Dual-pathway inhibition in patients with chronic limb-threatening ischemia requiring reintervention for infrapopliteal occlusions

IF 1.4 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart and Vessels Pub Date : 2024-04-22 DOI:10.1007/s00380-024-02406-5

Burak Teymen, Mehmet Emin Öner, Yiğit Erdağ

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Abstract

Our study aimed to assess the influence of incorporating new oral anticoagulant (NOAC) therapy on clinical outcomes among patients who underwent endovascular intervention for below-the-knee (BTK) occlusions necessitating reintervention. The inclusion criteria encompassed patients with chronic limb-threatening ischemia (CLTI) and had undergone a successful endovascular intervention for BTK artery occlusion, necessitating reintervention. Patients who underwent endovascular interventions for BTK reocclusion were compared to those who received dual-pathway inhibition with NOAC (rivaroxaban 2.5 mg 2 × 1) and clopidogrel (NOAC group), or dual-antiplatelet therapy with clopidogrel and aspirin (DAPT group). The primary endpoints were target vessel reocclusion and target lesion revascularization (TLR) at the 1-year follow-up, while major and minor amputations served as the secondary endpoint. Additionally, a one-year comparison was conducted between the two groups for major bleeding events. 64 patients in our clinic treated with endovascular reintervention (NOAC = 28, DAPT = 34). The TLR rate is 10.7% in NOAC group (N = 3) and 32.4% in DAPT group (N = 11, p = 0.043). The target vessel reocclusion rate is 17.8% in NOAC group (N = 5) and 41.2% in DAPT group (N = 14, p = 0.048). Minor or major amputation rate at 1-year follow-up was 3.6% in NOAC group (N = 1) and 11.7% in DAPT group (N = 4, p = 0.245). The patency rate is significantly higher, and the TLR rate is significantly lower in the NOAC group compared to the DAPT group, with no significant difference in major bleeding between the two groups. Although no statistically significant difference exists in amputation rates, a numerical distinction is evident.

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双途径抑制治疗因腘下动脉闭塞而需要再次干预的慢性肢体缺血患者

我们的研究旨在评估新口服抗凝剂（NOAC）疗法对接受血管内介入治疗的膝下动脉（BTK）闭塞患者临床预后的影响。纳入标准包括慢性肢体危重缺血（CLTI）患者，以及因BTK动脉闭塞而成功接受血管内介入治疗并需要再次介入治疗的患者。接受血管内介入治疗 BTK 再闭塞的患者与接受 NOAC（利伐沙班 2.5 毫克 2 × 1）和氯吡格雷双通道抑制疗法（NOAC 组）或氯吡格雷和阿司匹林双抗血小板疗法（DAPT 组）的患者进行了比较。主要终点是随访一年时靶血管再闭塞和靶病变血管再通（TLR），次要终点是大截肢和小截肢。此外，还对两组患者一年的大出血事件进行了比较。我们诊所有 64 名患者接受了血管内再介入治疗（NOAC = 28 例，DAPT = 34 例）。NOAC 组的 TLR 率为 10.7%（3 例），DAPT 组为 32.4%（11 例，P = 0.043）。NOAC组靶血管再闭塞率为17.8%（5人），DAPT组为41.2%（14人），P=0.048。随访1年时的轻度或重度截肢率，NOAC组为3.6%（1人），DAPT组为11.7%（4人），P=0.245。与 DAPT 组相比，NOAC 组的通畅率明显更高，TLR 率明显更低，两组在大出血方面无明显差异。虽然在截肢率方面没有统计学意义上的显著差异，但数字上的区别是显而易见的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Heart and Vessels 医学-外周血管病

CiteScore

3.10

自引率

13.30%

发文量

211

审稿时长

2 months

期刊介绍： Heart and Vessels is an English-language journal that provides a forum of original ideas, excellent methods, and fascinating techniques on cardiovascular disease fields. All papers submitted for publication are evaluated only with regard to scientific quality and relevance to the heart and vessels. Contributions from those engaged in practical medicine, as well as from those involved in basic research, are welcomed.