Impact of long-term warfarin treatment on EVAR durability: a meta-analysis.

Abstract

PURPOSE:

To evaluate whether postoperative long-term oral anticoagulation affects the durability of endovascular aneurysm repair (EVAR) and whether it is associated with an increased incidence of endoleak and subsequent need for reintervention.

METHODS:

A literature search was performed to identify studies of abdominal aortic aneurysm patients undergoing EVAR including an arm receiving warfarin postoperatively and reporting the frequency of any endoleaks and/or persistent type II endoleaks and reinterventions. The search identified 81 articles, of which 5 observational cohort studies ultimately met the inclusion criteria.

RESULTS:

Postoperative anticoagulation was required in 219 (14.6%) of the 1499 patients in the selected studies. The pooled effects analysis found that EVAR patients receiving long-term warfarin postoperatively had significantly more endoleaks of any type (OR 1.77, 95% CI 1.26 to 2.48, p=0.001) as well as persistent type II endoleaks (OR 1.58, 95% CI 1.05 to 2.37, p=0.03) compared with patients not on anticoagulation; however, there was no statistically significant difference in the reintervention rate between the groups.

CONCLUSION:

Long-term anticoagulation in EVAR patients was associated with a statistically significant increase in any endoleak and persisting type II endoleaks, although it was not linked to an increased risk of reintervention. Close monitoring for EVAR patients who require long-term oral anticoagulation is advised.

• Authors: Miltos K Lazarides, George S Georgiadis, Dimitrios G Charalampidis, George A Antoniou, Efstratios I Georgakarakos, George Trellopoulos
• Journal: Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists (J Endovasc Ther) Vol. 21 Issue 1 Pg. 148-53 (Feb 2014) ISSN: 1545-1550 [Electronic] United States
• PMID: 24502496 (Publication Type: Journal Article, Meta-Analysis, Review)

Chemical References

• Anticoagulants
• Warfarin

Topics

• Administration, Oral
• Anticoagulants (administration & dosage, adverse effects)
• Aortic Aneurysm, Abdominal (diagnosis, surgery)
• Blood Vessel Prosthesis Implantation (adverse effects)
• Chi-Square Distribution
• Endoleak (diagnosis, etiology, therapy)
• Endovascular Procedures (adverse effects)
• Humans
• Odds Ratio
• Retreatment
• Risk Assessment
• Risk Factors
• Time Factors
• Treatment Outcome
• Warfarin (administration & dosage, adverse effects)