Dual Antiplatelet Therapy Is Selectively Associated With Decreased Major Adverse Limb Events In Patients With Low Wifi Scores
C. Y. Maximilian Png, MD1, Jenna Beardsley1, Charles DeCarlo1, Young Kim, MD2, Sujin Lee, MD1, Katherine Morrow, MD1, Tiffany Bellomo, MD1, Anahita Dua, MD1.
1Massachusetts General Hospital, Boston, MA, USA, 2Duke University, Durham, NC, USA.
OBJECTIVES: 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 recently developed Wound, Ischemia and Foot Infection (WIFI) score is 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 study of infrainguinal bypass procedures completed at a single hospital system between January 2018 to January 2021 was performed, and pre-operative WIFI scores were extracted for each patient. Patients with either Wounds 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: 191 procedures in 184 patients were included in the study. 66 (34.6%) of patients were discharged on single antiplatelet therapy (SAPT), compared to 125 (65.5%) who were discharged on either dual-antiplatelet therapy or anticoagulation (DAPT/AC). There was a higher prevalence of atrial fibrillation in the DAPT/AC group (24.8% vs 9.1%, P=0.01); no other demographic or procedural variable analyzed had any significant differences between the two groups. At 30-days postoperatively, there was no significant difference in postoperative reintervention or graft occlusion rates, however the DAPT/AC group had a significantly lower rates of mortality (2.2% vs. 9.1%, P=0.01), major amputation (1.6% vs. 7.6%, P = 0.04) and MALE (4.8% vs. 16.7%, P<0.01). Survival analysis demonstrated that MALE free survival was higher in the DAPT/AC group compared to the SAPT group (P<0.01). (Figure 1) CONCLUSIONS: Lower extremity bypasses patients 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 post-bypass patients on DAPT/AC. 
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