Two-year follow-up after acute thromboembolic lower limb ischaemia: the importance of continuing warfarin treatment

Abstract

BACKGROUND: The Vascular Surgical Society carried out an audit of follow-up after acute thromboembolic lower limb ischaemia. METHODS: The audit of acute lower limb ischaemia was done between 1 January and 31 March 1996 and included 474 patients. This report describes a 2-year follow-up of patients with a diagnosis of thrombosis or embolism who survived 30 days. Details were obtained for 214 (75 per cent) of 287 patients: half (107) were men, and the age range was 21-96 (mean 74) years. RESULTS: Amputation of the leg affected initially had been required (after 30 days) in 12 per cent. Further acute leg ischaemia had occurred in 11 per cent, and 9 per cent had undergone arterial reconstruction (11), angioplasty (seven) or thrombolysis (two). Major medical events were reported in 31 per cent and 35 per cent had died during the 2-year period. After the episode of acute ischaemia, warfarin was started in 57 per cent of patients, but was continued in only 43 per cent. Reasons for stopping were seldom known, nor was duration of treatment (range 1-22 (median 6) months in reported cases). Significantly more patients who were not on warfarin suffered recurrent acute limb ischaemia (19 versus 3 per cent; P < 0.01). No significant association was found between recurrent acute ischaemia and initial diagnosis of embolism, thrombosis or atrial fibrillation (but numbers of recurrences in each group were small). CONCLUSION: The incidence of recurrent acute thromboembolic limb ischaemia up to 2 years was significantly lower in patients treated with warfarin. Warfarin treatment is often stopped for no clear reason, especially in the elderly. Explicit advice about long-term warfarin therapy should be given when these patients are discharged from hospital.

Peripheral Arterial Embolism: Prevalence, Outcome, and the Role of Echocardiography in Management

“…1,8 It has been suggested that this change is the result of improved prescribing of anticoagulants for patients in atrial fibrillation and a decrease in incidence of rheumatic heart disease. 5,9,26,27 The present review demonstrates that around 10 patients who present to a single vascular unit each year still require surgical embolectomy. The majority are primary referrals from a local catchment population of about 500,000 with the remainder being tertiary referrals from southeast London and Kent (up to 4 million people).…”

“…3,4 Patients presenting with acute embolic occlusions tend to be elderly with coexisting medical problems. These factors have contributed to a persistent risk of amputation and death after surgical embolectomy [4][5][6][7][8][9][10][11] (Table I). Our experience did not reflect these findings, so we carried out this review to determine the prevalence and outcome of all surgical embolectomies presenting to our unit over a 3-year period.…”

The role of transthoracic echocardiography in embolic acute limb ischaemia

“…Acute limb ischaemia (ALI) is a significant cause of morbidity and mortality in our increasingly elderly population, with hospital mortality rates ranging from 17 to 30% [1][2][3] and amputation rates of 5-16% in survivors [4,5]. The cause of ALI is peripheral embolism in approximately 40% of cases, with the heart being the commonest embolic source [6].…”

Upper Limb Ischemia: 20 Years Experience from a Single Center

“…In contrast, lower limb revascularization is a common procedure, with large numbers of published series of outcome following acute and chronic ischemia. [23][24][25][26][27][28] The purpose of this study was to review a single center's experience of acute and chronic upper limb revascularization over a 20-year period. The outcome of surgical and endovascular intervention is presented and compared with published series of upper and lower limb revascularization.…”