+ Resolve Article
+ Follow Us
Follow on FacebookFollow on Facebook
Follow on TwitterFollow on Twitter

+ Translate
+ Subscribe to Site Feed
GeoScience Most Shared ContentMost Shared Content

Antiplatelet and anticoagulant drugs for prevention of restenosis/reocclusion following peripheral endovascular treatment

, : Antiplatelet and anticoagulant drugs for prevention of restenosis/reocclusion following peripheral endovascular treatment. Cochrane Database of Systematic Reviews (): Cd002071-Cd002071

Peripheral arterial disease (PAD) is frequently treated by balloon angioplasty. Restenosis/reocclusion of the dilated segments occurs often, depending on length of occlusion, lower leg outflow, stage of disease and presence of cardiovascular risk factors. To prevent reocclusion, patients are treated with antithrombotic agents. This is an update of a review first published in 2005. To determine whether any antithrombotic drug is more effective in preventing restenosis or reocclusion after peripheral endovascular treatment, compared to another antithrombotic drug, no treatment, placebo or other vasoactive drugs. For this update the Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched 14 February 2012) and CENTRAL (2012, Issue 1). We selected randomised controlled trials (RCTs). Participants were patients with symptomatic PAD treated by endovascular revascularisation of the pelvic or femoropopliteal arteries. Interventions were anticoagulant, antiplatelet or other vasoactive drug therapy compared with no treatment, placebo or any other vasoactive drug. Clinical endpoints were reocclusion, restenosis, amputation, death, myocardial infarction, stroke, major bleeding and other side effects, such as minor bleeding, puncture site bleeding, gastrointestinal side effects and haematoma. We independently extracted and assessed details of the number of randomised patients, treatment, study design, patient characteristics and risk of bias. Analysis was based on intention-to-treat data. To examine the effects of outcomes such as reocclusion, restenosis, amputation and major bleeding, we computed odds ratios (OR) with 95% confidence intervals (CI) using a fixed-effect model. Twenty-two trials with a total of 3529 patients are included (14 in the original review and a further eight in this update). For the majority of comparisons, only one trial was available so results were rarely combined in meta-analyses. Individual trials were generally small and risk of bias was often unclear due to limitations in reporting. Three trials reported on drug versus placebo/control; results were consistently available for a maximum follow-up of only six months. At six months post intervention, a statistically significant reduction in reocclusion was found for high-dose acetylsalicylic acid (ASA) combined with dipyridamole (DIP) (OR 0.40, 95% CI 0.19 to 0.84), but not for low-dose ASA combined with DIP (OR 0.69, 95% CI 0.44 to 1.10; P = 0.12) nor in major amputations for lipo-ecraprost (OR 0.89, 95% CI 0.44 to 1.80). The remaining trials compared different drugs; results were more consistently available for a longer period of 12 months. At 12 months post intervention, no statistically significant difference in reocclusion/restenosis was detected for any of the following comparisons: high-dose ASA versus low-dose ASA (OR 0.98, 95% CI 0.64 to 1.48; P = 0.91), ASA/DIP versus vitamin K antagonists (VKA) (OR 0.65, 95% CI 0.40 to 1.06; P = 0.08), clopidogrel and aspirin versus low molecular weight heparin (LMWH) plus warfarin (OR 0.31, 95% CI 0.06 to 1.68; P = 0.18), suloctidil versus VKA: reocclusion (OR 0.59, 95% CI 0.20 to 1.76; P = 0.34), restenosis (OR 1.87, 95% CI 0.66 to 5.31; P = 0.24) and ticlopidine versus VKA (OR 0.71, 95% CI 0.37 to 1.36; P = 0.30). Treatment with cilostazol resulted in statistically significantly fewer reocclusions than ticlopidine (OR 0.32, 95% CI 0.13 to 0.76; P = 0.01). Compared with aspirin alone, LMWH plus aspirin significantly decreased occlusion/restenosis (by up to 85%) in patients with critical limb ischaemia (OR 0.15, 95% CI 0.06 to 0.42; P = 0.0003) but not in patients with intermittent claudication (OR 1.73, 95% CI 0.97 to 3.08; P = 0.06) and batroxobin plus aspirin reduced restenosis in diabetic patients (OR 0.28, 95% CI 0.13 to 0.60). Data on bleeding and other potential gastrointestinal side effects were not consistently reported, although there was some evidence that high-dose ASA increased gastrointestinal side effects compared with low-dose ASA, that clopidogrel and aspirin resulted in fewer major bleeding episodes compared with LMWH plus warfarin, and that abciximab resulted in more severe bleeding episodes. There is limited evidence suggesting that restenosis/reocclusion at six months following peripheral endovascular treatment is reduced by use of antiplatelet drugs compared with placebo/control, but associated information on bleeding and gastrointestinal side effects is lacking. There is also some evidence of variation in effect according to different drugs with cilostazol reducing reocclusion/restenosis at 12 months compared with ticlopidine and both LMWH and batroxobin combined with aspirin appearing beneficial compared with aspirin alone. However, available trials are generally small and of variable quality and side effects of drugs are not consistently addressed. Further good quality, large-scale RCTs, stratified by severity o f disease, are required.


PMID: 22895926

DOI: 10.1002/14651858.CD002071.pub3

Other references

Wang, W-Bei.; Levy, D.E.; Lee, C-Kuo., 2011: STAT3 negatively regulates type I IFN-mediated antiviral response. Type I IFNs are crucial cytokines of innate immunity for combating viral infections. Signaling through type I IFN receptors triggers the activation of STAT proteins, including STAT1, STAT2, and STAT3. Although an essential role of STAT1 and STAT2...

Jiang; Wang; Fung; Kuo, 1991: Direct observation of domains and discommensurations in Mn-Si-Al octagonal quasicrystal by transmission electron microscopy. Physical Review Letters 67(10): 1302-1305

Saigal, S.; Rosenbaum, P.; Stoskopf, B.; Hoult, L.; Furlong, W.; Feeny, D.; Hagan, R., 2005: Development, reliability and validity of a new measure of overall health for pre-school children. Few comprehensive systems are available for assessing and reporting the overall health of preschool children. (i) To develop a multi-dimension health status classification system (HSCS) to describe pre-school (PS) children 2.5-5 years of age; (ii)...

Anonymous, 1973: Malpractice through selling professional drug samples and hospital packages. Medizinische Monatsschrift 27(9): 429-430

Brigham, R.D., 1968: Inheritance of the rough petiole character in dwarf-internode castor, Ricinus communis L. Breeding lines having rough petioles with small spiny protuberances were crossed with smooth-petioled parents. The F1 plants were mainly intermediate in the degree of roughness. Results from further crosses indicated that a single factor is respon...

Zeitlhofer, J.; Steiner, M.; Zadrobilek, E.; Häusl, E.; Sporn, P.; Asenbaum, S.; Oder, W.; Baumgartner, C.; Deecke, L., 1989: Evoked potentials in the follow-up and prognosis of patients with craniocerebral trauma. The aims of this study were to find a reliable way of establishing the prognosis for the final outcome in the first week after head injury, to show the correlation between abnormalities in evoked potentials (EP) and clinical coma score, and finall...

Hansson H A.; Norstrom E., 1991: Afgf egf and their receptors in the normal and in the healing rat gastric mucosa. Digestion 49(SUPPL 1): 17-18

Gridelli, B.; Perico, N.; Remuzzi, G., 2001: Strategies for a greater supply of organs for transplantation. The number of recipients waiting for a solid organ transplantation has increased greatly in the past 5 years. The supply of donor organs during this period has not kept pace, resulting in a large shortage of suitable organs. In an effort to overco...

Anonymous, 1990: Brown v. British Columbia (Minister of Health). In June 1987, British Columbia's Minister of Health put AZT into the provincial Pharmacare Plan. AIDS patients receiving AZT were required to pay part of the drug's cost, not to exceed $2000 annually. British Columbia provides full fundi...

Patrick, C.W.; Friedrich, J.; Miller, M.J., 1998: Computer-assisted histometric analysis of tissue-engineered ovine bone. OBJECTIVE: To develop a computer-assisted histometric technique that quantitatively determines the amount of regenerating bone, while excluding fibrovascular tissue and void spaces, in tissue-engineered bone constructs. To this end, a histometric...