Key result
The use of anticoagulants after elective endovascular aneurysm repair was associated with a significantly higher risk of prosthetic limb occlusion (HR 3.79) compared to single antiplatelet therapy.
Why the study?
The influence of antithrombotic therapy on the occurrence of thrombotic and bleeding complications after elective endovascular aneurysm repair was unknown.
Does the use of anticoagulants or dual antiplatelet therapy compared to single antiplatelet therapy affect the incidence of MACE, prosthetic limb occlusion, and bleeding complications in patients after elective EVAR for AAA?
Cohort (n=616)
No
Does the use of anticoagulants or dual antiplatelet therapy compared to single antiplatelet therapy affect the incidence of MACE, prosthetic limb occlusion, and bleeding complications in patients after elective EVAR for AAA?
Hazard Ratio: 3.79 (95% CI 1.46–9.83)
Absolute Event Rate: 10.7% vs 5.8%
p-value: p=0.006
In patients undergoing elective EVAR, the use of anticoagulants is associated with a significantly higher risk of prosthetic limb occlusion compared to single antiplatelet therapy, highlighting the need for careful risk-benefit assessment.
PURPOSE: To investigate the influence of antithrombotic therapy on occurrence of thrombotic and bleeding complications after endovascular aneurysm repair (EVAR). METHODS: In this retrospective single-center cohort study, patients who underwent elective endovascular aneurysm repair for abdominal aortic aneurysm were categorized into three antithrombotic groups: single antiplatelet therapy (SAPT), anticoagulants, or dual antiplatelet therapy (DAPT). Outcome measures were the incidence of major adverse cardiovascular events (MACE), prosthetic limb occlusions, and bleeding complications during follow-up. RESULTS: Among 616 patients (SAPT: n = 450, anticoagulants: n = 84, and DAPT: n = 82), Kaplan-Meier analysis showed no significant difference (log-rank p = 0.37) in incidence of MACE between patients receiving SAPT (20.9%), anticoagulants (25.0%), and DAPT (14.6%) during a median follow-up of almost 4 years. In multivariable Cox regression analysis, only age (HR = 1.03; 95% CI 1.01-1.06, p = 0.01) and American Society of Anesthesiologists (ASA) classification (HR = 1.46; 95% CI 1.12-1.91; p = 0.01) were significant predictors for MACE. Prosthetic limb occlusion was observed in 38 patients during a median follow-up of 4 years; incidence between patients receiving SAPT (5.8%), anticoagulants (10.7%), and DAPT (3.7%) was not significantly different (log-rank p = 0.08). Age (HR = 0.96; 95% CI 0.92-1.00; p = 0.03) and use of anticoagulants (HR = 3.79, 95% CI 1.46-9.83; p < 0.01) were significant predictors for prosthetic limb occlusion. Bleeding complications occurred in 73 patients during median follow-up of almost 4 years, without significant difference (log rank p = 0.06) in incidence between patients receiving SAPT (10.7%), anticoagulants (19.0%), and DAPT (11.0%). ASA classification (HR = 1.74; 95% CI 1.23-2.46; p < 0.01) was a significant predictor for bleeding complications. CONCLUSION: Use of anticoagulants after EVAR appears to be associated with a higher risk of prosthetic limb occlusion compared to the use of single or dual antiplatelet therapy.
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Kranendonk et al. (2025) conducted a cohort in Abdominal aortic aneurysm (n=616). Anticoagulants vs. Single antiplatelet therapy (SAPT) was evaluated on Prosthetic limb occlusion (HR 3.79, 95% CI 1.46-9.83, p=0.006). The use of anticoagulants after elective endovascular aneurysm repair was associated with a significantly higher risk of prosthetic limb occlusion (HR 3.79) compared to single antiplatelet therapy.
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