Effect of chronic oral anticoagulation with warfarin on the durability and outcomes of endovascular aortic aneurysm repair.
Effect of chronic oral anticoagulation with warfarin on the durability and outcomes of endovascular aortic aneurysm repair.
复制标题
长期口服华法林抗凝药对血管内主动脉瘤修复术的耐久性和结果的影响。
DOI：
10.1016/j.jvs.2012.12.082
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发表时间：
2013
影响因子：
4.3
通讯作者：
Christopher T. Healey
中科院分区：
文献类型：
--
作者：
Marques S. Johnson;J. Chiang;J. Eldrup;D. Clark;Christopher T. Healey
目的主动脉瘤腔内修补术(Endoleak，EVAR)后的Endoleak会影响修补术的耐久性，导致囊持续扩张、破裂，需要进一步的腔内或开放手术干预。这项研究的目的是确定使用华法林的慢性抗凝治疗是否与EVAR后内漏发生率的增加和再次干预的需要增加相关。方法我们回顾了从2003年到2011年在一家机构接受EVAR的连续401例患者的记录。服用华法林的患者与未服用华法林的对照组进行了比较。主要终点包括再次干预，定义为破裂、植入物或血管造影术；任何原因导致的死亡；以及再次干预或死亡的综合结果。经计算机断层扫描或超声扫描确定的最后一次随访时出现内漏，以及动脉瘤囊大小增加超过5 mm是次要终点。采用COX比例风险模型，在控制了年龄、性别、肥胖、特殊合并症、抗血小板药物、他汀类药物的使用和EVAR的紧迫性的情况下，评估了华法林的使用对初次和二次结局的影响。结果363名患者的中位随访时间为29个月，有足够的数据进行分析。华法林的使用与任何主要终点的风险增加无关。通过比例风险模型控制协变量和观察时间，华法林的影响仍然不显著。然而，回归分析发现，急诊EVAR后和不适合开放手术修复的患者的不良结局更常见。结论慢性口服抗凝似乎不影响EVAR后内漏的发生率，也不影响再次干预的必要性或囊的退缩程度。我们认为华法林可以安全地用于EVAR术后患者。看来，急诊EVAR后和不适合开放手术的患者更有可能出现不良的长期结果。
ObjectiveEndoleak after endovascular aortic aneurysm repair (EVAR) can affect the durability of the repair and lead to continued sac expansion, rupture, and the need for further endovascular or open surgical interventions. The purpose of this study was to determine whether chronic anticoagulation therapy with warfarin is associated with an increased incidence of endoleak and thus increased need for reintervention after EVAR.MethodsWe reviewed the records of 401 consecutive patients who underwent EVAR at a single institution from 2003 until 2011. Patients on warfarin were compared with a control group not on warfarin. Primary endpoints included reintervention, defined as rupture, explant, or angiography; death from any cause; and a composite outcome of reintervention or death. The presence of an endoleak at last follow-up, identified by computed tomography or ultrasound scan, and increase of more than 5 mm in aneurysm sac size were secondary endpoints. Cox proportional hazards models were used to estimate the effect of warfarin use on the primary and secondary outcomes, controlling for age, gender, obesity, specific comorbidities, antiplatelet drugs, statin use, and urgency of EVAR.ResultsThree hundred sixty-three patients with a median follow-up period of 29 months had sufficient data for analysis. Warfarin use was not associated with an increased risk of any of the primary endpoints. Controlling for covariates and length of observation via proportional hazards models, the effect of warfarin remained insignificant. It was found, however, on regression analysis, that adverse outcomes were more prevalent after emergency EVAR and in patients deemed unfit for open surgical repair.ConclusionsChronic oral anticoagulation does not appear to affect the incidence of endoleak after EVAR, nor does it impact the need for reintervention or degree of sac regression. We feel that warfarin may be safely used in post-EVAR patients. It appears that adverse long-term outcomes are more likely after emergency EVAR and in patients deemed unfit for open surgery.