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. 2023 May;77(5):1453-1461.
doi: 10.1016/j.jvs.2022.12.012. Epub 2022 Dec 20.

Use of direct-acting oral anticoagulants associated with improved survival and bypass graft patency compared with warfarin after infrageniculate bypass

David P Ebertz  1 , Saideep Bose  2 , Justin A Smith  1 , Anuja L Sarode  3 , Ravi N Ambani  1 , Jae S Cho  1 , Norman H Kumins  1 , Vikram S Kashyap  4 , Benjamin D Colvard  5
Affiliations
Free article

Use of direct-acting oral anticoagulants associated with improved survival and bypass graft patency compared with warfarin after infrageniculate bypass

David P Ebertz et al. J Vasc Surg. 2023 May.
Free article

Erratum in

  • Correction.
    [No authors listed] [No authors listed] J Vasc Surg. 2023 Aug;78(2):563. doi: 10.1016/j.jvs.2023.05.028. J Vasc Surg. 2023. PMID: 37481284 No abstract available.

Abstract

Objective: No consensus has yet been reached regarding the optimal antiplatelet and anticoagulant regimen for patients after lower extremity bypass. Usually, patients who have undergone below-the-knee bypass will begin oral anticoagulation therapy. Historically, the bypass has been with prosthetic conduits and the anticoagulation therapy has been warfarin. However, the use of direct-acting oral anticoagulants (DOACs) has been increasing owing to their relative ease of dosing. The goal of the present study was to evaluate whether a difference exists in the postoperative outcomes for patients who have undergone infrageniculate bypass stratified by the use of on DOACs vs warfarin.

Methods: The Vascular Quality Initiative infrainguinal bypass database was queried for all patients who had undergone infrageniculate bypass, been anticoagulation naive at baseline, and been discharged with anticoagulation therapy. A survival analysis was performed for patients for ≤2 years postoperatively to determine whether discharge with warfarin vs DOACs was associated with differences in overall mortality, loss of primary patency, risk of amputation, and risk of major adverse limb events (MALE). A multivariable Cox proportional hazards analysis was performed to control for differences in the baseline demographic factors between the two groups.

Results: During the study period (2007-2020) 57,887 patients had undergone infrageniculate bypass. Of these patients, 2786 had been anticoagulation naive and discharged with either warfarin (n = 1889) or DOACs (n = 897). Discharge with a DOAC was associated with a lower risk of overall mortality (hazard ratio [HR], 0.62; 95% confidence interval [CI], 0.47-0.83; P = .001), loss of primary patency (HR, 0.74; 95% CI, 0.62-0.87; P < .001), risk of amputation (HR, 0.70; 95% CI, 0.57-0.86; P = .001), and risk of MALE (HR, 0.83; 95% CI, 0.71-0.97; P = .017).

Conclusions: Anticoagulation-naive patients who had undergone infrageniculate bypass had had higher rates of overall survival, bypass patency, amputation-free survival, and freedom from MALE when discharged with a DOAC than with warfarin.

Keywords: Anticoagulation; Direct-acting oral anticoagulant; Lower extremity; Peripheral arterial disease; Warfarin.

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