Southern Association For Vascular Surgery

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Association of Chronic Anticoagulation and Antiplatelet Therapy with Endoleak Reintervention Following EVR
Mark D Balceniuk, Peng Zhao, Brian C Ayers, Roan J Glocker, Adam J Doyle, Michael C Stoner
University of Rochester Medical Center, Rochester, NY

INTRODUCTION: The literature is conflicting concerning the effect of chronic anticoagulation (AC) and antiplatelet (AP) therapy on endoleak following endovascular repair of abdominal aortic aneurysm (EVR). While there are data suggesting higher rates of endoleak in patients taking anticoagulation, it is still unknown whether AC or AP therapy predispose patients to clinically significant endoleak. The objective of this study is to evaluate the impact of these medications on the rate of both endoleak and reintervention following EVR.

METHODS: 14,798 patients abstracted from the Vascular Quality Initiative (VQI) index hospitalization and long-term follow up (LTF) datasets for EVR (2008-2016) were included in the analysis. LTF in VQI is recorded as 9-21 months post-index procedure (or longer if available). Patients not taking any anticoagulant, antiplatelet agent or aspirin (ASA) postoperatively were excluded. Patients taking any combinations of anticoagulant and or antiplatelet agent (treatment) following the index procedure were compared against patients taking aspirin alone (control). Primary endpoints were rate of follow-up endoleak and rate of reintervention for endoleak.

RESULTS: There were 11,023 patients receiving ASA alone, 2,761 receiving both ASA and another AP agent, 938 receiving ASA and AC, and 76 patients receiving all three medications. Treatment groups were different from the control for age, race, coronary artery disease and COPD (Table 1). Significant differences between control and treatment groups for aortic anatomy are shown in Table 1. Combined endoleak (defined as any endoleak identified during index procedure or LTF) was significantly higher in every group taking more than ASA compared to the group on ASA alone (Table 2). There were no statistically significant differences between any of the treatment groups and the control group for LTF endoleak. However, there is a significantly increased rate of reintervention for endoleak in the aspirin + anticoagulation group, compared to aspirin alone (19 [3.3%] vs 112 [1.8%], p=0.017). Additionally, analysis of variance also demonstrates a significant difference of combined endoleak between treatment groups, p=0.005.

CONCLUSIONS: This is the first study to evaluate the impact of anticoagulation and antiplatelet status on rate of reintervention for mid-term endoleak following EVR. We demonstrate that the combination of aspirin and anticoagulation therapy following EVR is associated with an increased rate of reintervention for endoleak. However, our findings show that dual-antiplatelet therapy has minimal effect on reintervention rate. Additional investigation may be needed to further delineate the relationship between anticoagulation and endoleak reintervention.
Table 2. Endoleak Outcomes
Control (ASA alone)ASA + AntiplateletASA + AntiplateletASA + AnticoagulationASA + AnticoagulationASA + antiplatelet and anticoagulationASA + antiplatelet and anticoagulation
N (%)N (%)p-valueN (%)p-valueN (%)p-value
Combined Endoleak2978 (27)681 (24.7)0.012283 (30.2)0.03931 (40.8)0.009
LTF Endoleak781 (12.5)189 (12.3)0.86378 (13.4)0.5137 (17.1)0.345
LTF Endoleak Requiring Reintervention112 (1.8)24 (1.6)0.58819 (3.3)0.0170 (0)1.0

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