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Meta-Analysis
. 2014 May 7;2014(5):CD001999.
doi: 10.1002/14651858.CD001999.pub2.

Anticoagulants (heparin, low molecular weight heparin and oral anticoagulants) for intermittent claudication

Benilde Cosmi  1 , Eleonora Conti, Sergio Coccheri
Affiliations
Meta-Analysis

Anticoagulants (heparin, low molecular weight heparin and oral anticoagulants) for intermittent claudication

Benilde Cosmi et al. Cochrane Database Syst Rev. .

Abstract

Background: Anticoagulant treatment for intermittent claudication might improve functional capacity and prevent acute cardiovascular complications caused by peripheral obstructive arterial disease. This is an update of the review first published in 2001.

Objectives: To assess the effects of anticoagulant drugs (heparin, low molecular weight heparin (LMWH) and oral anticoagulants) in patients with intermittent claudication (Fontaine stage II) in terms of improving walking capacity (pain-free walking distance or absolute walking distance), mortality, cardiovascular events, ankle/brachial pressure index, progression to surgery, amputation-free survival and side effects of these drugs.

Search methods: For this update the Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched May 2013) and CENTRAL (2013, Issue 4).

Selection criteria: All randomised trials of anticoagulants used to treat patients with intermittent claudication.

Data collection and analysis: Seven studies were included. Only three studies (two evaluating oral anticoagulants, one evaluating heparin) met the high quality methodological inclusion criteria and were included in the primary analysis. Four other studies were included in the sensitivity analysis. The authors extracted the data independently.

Main results: No new studies were included for this update. Seven studies with a combined total of 802 participants were included in this review. No significant difference was observed between heparin treatment and control groups for pain-free walking distance or maximum walking distance at the end of treatment. There were no data to indicate that LMWHs benefit walking distance. Revascularisation or amputation-free survival rates were reported in one study only with a five year follow-up. No study reported a significant effect on overall mortality or cardiovascular events and the pooled odds ratios were not significant for these outcomes either. Major and minor bleeding events were significantly more frequent in the group treated with oral anticoagulants compared to control, with a non-significant increase in fatal bleeding events. No major bleeding events were reported in the study evaluating heparin, while a non-significant increase in minor bleeding events was reported.

Authors' conclusions: The benefit of heparin, LMWHs and oral anticoagulants for treatment of intermittent claudication has not been established while an increased risk of major bleeding events has been observed, especially with oral anticoagulants. There is no clear evidence to support the use of anticoagulants for intermittent claudication at this stage.

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Conflict of interest statement

None known

Figures

1
1
Study flow diagram
1.1
1.1. Analysis
Comparison 1 Pain‐free walking distance, Outcome 1 Pain‐free walking distance in all studies.
2.1
2.1. Analysis
Comparison 2 Maximum walking distance, Outcome 1 Maximum walking distance in all studies.
3.1
3.1. Analysis
Comparison 3 Ankle/brachial pressure index (ABI), Outcome 1 ABI at rest: sintrom versus pentoxifylline.
3.2
3.2. Analysis
Comparison 3 Ankle/brachial pressure index (ABI), Outcome 2 ABI after effort: sintrom versus placebo.
3.3
3.3. Analysis
Comparison 3 Ankle/brachial pressure index (ABI), Outcome 3 ABI at rest: sintrom versus placebo.
3.4
3.4. Analysis
Comparison 3 Ankle/brachial pressure index (ABI), Outcome 4 ABI after effort: sintrom versus pentoxifylline.
4.1
4.1. Analysis
Comparison 4 Revascularisation and amputation‐free survival, Outcome 1 Disease progression at five years (peripheral disease).
5.1
5.1. Analysis
Comparison 5 Cardiovascular events (TIA, stroke, UA, AMI), Outcome 1 Cardiovascular events.
5.2
5.2. Analysis
Comparison 5 Cardiovascular events (TIA, stroke, UA, AMI), Outcome 2 Progression of vascular disease (events at five years).
6.1
6.1. Analysis
Comparison 6 Overall mortality, Outcome 1 Overall mortality.
7.1
7.1. Analysis
Comparison 7 Major bleeding events, Outcome 1 Major bleeding events in all studies.
7.2
7.2. Analysis
Comparison 7 Major bleeding events, Outcome 2 Major bleeding events (oral anticoagulants).
8.1
8.1. Analysis
Comparison 8 Minor bleeding events, Outcome 1 Minor bleeding events in all studies.
8.2
8.2. Analysis
Comparison 8 Minor bleeding events, Outcome 2 Minor bleeding events (oral anticoagulants).
8.3
8.3. Analysis
Comparison 8 Minor bleeding events, Outcome 3 Minor bleeding events (standard heparin).
9.1
9.1. Analysis
Comparison 9 Fatal bleeding events, Outcome 1 Fatal bleeding events in all studies.
9.2
9.2. Analysis
Comparison 9 Fatal bleeding events, Outcome 2 Fatal bleeding events (oral anticoagulants).
See this image and copyright information in PMC

Update of

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References to other published versions of this review

Cosmi 2001
    1. Cosmi B, Conti E, Coccheri S. Anticoagulants (heparin, low molecular weight heparin and oral anticoagulants) for intermittent claudication. Cochrane Database of Systematic Reviews 2001, Issue 2. [DOI: 10.1002/14651858.CD001999] - DOI - PubMed

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