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Objectives:
The use of postoperative anticoagulation is not uncommon for patients undergoing lower extremity arterial procedures, whether for adjunctive therapy to the surgical procedure or for resumption of preoperative anticoagulation. Longer postoperative length of stay is necessary to achieve and adequate therapeutic international normalized ratio with traditional protocols that call for the use of unfractionated heparin. We hypothesized the novel oral anticoagulants (NOAC) are an attractive alternative to provide adequate anticoagulation patients who undergo lower extremity arterial procedures.
Methods:
We retrospectively examined 11 cases to examine the safety and efficacy of the NOAC’s in a single institution between 2012 and 2015. Patency, freedom from re-intervention, and major adverse limb event were evaluated. These NOAC agents were dabigatran, rivaroxaban, and apixaban. For the first 24 hours patients were kept on intravenous unfractionated heparin before being switched to a NOAC.
Results:
NOAC’s were utilized in a total of 11 patients (55% men; mean age 69 ± 11 years) during the study period. Indication for NOAC was either ePTFE bypasses below the knee joint or after lower extremity angioplasty with disadvantaged run-off. Mean follow-up was 269 ± 350 days. 73% of patients who were given NOAC’s for PTFE bypasses, graft patency, freedom from re-intervention, and major adverse limb event were 100%, 100%, and 0% respectively. 27% of patients treated with NOAC’s for disadvantaged run-off after balloon angioplasty of the lower extremity, patency, freedom from re-intervention, and major adverse limb event were 100%, 100%, and 0% respectively. For the patients who underwent NOAC administration for disadvantaged runoff primary patency at 6 months was 100%. There was 1 patient who developed wound dehiscence unrelated to NOAC administration.
Conclusions:
These preliminary data suggest that there may be a role for using the novel oral anticoagulants with patients who undergo lower extremity arterial procedures.