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Short Communication - (2016) Volume 4, Issue 6
Effects of Unfractionated Heparin or Low-Molecular-Weight Heparin for Preventing Thrombosis after Infrainguinal Arterial Bypass Procedures
*Corresponding Author: Emile Calenda, Department of Anesthesiology, Rouen University Hospital Institute for Biomedical Research, 76031 Rouen Cedex, France, Tel: 0033232888057, Fax: 0033232888046 Email:
Abstract
Unfractionated heparin or low-molecular-weight heparin for preventing thrombosis after infrainguinal arterial bypass procedures are commonly used without validation. We decided to assess both attitudes with the help of a retrospective study. We reported a non-inferiority between low-molecular-weight heparin and unfractionated heparin. It is possible to use unfractionated heparin in case of renal failure and a low molecular weight heparin when the clearance is normal because both therapies are equivalent.
Keywords: Unfractionated heparin; Low-molecular-weight heparin; Infrainguinal arterial bypass procedures
Introduction
Patients affected from chronic peripheral arterial disease frequently profit from venous or artificial graft implantation in infrainguinal position. Antithrombotic agents for preventing thrombosis are commonly used in patients receiving an artificial graft and antivitamin K antagonists in patients scheduled for venous bypass [1]. An update from the same team in 2011 concluded that controlled trials with a large number of patients were missing to determine a true decision with Antithrombotic therapies [2]. A recent survey showed multiple variations for perioperative arterial thrombosis prophylaxis amongst Dutch vascular surgeons [3].
Material and Methods
The strength of information and the existence of two protocols in our institution led us to conduct a retrospective comparative study between both groups of patients. The aim of that comparison was to statistically prove an equivalence between unfractionated heparin and low-molecular-weight heparin. We selected patients undergoing major surgery scheduled for a sub-inguinal bypass (venous or artificial) without aortic surgery associated. Patients with a renal clearance under 30 ml/min were excluded. Acetyl salicylic acid was prescribed or maintained in all patients The study population included 66 patients distributed such as 35 patients in the low-molecular-weight heparin group and 31 in the unfractionated heparin group. The main judgment criterion was the appearance of an early thrombosis. The constitution of an hemorrhage was the second criterion. The above criteria were noticed during the postoperative follow up of 7 days. The Fisher exact test was employed to compare both groups.
Results
Groups were comparable in terms of age, sex, weight, cardiovascular risk factors and history. Results were displayed in Table 1. We reported non-inferiority between low-molecular-weight heparin and unfractionated heparin for preventing thrombosis of infrainguinal bypass without increasing bleeding complications. The incidence of early thrombosis in infrainguinal vascular bypass surgery was reported at 4.5% [4].
| Unfractionated heparin (n=31) | low-molecular-weight heparin (n=35) | p | |
|---|---|---|---|
| Bypass thrombosis J7 | 2 (6.4%) | 3 (8.5%) | 1 (NS) |
| Hemorrhage complications J7 | 2 (6.4%) | 4 (11.4%) | 0,67 (NS) |
Table 1: Unfractionated heparin versus low-molecular-weight heparin.
Discussion
Our results were different but it was not possible to show significance.
It is possible to use unfractionated heparin in case of renal failure and a low molecular weight heparin when the clearance is normal because both therapies are equivalent.
References
- Dörffler-Melly J, Büller HR, Koopman MM, Prins MH (2003) Antithrombotic agents for preventing thrombosis after infrainguinal arterial bypass surgery. Cochrane Database Syst Rev.
- Geraghty AJ, Welch K (2011) Antithrombotic agents for preventing thrombosis after infrainguinal arterial bypass surgery. Cochrane Database Syst Rev.
- Wiersema A, Bruijninckx C, Reijnen M, Vos J, Van Delden O, et al. (2013) Perioperative prophylactic antithrombotic strategies in vascular surgery: current practice in the Netherlands. J Cardiovasc Surg.
- Lombardi JV, Dougherty MJ, Calligaro KD, Campbell FJ, Schindler N, et al. (2000) Predictors of outcome when reoperating for early infrainguinal bypass occlusion. Ann Vasc Surg 14: 350-355.
Copyright: © 2016 Calenda E, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
