Direct Oral Anticoagulants as the First Choice of Anticoagulation for Patients with Peripheral Artery Disease to Prevent Adverse Vascular Events: A Systematic Review and Meta-Analysis

Abstract

The best method of anticoagulation for patients with peripheral artery disease (PAD) is still a topic of interest for physicians. We conducted a meta-analysis to compare the effects of direct oral anticoagulants (DOACs) with those of vitamin-K-antagonist (VKA) anticoagulants in patients with peripheral artery disease. Five databases (Medline (via PubMed), EMBASE, Scopus, Web of Science, and CENTRAL) were searched systematically for studies comparing the effects of the two types of anticoagulants in patients with PAD, with an emphasis on lower-limb outcomes, cardiovascular events, and mortality. In PAD patients with concomitant non-valvular atrial fibrillation (NVAF), the use of DOACs significantly reduced the risk of major adverse limb events (HR = 0.58, 95% CI, 0.39–0.86, p < 0.01), stroke/systemic embolism (HR 0.76; 95% CI 0.61–0.95; p < 0.01), and all-cause mortality (HR 0.78; 95% CI 0.66–0.92; p < 0.01) compared with warfarin, but showed similar risks of MI (HR = 0.81, 95% CI, 0.59–1.11, p = 0.2) and cardiovascular mortality (HR = 0.77, 95% CI, 0.58–1.02, p = 0.07). Rivaroxaban at higher doses significantly increased the risk of major bleeding (HR = 1.16, 95% CI, 1.07–1.25, p < 0.01). We found no significant difference in terms of revascularization (OR = 1.49, 95% CI, 0.79–2.79, p = 0.14) in PAD patients in whom a poor distal runoff was the reason for the anticoagulation. DOACs have lower rates of major limb events, stroke, and mortality than VKAs in PAD patients with atrial fibrillation. Rivaroxaban at higher doses increased the risk of major bleeding compared with other DOAC drugs. More high-quality studies are needed to determine the most appropriate anticoagulation regimen for patients with lower-limb atherosclerosis.

Emergency vascular repairs in trauma: Predictors of poor prognosis and a novel scoring system

“…The UT Houston Score may be a reasonable way to protocolize risk-stratified vascular surgery consultation. Although contraindications to systemic anticoagulation are frequent in trauma, some studies report a benefit to intraoperative and postoperative anticoagulation for arterial injuries, suggesting that systemic anticoagulation and early antiplatelet therapy may be beneficial in high-risk patients 25–28 . In the current study, postoperative medications were provider dependent and differed between trauma and vascular surgeons.…”

“…Although contraindications to systemic anticoagulation are frequent in trauma, some studies report a benefit to intraoperative and postoperative anticoagulation for arterial injuries, suggesting that systemic anticoagulation and early antiplatelet therapy may be beneficial in high-risk patients. [25][26][27][28] In the current study, postoperative medications were provider dependent and differed between trauma and vascular surgeons. Future protocolized administration of a combination of antiplatelet and anticoagulant medications may be beneficial for high-risk patients in the absence of contraindications.…”

Annulated Heterocyclic[g]Coumarin Composites: Synthetic Approaches and Bioactive Profiling

“…Dong et al [36] synthesized the compound ( 16) using the same synthesis process as Yu et al [35] and then went on to produce derivatives of sulfonohydrazide. Compound ( 16) was subjected to an esterification and hydrazine synthesis reaction to create compound (17), which was then used to create compound (19). In order to produce the desired compound (19), the second step involves using trifluoromethane sulfonyl chloride (18) with pyridine as a solvent, as shown in Scheme 3.…”

“…Warfarin, nicouramol, and liquefaction are widely acknowledged as highly effective blood thinners. [16,17] While Armillarisinum A, Calanolide A, imecromone, and scopoletin are classified as antibiotics, [18] antiretrovirals, [19] spasmolytic, [20] and antiradical [21] agents, respectively. A well-known coumarin derivative, esculinin, considerably improves mental acuity through modulating the neurotransmitter system.…”

“…Owing to its many pharmacological possibilities and proven safety concerning regular cell function, this heterocycle has been thoroughly investigated and recorded in many reviews and research publications for medical use. Warfarin, nicouramol, and liquefaction are widely acknowledged as highly effective blood thinners [16,17] . While Armillarisinum A, Calanolide A, imecromone, and scopoletin are classified as antibiotics, [18] antiretrovirals, [19] spasmolytic, [20] and antiradical [21] agents, respectively.…”