Jivegård L, Holm J, Scherstén T
Acta Chir Scand. 1986 Aug-Sep;152:493-7.
Perioperative administration of heparin with subsequent coumarin therapy is often recommended in surgery for acute limb ischemia. This retrospective study compares the results of arterial thromboembolectomy with and without concomitant use of anticoagulants. Good results were more common in adequately anticoagulated patients, but the hospital death rate did not differ. Further analysis, however, showed that the better results in the anticoagulated patient group could have been influenced by selection factors. The cumulative recurrence rate of thromboembolism was not significantly reduced in patients on long-term anticoagulation treatment. A review of 15 recently published series of acute limb ischemia showed similar results from centers in which anticoagulants were administered after arterial thromboembolectomy and in centers where postoperative anticoagulant therapy was not used. Definite evidence of a beneficial effect of anticoagulants given before and after arterial thromboembolectomy thus is concluded to be lacking, and a prospective randomized trial is required.
对于急性肢体缺血的手术，通常建议围手术期给予肝素并随后进行香豆素治疗。这项回顾性研究比较了在动脉血栓切除术时使用和不使用抗凝剂的结果。在抗凝充分的患者中，良好结果更为常见，但医院死亡率并无差异。然而，进一步分析表明，抗凝患者组较好的结果可能受到选择因素的影响。长期抗凝治疗患者的血栓栓塞累积复发率并未显著降低。对最近发表的15个急性肢体缺血系列研究的综述显示，在动脉血栓切除术后使用抗凝剂的中心和未使用术后抗凝治疗的中心得到了类似的结果。因此得出结论，缺乏动脉血栓切除术前和术后给予抗凝剂有益效果的确切证据，需要进行前瞻性随机试验。
