Arterial thromboembolectomy--should anticoagulants be administered?

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.