| Combination therapy with warfarin plus clopidogrel improves outcomes in femoropopliteal bypass surgery patients. | |
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MedLine Citation:
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PMID: 22551909 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Patients having undergone femoropopliteal bypass surgery remain at significant risk of graft failure. Although antithrombotic therapy is of paramount importance in these patients, the effect of oral anticoagulation therapy (OAT) on outcomes remains unresolved. We performed a randomized, prospective study to assess the impact of OAT plus clopidogrel vs dual antiplatelet therapy on peripheral vascular and systemic cardiovascular outcomes in patients who had undergone femoropopliteal bypass surgery. METHODS: Three hundred forty-one patients who had undergone femoropopliteal surgery were enrolled and randomized: 173 patients received clopidogrel 75 mg/d plus OAT with warfarin (C + OAT), and 168 patients received dual antiplatelet therapy with clopidogrel 75 mg/d plus aspirin 100 mg/d (C + acetylsalicylic acid [ASA]). Study end points were graft patency and the occurrence of severe peripheral arterial ischemia, and the incidence of bleeding episodes. RESULTS: Follow-up ranged from 4 to 9 years. The graft patency rate and the freedom from severe peripheral arterial ischemia was significantly higher in C + OAT group than in C + ASA group (P = .026 and .044, respectively, Cox-Mantel test). The linearized incidence of minor bleeding complications was significantly higher in C + OAT group than in C + ASA group (2.85% patient-years vs 1.37% patient-years; P = .03). The incidence of major adverse cardiovascular events, including mortality, was found to be similar (P = .34) for both study groups. CONCLUSIONS: In patients who have undergone femoropopliteal vascular surgery, combination therapy with clopidogrel plus warfarin is more effective than dual antiplatelet therapy in increasing graft patency and in reducing severe peripheral ischemia. These improvements are obtained at the expenses of an increase in the rate of minor anticoagulation-related complications. |
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Authors:
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Mario Monaco; Luigi Di Tommaso; Giovanni Battista Pinna; Stefano Lillo; Vincenzo Schiavone; Paolo Stassano |
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Publication Detail:
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Type: Journal Article; Randomized Controlled Trial Date: 2012-05-01 |
Journal Detail:
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Title: Journal of vascular surgery Volume: 56 ISSN: 1097-6809 ISO Abbreviation: J. Vasc. Surg. Publication Date: 2012 Jul |
Date Detail:
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Created Date: 2012-07-03 Completed Date: 2012-09-20 Revised Date: 2012-10-03 |
Medline Journal Info:
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Nlm Unique ID: 8407742 Medline TA: J Vasc Surg Country: United States |
Other Details:
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Languages: eng Pagination: 96-105 Citation Subset: IM |
Copyright Information:
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Copyright © 2012 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved. |
Affiliation:
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Departments of Cardiovascular Surgery and Anesthesiology, Istituto Clinico Pineta Grande, Castel Volturno (CE), Italy. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Administration, Oral Aged Aspirin / administration & dosage, therapeutic use Cardiovascular Diseases / prevention & control* Chi-Square Distribution Comorbidity Drug Therapy, Combination Female Femoral Artery / surgery* Graft Occlusion, Vascular / prevention & control* Humans Logistic Models Male Peripheral Vascular Diseases / prevention & control Platelet Aggregation Inhibitors / administration & dosage, therapeutic use* Popliteal Artery / surgery* Proportional Hazards Models Prospective Studies Ticlopidine / administration & dosage, analogs & derivatives*, therapeutic use Treatment Outcome Vascular Patency Warfarin / administration & dosage, therapeutic use* |
| Chemical | |
Reg. No./Substance:
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0/Platelet Aggregation Inhibitors; 50-78-2/Aspirin; 55142-85-3/Ticlopidine; 81-81-2/Warfarin; 90055-48-4/clopidogrel |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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