- Peripheral Vascular Diseases
Acenocoumarol in PVD
Oral anticoagulants are commonly used in patients with peripheral vascular disease (PVD). Acenocoumarol treatment has been shown to improve the symptoms of peripheral vascular disease and improve the exercise performance in these patients.61
- The Dutch Bypass Oral Anticoagulants or Aspirin Study
- Optimal Oral Anticoagulant Intensity
Efficacy of oral anticoagulants compared with aspirin after infrainguinal bypass surgery (The Dutch Bypass Oral Anticoagulants or Aspirin Study): A randomized trial
Lancet. 2000 Jan 29;355(9201):346-51.
To compare the efficacy and safety of oral anticoagulants and aspirin in patients with PVD undergoing infrainguinal bypass graft surgery
Multi-center, randomized, open trial
2690 patients who had undergone infrainguinal grafting
Patients were randomly assigned oral anticoagulants (acenocoumarol or phenprocoumon, target international normalized ratio 3.0-4.5, n=1339) or aspirin (80 mg daily, n=1351) and followed-up for a mean of 21 months.
The primary outcome was graft occlusion. Secondary outcome was cardiovascular (CV) events and hemorrhagic events.
The two groups were comparable in efficacy in preventing graft occlusion.
- Graft occlusions: 308 in the oral anticoagulants group compared with 322 in the aspirin group (hazard ratio 0.95 [95% CI 0.82-1.11]).
- Secondary outcome: The composite outcome of vascular death, myocardial infarction, stroke, or amputation occurred 248 times in the oral anticoagulants group and 275 times in the aspirin group (0.89 [0.75-1.06]).
Optimal oral anticoagulant intensity to prevent secondary ischemic and hemorrhagic events in patients after infrainguinal bypass graft surgery
Marco et al., J Vasc Surg 2001; 33: 522-27.
A substudy of the Dutch BOA study, assessing the efficacy of oral anticoagulants as per the international normalized ratio (INR) in patients with PVD undergoing infrainguinal bypass grafting.
1326 patients on oral anticoagulants.
The optimal INR was in the range of 3.0-4.0, which was found to be effective and safe for prevention of ischemic events.