Effectiveness and Safety of Rivaroxaban Compared to Acenocumarol after Infrainguinal Surgical Revascularization

Critical limb ischemia (CLI) constitutes the most advanced form of peripheral artery disease (PAD) and is characterized by ischemic rest pain, tissue loss and/or gangrene. Optimized medical care and risk factor modification in addition to revascularization could reduce the incidence of cardiovascular events and major adverse limb events, improving patients’ quality of life and promising higher survival rates. Adequate adherence to cardioprotective medications, including antithrombotic therapy (e.g. antiplatelets, anticoagulants), cholesterol-lowering agents (e.g. statins, proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors), angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), and smoking cessation should be strongly encouraged for patients with CLI. This review examines these guideline-recommended therapies in terms of cardiovascular and limb-related risk reduction in patients with CLI.

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“…Studies reporting on the outcomes of DOACs for patients with PAD are presented in Table 4. 86,[88][89][90][91][92][93][94]…”

Section: Direct Oral Anticoagulantsmentioning

confidence: 99%

Medical therapy for cardiovascular and limb-related risk reduction in critical limb ischemia

Giannopoulos

Armstrong

2021

Vasc Med

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“…The literature search yielded a total of 1089 articles. During the selection procedures, 52 full-text articles were screened for eligibility, of which a total of 12 articles (three post hoc analyses from big randomized controlled trials [ 30 , 31 , 32 ], and nine observational cohorts [ 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ]) were finally included ( Figure 2 ).…”

Section: Resultsmentioning

confidence: 99%

“…The results of Aurshina et al suggest [ 33 ] that therapy with DOACs has an excellent graft primary patency rate at one-year follow-up. According to Ferreira et al [ 37 ], rivaroxaban has equivalent efficacy to acenocoumarol after infrainguinal bypass revascularization, with similar rates of occlusion, major amputation, and mortality. In addition, Obi et al found in patients undergoing lower-extremity surgical bypass that those receiving DOAC postoperatively had a shorter length of stay and were less likely to receive a transfusion in the following 30 days without compromising the graft patency and readmission rates for anticoagulation complications, thrombectomy, or thrombolysis, or affecting the amputation rate compared with those receiving a VKA [ 40 ].…”

Section: Discussionmentioning

confidence: 99%

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

Pomozi

Nagy

Fehérvári

et al. 2023

JCDD

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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.

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“…Багата ліпідами бляшка містить тканинний фактор, який локально ініціює активацію системи згортання. [1] Мета дослідження. Метою даного дослідження є оцінка функціонального стану судинно -тромбоцитарної, коагуляційної ланки і фібринолізу системи гемостазу та їх розладів за допомогою низькочастотної п'єзоелектричної тромбоеластографії (НПТЕГ) у хворих на облітеруючий атеросклероз нижніх кінцівок на фоні лікування.…”

Section: изменения системы гемостаза на фоне различных схем лечения уunclassified

Hemostatic System Changes Against the Background of the Different Treatment Regimens in Patients With Atherosclerosis of Lower Extremities

Tverdovsky¹

2019

Clinical Anesthesiology and Intensive Care

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изменения в сторону нормализации во всех составляющих системы гемостаза по методике НПТЕГ. Состояние коагуляционного звена системы гемостаза у больных ОА на 7 сутки терапии достоверно не отличается от показателей нормы, возможно отметить достоверные сдвиги в сторону гипокоагуляции в пределах нормы. Фибринолитическая система на 7 сутки лечения статистически не отличается от показателей нормы, имеет достоверную положительную динамику по сравнению с 1 сутками. Во второй группе выявлено статистически достоверную нормализацию всех показателей, характеризующих гемокоагуляционный потенциал крови КТА, ЧЗК, ИКД, ИПС, МА и показатели А0, R (t1) и ИКК, характеризующих агрегационную способность тромбоцитов, а также показателя, который отвечает за изменения фибринолитической системы крови. Ключевые слова: облитерирующий атеросклероз, тромбообразование, гемостаз.

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Effectiveness and Safety of Rivaroxaban Compared to Acenocumarol after Infrainguinal Surgical Revascularization

Cited by 6 publications

References 10 publications

Medical therapy for cardiovascular and limb-related risk reduction in critical limb ischemia

Medical therapy for cardiovascular and limb-related risk reduction in critical limb ischemia

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

Hemostatic System Changes Against the Background of the Different Treatment Regimens in Patients With Atherosclerosis of Lower Extremities

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