1016/j.amjcard.2023.01.030</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0001-5968-1216</orcidid></addata></record> |
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| subjects | Amputation Angioplasty Anticoagulants Anticoagulants - adverse effects Cardiac arrhythmia Cardiovascular disease Cardiovascular system Endovascular Procedures Humans Intervention Ischemia Male Males Mortality Occlusion Patients Peripheral Arterial Disease Retrospective Studies Risk Risk Factors Statistical analysis Treatment Outcome Vascular diseases Vascular Patency Vein & artery diseases |
| title | Association of Anticoagulation and Major Adverse Limb Events After Index Peripheral Endovascular Intervention |
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