Effect Of Novel Oral Anticoagulants And Warfarin Therapy On The Incidence Of Endoleak And Reintervention After Endovascular Abdominal Aortic Aneurysm Repair
Aravinda Abeysekera, MD.
SIUH Northwell, Staten Island, NY, USA.
Objective
Endoleak after endovascular aneurysm repair (EVAR) can be a significant problem. The effects of warfarin therapy (WT) and antiplatelet therapy on endoleaks has been studied in the past. However, the effects of Novel Oral Anticoagulants (NOACs) on the incidence of endoleak and re-intervention after EVAR are unclear. This study aims to compare the effects of NOACs and WT on the incidence of endoleaks and re-intervention after EVAR at our institution
Methods
A retrospective longitudinal, single center study comparing the effects of NOACs vs. WT on the outcomes after EVAR from January 2014 to June 2018. Demographics and EVAR related outcomes were reviewed. Primary outcomes were endoleak and re-intervention rates. Secondary outcomes were graft or limb occlusion and mortality. Data was analyzed in multivariate generalized linear models with long rank test to determine survival in Kaplan Meier curve.
Results
164 patients underwent EVAR with a mean follow up of 17.3 ± 2.9 months. 18 (11%) were on NOACs and 14 (9%) on WT, perioperative. Both groups had similar demographics (Table 1). During the study period, total of 23 (14%) endoleaks were detected. 5 (28%) patients on NOACs had endoleaks as compared to 2 (14%) patients on WT (p=0.36). Freedom from endoleak did not differ in two groups (Figure 1). Type II endoleak rates were higher in NOACs group (4, 22%) vs. WT group (1, 7%) (p=0.04), none of them required re-intervention. 1 patient in NOACs group required re-intervention for type III endoleak (open explantation and repair) as compared to 3 re-interventions in WT group; 1 for type V endoleak (embolization of inferior mesenteric artery followed by open explantation of the endograft) and 2 for limb occlusions (femoral to femoral bypass).
Conclusion
NOACs and WT appear to be safe in EVAR patients with acceptable endoleak and re-intervention rates. Both groups had similar re-interventions for endoleak and overall endoleak rates but higher incidence of Type II endoleak in NOAC's group, none requiring re-intervention. WT group had higher mortality than NOAC's in our study. Larger, multicenter studies are needed to further evaluate the effect and safety of these anticoagulants in this subset of patients 
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