Frias Francisca, Kalender Günay
Department of Vascular and Endovascular Surgery, Vivantes Hospital Neukoelln, 12351 Berlin, Germany.
Science & Research Department, Brandenburg Medical School Theodor Fontane, 16816 Neuruppin, Germany.
J Pers Med. 2025 Jul 7;15(7):292. doi: 10.3390/jpm15070292.
Peripheral artery disease (PAD) affects over 200 million individuals globally, leading to significant morbidity and mortality. For patients with complex lesions of the superficial femoral artery requiring revascularization, autologous vein bypass surgery remains a viable treatment option. Postoperative anticoagulation is critical for maintaining graft patency, but the optimal choice between direct oral anticoagulants (DOACs) and warfarin remains uncertain. : This study aims to evaluate the patency of below-the-knee autologous vein bypasses in PAD patients receiving either DOACs or warfarin over a two-year period. : A retrospective cohort study was conducted at a tertiary care hospital in Berlin, Germany, including patients who underwent femoropopliteal or femorocrural bypass surgery between 2017 and 2022. Patients were divided into two groups based on postoperative anticoagulation therapy: DOACs or warfarin. The primary outcome was graft patency at 24 months. : Out of 192 patients, after applying exclusion criteria, 36 were analyzed. The mean bypass patency was longer in the warfarin group (18.3 months) compared to the DOAC group (14.3 months). However, the log-rank test -value (0.524) suggests that this difference is not statistically significant. Given the log-rank test's limitations in accounting for confounders, a multivariable Cox regression was performed, including age, sex, comorbidities, bypass type and antiplatelet use. The model (Omnibus = 0.93) showed no statistically significant effect for any variable. : DOACs appear to be a viable alternative to warfarin in maintaining graft patency in below-the-knee autologous vein bypasses for PAD patients. The lack of a need for regular INR monitoring with DOACs may offer a practical advantage in clinical settings.
外周动脉疾病（PAD）在全球影响着超过2亿人，导致了严重的发病率和死亡率。对于需要进行血运重建的股浅动脉复杂病变患者，自体静脉搭桥手术仍然是一种可行的治疗选择。术后抗凝对于维持移植物通畅至关重要，但直接口服抗凝剂（DOACs）和华法林之间的最佳选择仍不确定。本研究旨在评估在两年时间内接受DOACs或华法林治疗的PAD患者膝下自体静脉搭桥的通畅情况。在德国柏林的一家三级医疗中心进行了一项回顾性队列研究，纳入了2017年至2022年间接受股腘或股胫搭桥手术的患者。根据术后抗凝治疗将患者分为两组：DOACs组或华法林组。主要结局是24个月时的移植物通畅情况。在192例患者中，应用排除标准后，对36例进行了分析。华法林组的平均搭桥通畅时间（18.3个月）比DOACs组（14.3个月）更长。然而，对数秩检验P值（0.524）表明这种差异无统计学意义。鉴于对数秩检验在考虑混杂因素方面的局限性，进行了多变量Cox回归分析，纳入了年龄、性别、合并症、搭桥类型和抗血小板药物使用情况。该模型（综合检验P = 0.93）显示任何变量均无统计学意义。对于PAD患者膝下自体静脉搭桥，DOACs似乎是华法林在维持移植物通畅方面的可行替代方案。DOACs无需定期监测国际标准化比值（INR），这在临床环境中可能具有实际优势。
