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Analysis of Long-term Oral Anticoagulation and Relation to Recurrence of Acute Limb Ischemia After Urgent Upper Limb Embolectomy: A 5-year Evaluation

2019; Elsevier BV; Volume: 58; Issue: 6 Linguagem: Inglês

10.1016/j.ejvs.2019.09.416

1532-2165

Joana Cruz Silva, Vânia Constâncio, Juliana Varino, Manuel Fonseca, Óscar F. Gonçalves,

Venous Thromboembolism Diagnosis and Management

Introduction: Acute upper limb ischemia annual incidence has been reported as 1.3 cases per 100.000. These patients should receive lifelong anticoagulation unless contraindicated in order to prevent recurrence of thromboembolic disease. However, the proportion of long-term maintenance of anticoagulation following thrombembolectomy of the upper extremity is not known. The aim of this study was to evaluate short- and long-term anticoagulation following thrombembolectomy of the upper extremity and to calculate the relation between long-term anticoagulation and recurrence of acute limb ischemia. Methods: All patients with diagnosis of acute upper limb ischemia undergoing thrombembolectomy with Fogarty catheter in our institution from January 2013 until March 2018 were retrospectively identified. Epidemiologic data, comorbidities, orientation after discharge, recurrence rate and antiaggregant/anticoagulant medication were assessed at entry, discharge date and after 6-months/ at the time of the study. Chi-Square, Kaplan-Meier and Log-rank tests were used for statistical analysis. Results: 172 patients were included. Median age was 74 (range 43-104) and 73% were females. 76% of the events were considered cardioembolic. 3.5% of the patients were correctly anticoagulated at entry, 12% were on subtherapeutic anticoagulation and 37% were on antiaggregation. There was a 5.8% 30-day mortality and a 41.3% mortality at the time of the study, mean survival time was 42.9 months. 75% of the 167 patients had written indication for long-term anticoagulation at discharge/transference note; 9.6% were treated with coumarin at discharge date, 24% received new oral anticoagulants (NOACs) and 55% low-molecular-weight heparin. 40% were followed only by the family doctor after discharge. Long-term medication was assessed in 118 patients. 71% of those were correctly anticoagulated at the time of the study, 73% with NOACs. However, 51% of the patients followed by the family doctor were not anticoagulated versus only 19% of the patients observed in Vascular Surgery/ Cardiology/ Internal Medicine consultation (p < 0.001). 95% of the patients anticoagulated with NOACs at discharge were anticoagulated with NOACs at the time of the study (p < 0.001). Acute limb ischemia recurrence rate was 3.6%. 1.3% of the patients who were correctly anticoagulated had a recurrence versus 12.2% of the patients who were not correctly anticoagulated (p 0.009). Conclusion: In this study it was more probable that patients with acute upper limb ischemia undergoing thrombembolectomy that were followed by Vascular Surgery/ Cardiology/ Internal Medicine after discharge were correctly long-term anticoagulated. There was also a correlation among NOACs prescription at discharge and long-term NOACs medication. Finally, long-term correct anticoagulation was related with a lower recurrence rate of acute limb ischemia. Disclosure: Nothing to disclose