Kaplovitch Eric, Collins Andrew, McClure Graham, Tse Ryan, Bhagirath Vinai, Chan Noel, Szalay David, Harlock John, Anand Sonia S
Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada.
Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
CJC Open. 2021 Jun 17;3(11):1325-1332. doi: 10.1016/j.cjco.2021.06.006. eCollection 2021 Nov.
Following severe limb ischemia requiring urgent/emergent revascularization, peripheral arterial disease patients suffer a high risk of recurrent atherothrombosis.
Patients discharged from Hamilton General Hospital (Hamilton, Ontario) between April 2016 and September 2017 following severe limb ischemia requiring urgent/emergent revascularization were identified via the Local Health Integration Network CorHealth database, with supplemental information from chart review.
A total of 158 patients admitted for urgent/emergent revascularization were identified (148 alive at discharge). Among patients without a pre-existing indication for anticoagulation, 38.8% ( = 47) were discharged on single-antiplatelet therapy, 27.3% ( = 33) on dual-antiplatelet therapy, 19.8% ( = 24) on anticoagulants plus antiplatelet therapy, 6.6% ( = 8) on anticoagulants alone, and 2.6% ( = 3) on unknown therapy. Patients who received angioplasty with stenting were more likely be discharged on dual-antiplatelet therapy (hazard ratio [HR]: 7.14; 95% confidence interval [CI]: 2.87-17.76; < 0.01); patients who received an embolectomy/thrombectomy were more likely be discharged on an anticoagulant alone (HR: 2.61; 95% CI: 1.00-6.81; = 0.049); and patients who received peripheral bypass grafting were more likely be discharged on single-antiplatelet therapy (HR: 2.28; 95% CI: 1.11-4.69; = 0.024). Neither statins (60.8% vs 56.3%; = 0.23) nor renin-angiotensin-aldosterone system inhibitors (48.7% vs 50.6%; = 0.58) were prescribed at higher rates at discharge, compared with the rate at admission.
Substantial heterogeneity exists in antithrombotic prescription following urgent/emergent revascularization. No intensification of non-antithrombotic vascular protective medications occurred during hospitalization. Clinical trials and health system interventions to optimize medical therapy in peripheral arterial disease patients are urgently needed.
在严重肢体缺血需要紧急血管重建术后，外周动脉疾病患者发生复发性动脉粥样硬化血栓形成的风险很高。
通过当地卫生整合网络CorHealth数据库识别2016年4月至2017年9月间因严重肢体缺血需要紧急血管重建术后从汉密尔顿综合医院（安大略省汉密尔顿）出院的患者，并通过病历审查获取补充信息。
共识别出158例因紧急血管重建术入院的患者（出院时148例存活）。在无预先存在的抗凝指征的患者中，38.8%（n = 47）出院时接受单药抗血小板治疗，27.3%（n = 33）接受双联抗血小板治疗，19.8%（n = 24）接受抗凝剂加抗血小板治疗，6.6%（n = 8）仅接受抗凝剂治疗，2.6%（n = 3）接受未知治疗。接受血管成形术加支架置入的患者更有可能出院时接受双联抗血小板治疗（风险比[HR]：7.14；95%置信区间[CI]：2.87 - 17.76；P < 0.01）；接受栓子切除术/血栓切除术的患者更有可能出院时仅接受抗凝剂治疗（HR：2.61；95%CI：1.00 - 6.81；P = 0.049）；接受外周旁路移植术的患者更有可能出院时接受单药抗血小板治疗（HR：2.28；95%CI：1.11 - 4.69；P = 0.024）。与入院时相比，出院时他汀类药物（60.8%对56.3%；P = 0.23）和肾素 - 血管紧张素 - 醛固酮系统抑制剂（48.7%对50.6%；P = 0.58）的处方率均未更高。
紧急血管重建术后抗血栓治疗的处方存在很大异质性。住院期间未出现非抗血栓血管保护药物的强化使用。迫切需要进行临床试验和卫生系统干预，以优化外周动脉疾病患者的药物治疗。
