Janzen Mark L, Dombrovskiy Viktor Y, Galiñanes Edgar Luis, Vogel Todd R
Division of Vascular Surgery, University of Missouri, School of Medicine, Columbia, MO, USA.
Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
Vasc Endovascular Surg. 2014 Oct-Nov;48(7-8):509-15. doi: 10.1177/1538574414561233. Epub 2014 Dec 8.
To evaluate freedom from amputation in patients identified utilizing clopidogrel following their lower extremity endovascular revascularization (LER).
Patients, 65 years of age and older, undergoing LER were identified from Medicare Provider Analysis and Review and Carrier files utilizing International Classification of Diseases diagnosis and Current Procedural Terminology codes. Postprocedural use of clopidogrel was identified using the National Drug Code directory. Outcomes were evaluated.
A total of 14 353 patients were identified: 5697 (39.7%) with claudication, 1467 (10.2%) with rest pain, and 7189 (50.1%) with ulceration/tissue loss. In all, 5416 (37.7%) patients were identified using clopidogrel after LER. Overall, patients initiated on clopidogrel had lower amputation rates at 30 days (10.34% vs 14.09%; P < .0001), 90 days (14.05% vs 18.71%; P < .0001), and 1 year (19.68% vs 24.06%; P < .0001).
Utilization of clopidogrel after LER was associated with lower rates of amputation, yet only 38% of the Medicare population was identified as using clopidogrel. Patients with ulceration and tissue loss benefited the most with significantly greater freedom from amputation and overall survival.
评估在接受下肢血管腔内血管重建术（LER）后使用氯吡格雷的患者的无截肢情况。
利用国际疾病分类诊断代码和现行手术操作术语代码，从医疗保险提供者分析与审查以及承保文件中识别出年龄在65岁及以上且接受LER的患者。使用国家药品代码目录确定术后氯吡格雷的使用情况。对结果进行评估。
共识别出14353例患者：5697例（39.7%）有间歇性跛行，1467例（10.2%）有静息痛，7189例（50.1%）有溃疡/组织缺失。总共5416例（37.7%）患者在LER后使用氯吡格雷。总体而言，开始使用氯吡格雷的患者在30天时的截肢率较低（10.34%对14.09%；P <.0001），90天时（14.05%对18.71%；P <.0001），以及1年时（19.68%对24.06%；P <.0001）。
LER后使用氯吡格雷与较低的截肢率相关，但仅38%的医疗保险人群被确定为使用氯吡格雷。有溃疡和组织缺失的患者受益最大，无截肢和总体生存率显著提高。
