Edmondson R A, Cohen A T, Das S K, Wagner M B, Kakkar V V
Thrombosis Research Institute, London, UK.
Lancet. 1994 Oct 1;344(8927):914-8. doi: 10.1016/s0140-6736(94)92269-1.
Low-molecular weight heparin has theoretical advantages over aspirin and dipyridamole in maintaining vascular-graft patency by virtue of its better antithrombotic effect and antiproliferative activity on vascular, smooth-muscle cells. We tested the hypothesis that low-molecular weight heparin would be more effective than aspirin and dipyridamole in maintaining graft patency in patients undergoing femoropopliteal bypass grafting. Patients were randomised to receive either a daily injection of 2500 IU low-molecular weight heparin, or 300 mg aspirin with 100 mg dipyridamole 8 hourly for 3 months. 94 patients were randomised to low-molecular weight heparin and 106 to aspirin and dipyridamole. Patients were stratified according to indication for surgery and were followed up for 1 year. Kaplan-Meier estimate of graft patency showed 87% graft survival on low-molecular-weight heparin and 72% on aspirin and dipyridamole at 6 months. At 12 months, the respective figures were 78% and 64%. Stratified survival analysis showed that this benefit was confined to those having salvage surgery (log rank test p = 0.0006); for those having surgery for claudication there was no significant benefit. No major bleeding events occurred in either group. We conclude that low-molecular weight heparin is better than aspirin and dipyridamole in maintaining femoropopliteal-graft patency in patients with critical limb ischaemia undergoing salvage surgery. This treatment should have considerable cost benefits.
低分子量肝素在维持血管移植物通畅方面较阿司匹林和双嘧达莫具有理论优势，因为其抗血栓形成作用更强，对血管平滑肌细胞的抗增殖活性更高。我们检验了以下假设：在接受股腘动脉旁路移植术的患者中，低分子量肝素在维持移植物通畅方面比阿司匹林和双嘧达莫更有效。患者被随机分为两组，一组每天注射2500国际单位低分子量肝素，另一组每8小时服用300毫克阿司匹林和100毫克双嘧达莫，持续3个月。94名患者被随机分配接受低分子量肝素治疗，106名患者接受阿司匹林和双嘧达莫治疗。患者根据手术指征进行分层，并随访1年。Kaplan-Meier法评估的移植物通畅率显示，6个月时，接受低分子量肝素治疗的患者移植物存活率为87%，接受阿司匹林和双嘧达莫治疗的患者为72%。12个月时，相应的数据分别为78%和64%。分层生存分析表明，这种益处仅限于接受挽救性手术的患者（对数秩检验p = 0.0006）；对于因间歇性跛行而接受手术的患者，没有显著益处。两组均未发生重大出血事件。我们得出结论，在接受挽救性手术的严重肢体缺血患者中，低分子量肝素在维持股腘动脉移植物通畅方面优于阿司匹林和双嘧达莫。这种治疗方法应具有可观的成本效益。
