Antiplatelet agents for preventing thrombosis after peripheral arterial bypass surgery
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6. Flumignan CDQ, Amaral FCF, Flumignan RLG, et al. Angioplasty and stenting for below the knee ulcers in diabetic patients: protocol for a systematic review. Syst Rev. 2018;7(1):228. PMID: 30537989; https://doi.org/10.1186/s13643-018-0897-0. https://doi.org/10.1186/s13643-018-0897-...
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ASA 400-990 mg/d or ASA 400-900 mg/d plus DIP 150-450 mg/d versus placebo or nothing |
Benefits with ASA or ASA plus DIP Primary patency in venous bypass at 12 months Primary patency in prosthetic bypass at 1, 3, 6, 9 and 12 months |
No difference among intervention groups Gastrointestinal side effects; major bleeding; minor bleeding; wound or graft infection; limb amputation; cardiovascular events; mortality; primary patency in venous bypass at 1, 3, 6 and 24 months |
Higher risk with ASA or ASA plus DIP General side effects |
ASA or ASA 1050 mg/d plus DIP 150 mg/d versus pentoxifylline 1200 mg/d; venous or prosthetic bypasses |
Benefit with pentoxifylline Less gastric intolerance |
No difference among intervention groups Primary patency at 1, 3, 6 and 12 months; gastric bleeding; dizziness; limb amputation; mortality |
ASA 900 mg/d plus DIP 250 mg/d versus indobufen 400 mg/d; venous or prosthetic bypasses |
No difference among intervention groups Primary patency at 1, 3, 6, 9 and 12 months |
ASA 1000 mg or ASA 1000 mg plus DIP 225 mg/d versus VKA; venous or prosthetic bypasses |
No difference among intervention groups Graft primary patency at 3, 6, 12 and 24 months; limb amputation; cardiovascular events; mortality |
ASA 900 mg/d plus DIP 300 mg/d versus LMWH 2500 IU/d; venous or prosthetic bypasses |
Benefits with ASA plus DIP mortality |
No difference among intervention groups Graft primary patency at 6 and 12 months |
Ticlopidine 500 mg/d versus placebo; venous bypass |
Benefits with ticlopidine Graft primary patency at 6, 12 and 24 months |
No difference among intervention groups Graft primary patency at 1 month |
ASA 1500 mg/d versus prostaglandins (PGE1) 0.2 ng/kg/min; vein bypass |
No difference among intervention groups Early occlusion |
Clopidogrel 75 mg/d plus ASA 75-100 mg/d versus ASA 75-100 mg/d |
Benefits with clopidogrel plus ASA Primary patency in prosthetic bypasses at 24 months; amputation in prosthetic bypasses |
No difference among intervention groups Amputation of venous bypasses; mortality for venous or prosthetic bypasses; primary patency in venous bypasses at 24 months; minor, mild or major bleeding for prosthetic bypasses; major bleeding for venous bypasses |
Higher risk with clopidogrel plus ASA Minor or mild bleeding for venous bypasses |
Antithrombotic agents for preventing thrombosis after infrainguinal arterial bypass surgery
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7. Varga-Szabo D, Pleines I, Nieswandt B. Cell adhesion mechanisms in platelets. Arterioscler Thromb Vasc Biol. 2008;28(3):403-12. PMID: 18174460; https://doi.org/10.1161/ATVBAHA.107.150474. https://doi.org/10.1161/ATVBAHA.107.1504...
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VKA versus placebo |
Benefits with VKA Occlusion in venous bypasses at 6 months; occlusion in prosthetic bypasses at 5 years; limb loss in venous bypasses at 5 years; limb salvage for venous bypasses at 6 months; limb loss for venous or prosthetic bypasses at 3, 6 and 24 months and 5 years; mortality for venous or prosthetic bypasses at 12 months |
No difference among intervention groups Occlusion in venous bypasses at 3, 12 and 24 months and 5 years; occlusion in prosthetic bypasses at 3, 6, 12 and 24 months; limb loss in venous or prosthetic bypasses at 3, 6, 12, 24 months and 5 years for prosthetic; mortality in venous or prosthetic bypasses at 3, 6, 12 and 24 months and 5 years |
VKA versus ASA 80 mg/d or ASA 1000 mg/d plus DIP 225 mg/d |
Benefits with VKA Occlusion in venous bypasses at 3, 6, 12 and 24 months |
Benefits with ASA plus DIP Occlusion in prosthetic bypasses at 6, 12 and 24 months |
No difference among intervention groups Occlusion in prosthetic bypasses at 3 months |
LMWH (enoxaparin) 40 mg versus UFH 5000 IU (intraoperative) |
Benefits with LMWH Occlusion in venous or prosthetic bypasses at 10 and 30 days |
No difference among intervention groups Occlusion in venous or prosthetic bypasses at 24 hours |
LMWH (dalteparin) 2500 IU versus ASA 900 mg/d plus DIP 300 mg/d |
Benefits with LMWH Occlusion in venous or prosthetic bypasses at 6 and 12 months |
LMWH (dalteparin) 5000 IU versus placebo |
No difference among intervention groups Occlusion in venous or prosthetic bypasses at 1, 3 and 12 months |
UFH 5000 IU versus antithrombin 1500 IU |
Benefits with UFH Intraoperative occlusion of venous or prosthetic bypasses. |
No difference among intervention groups Occlusion in venous or prosthetic bypasses at 1 month |
LMWH (enoxaparin) 40 mg/d versus dextran 2500 ml plus heparin 5000 IU |
No difference among intervention groups Early occlusion in venous or prosthetic bypasses |
Antiplatelet and anticoagulant drugs for prevention of restenosis/reocclusion after peripheral endovascular treatment
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8. Bedenis R, Lethaby A, Maxwell H, Acosta S, Prins MH. Antiplatelet agents for preventing thrombosis after peripheral arterial bypass surgery. Cochrane Database Syst Rev. 2015;2015(2):CD000535. PMID: 25695213; https://doi.org/10.1002/14651858.CD000535.pub3. https://doi.org/10.1002/14651858.CD00053...
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ASA 50-330 mg/d plus DIP 75-400 mg/d versus placebo |
Benefits with ASA (330 mg)/DIP Occlusion/restenosis at 6 months |
No difference found among interventions Occlusion/ restenosis at 1, 3 and 6 months (other doses) and 12 months; amputation, mortality and bleeding at the puncture site at 1 month |
Higher risk with ASA (1000 mg/d) plus DIP Gastrointestinal side effects at 12 and 24 months |
ASA 150-990 mg/d plus DIP 225-400 mg/d versus VKA |
No difference found Occlusion/restenosis at 1, 3, 6, 12, 24 and 36 months |
Clopidogrel 75 mg/d plus ASA 100 mg/d versus LMWH (dalteparin) 5000 IU followed by warfarin |
No difference found Occlusion/restenosis at 24 hours and 1, 6, 12 and 18 months |
Higher risk with LMWH followed by warfarin Major bleeding |
Ticlopidine 1000 mg/d versus VKA |
No difference found Occlusion/restenosis at 12 months |
Higher risk with ticlopidine Gastrointestinal side effects |
Cilostazol 200 mg/d plus ASA 100 mg/d versus ticlopidine 200 mg/d plus ASA 100 mg/d |
Benefits with cilostazol plus ASA Occlusion/restenosis at 36 months. |
No difference found Occlusion/restenosis at 12 and 24 months; amputation, mortality and side effects at 36 months |
LMWH (therapeutic nadroparin) plus ASA 200 mg/d versus UFH (heparinization followed by ASA) |
Benefits with LMWH versus UFH Occlusion/restenosis at 3 weeks and 3 and 6 months (femoropopliteal arteries); occlusion/restenosis at 12 months for patients with critical ischemia |
No difference found among interventions Occlusion/restenosis at 3 weeks and 3 and 6 months (arteries of the pelvis); pseudoaneurysm hematoma and amputation |
LMWH (dalteparin) 2500 IU/d plus ASA 100 mg/d versus ASA 100 mg/d |
Benefit with LMWH plus ASA Occlusion/restenosis at 12 months for critical ischemia |
No difference found among interventions Occlusion/restenosis at 12 months for intermittent claudication |