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Abstract
The value of short-term anticoagulant treatment in improving the early outcome in
patients operated on for acute lower-limb ischemia has been debated and so far unproven.
In this prospective randomized multi-center study, 188 such patients were randomized
on admission, either to preoperative and postoperative anticoagulant medication (AC
group, n = 94) or no anticoagulant treatment during the first month after surgery
(O group, n = 94). Background factors were evenly distributed in the two groups, and
89% of the cases were considered as embolic. Analysis on an intention-to-treat basis
showed no differences in outcome after 30 days. Good results, survivors who had amputation,
and patients who died in the two groups are given respectively: AC group, 61%, 9%,
30%; O group, 65%, 11%, 24%. The results were similar in the two treatment groups
also if only patients with a cardiac source of embolism were analyzed. Local bleeding
complications were more common in the AC group (17% vs 2%, p < 0.01). It is concluded
that preoperative and early postoperative anticoagulant medication should not be routinely
administered since such treatment is unlikely to improve the short-term results of
lower-limb arterial thromboembolectomy while bleeding complications increase. The
possible value of late (beyond 1 month) long-term anticoagulant treatment remains
to be studied.
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Article info
Publication history
Accepted:
July 20,
1990
Footnotes
☆Supported by grants from The Swedish National Foundation for Heart and Lung diseases. Tore Nilsons Foundation for Medical Research, the Gothenburg Medical Society, The Swedish Medical Society, and the Swedish Medical Research Council (00759).
Identification
Copyright
© 1991 Published by Elsevier Inc.
