在伤口和足部感染评分较低的患者中,抗血栓治疗的增加与肢体重大不良事件的减少有关。

IF 1 4区 医学 Q4 PERIPHERAL VASCULAR DISEASE
Vascular Pub Date : 2024-12-01 Epub Date: 2023-08-06 DOI:10.1177/17085381231193506
Chien Yi Maximilian Png, Jenna G Beardsley, Mitri K Khoury, Sujin Lee, Katherine L Morrow, Tiffany R Bellomo, Sunita D Srivastava, Anahita Dua
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引用次数: 0

摘要

导言:下肢搭桥术后患者的最佳抗血栓治疗方法尚未完全阐明,部分原因是患者的表现和实践模式存在显著差异。伤口、缺血和足部感染(WIfI)评分是一个经过验证的评分系统,用于协助管理慢性肢体缺血(CLTI)患者。我们假设,根据 WIFI 评分进行限制分析将有助于对接受腹股沟下搭桥术的患者进行术后抗血栓治疗:选取了 2018 年 1 月至 2021 年 1 月期间在一家医院系统完成的腹股沟下搭桥术的回顾性队列,并提取了每位患者的术前 WIfI 评分。排除了伤口评分为 2 分和 3 分,或缺血评分为 0 分和 1 分,或足部感染评分为 3 分的患者。根据出院时抗血栓治疗方案的类型、人口统计学特征、合并症、搭桥类型、30 天移植物闭塞率、主要截肢率、死亡率和主要肢体不良事件(MALE)进行分析。统计分析包括 t 检验、卡方检验和时间-事件生存分析。69例(30.0%)患者出院时接受了单一抗血小板疗法(SAPT),而161例(70.0%)患者出院时接受了双重抗血小板疗法或抗凝疗法(DAPT/AC)。DAPT/AC组使用人工导管搭桥的比例更高(45.9% vs 31.8%,p = .047);其他人口统计学或手术变量分析均无显著差异。术后 30 天,DAPT/AC 组的术后再介入率没有显著差异,但死亡率(1.2% vs 7.2%,p = .01)、大截肢率(1.2% vs 5.8%,p = .04)和男性死亡率(3.7% vs 13.0%,p < .01)显著低于 DAPT/AC 组。出血并发症方面没有明显差异。生存分析表明,与 SAPT 组相比,DAPT/AC 组的男性无病生存率更高(p < .01)。根据 Cox 回归分析,DAPT/AC 与 MALE + 死亡率显著降低相关(危险比 (HR) 0.20 [0.06 - 0.66]):结论:与使用 SAPT 出院的患者相比,伤口评分和足部感染评分较低的下肢搭桥术患者术后使用 DAPT/AC 出院,其 30 天无并发症生存率明显更高;可考虑优先让此类下肢搭桥术后患者使用 DAPT/AC。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Increased anti-thrombotic therapy is associated with decreased major adverse limb events in patients with low wound and foot infection scores.

Introduction: The optimal anti-thrombotic management of patients after lower extremity bypass has yet to be fully elucidated, in part due to significant heterogeneity in patient presentation and practice patterns. The Wound, Ischemia, and foot Infection (WIfI) score is a validated scoring system to assist in the management of patients with chronic limb threatening ischemia (CLTI). We hypothesized that performing a restriction analysis based on WIFI scores would assist in the postoperative anti-thrombotic management of patients undergoing infrainguinal bypass.

Methods: A retrospective cohort of infrainguinal bypass procedures completed at a single hospital system between January 2018 and January 2021 was selected, and preoperative WIfI scores were extracted for each patient. Patients with either Wound scores of 2 and 3, or Ischemia Scores of 0 and 1, or Foot Infection Scores of 3 were excluded. Based on the type of anti-thrombotic regimen on discharge, demographics, comorbidities, type of bypass, 30-day rates of graft occlusion, major amputation, mortality, and major adverse limb events (MALE) were analyzed. Statistical analysis included t-tests, chi square tests, and time-to-event survival analysis.

Results: 230 procedures were included in the study. 69 (30.0%) patients were discharged on single antiplatelet therapy (SAPT), compared to 161 (70.0%) who were discharged on either dual antiplatelet therapy or anticoagulation (DAPT/AC). There was a higher prevalence of bypasses using prosthetic conduit in the DAPT/AC group (45.9 vs 31.8%, p = .047); no other demographic or procedural variable analyzed had any significant differences. At 30-days postoperatively, there was no significant difference in postoperative reintervention rates, however, the DAPT/AC group had significantly lower rates of mortality (1.2 vs 7.2%, p = .01), major amputation (1.2% vs 5.8%, p = .04), and MALE (3.7 vs 13.0%, p < .01). There were no significant differences in bleeding complications. Survival analysis demonstrated that MALE-free survival was higher in the DAPT/AC group compared to the SAPT group (p < .01). On Cox regression analysis, DAPT/AC was associated with significantly decreased rates of MALE + mortality (Hazard Ratio (HR) 0.20 [0.06 - 0.66]).

Conclusion: Lower extremity bypasses patients with low Wound and low foot Infection scores who are discharged on DAPT/AC postoperatively have a significantly higher 30-day MALE-free survival rate compared to patients discharged on SAPT; consideration could be made to preferentially discharge such post-bypass patients on DAPT/AC.

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来源期刊
Vascular
Vascular 医学-外周血管病
CiteScore
2.30
自引率
9.10%
发文量
196
审稿时长
6-12 weeks
期刊介绍: Vascular provides readers with new and unusual up-to-date articles and case reports focusing on vascular and endovascular topics. It is a highly international forum for the discussion and debate of all aspects of this distinct surgical specialty. It also features opinion pieces, literature reviews and controversial issues presented from various points of view.
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