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Antiplatelet agents for preventing thrombosis after peripheral arterial bypass surgery

Overview of attention for article published in Cochrane database of systematic reviews, October 2008
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Title
Antiplatelet agents for preventing thrombosis after peripheral arterial bypass surgery
Published in
Cochrane database of systematic reviews, October 2008
DOI 10.1002/14651858.cd000535.pub2
Pubmed ID
Authors

Brown, Julie, Lethaby, Anne, Maxwell, Heather, Wawrzyniak, Andrew J, Prins, Martin H

Abstract

Peripheral arterial disease (PAD) may cause occlusions (blockages) in the main arteries of lower limbs. One treatment option is bypass surgery using autologous (the patient's own tissue) vein graft or artificial graft. A number of factors influence occlusion rates, including the material used. To prevent graft occlusion patients are usually treated with antiplatelet, antithrombotic drugs, or a combination of both. To evaluate whether antiplatelet treatment in patients with symptomatic PAD undergoing infrainguinal bypass surgery improves graft patency, limb salvage and survival. The authors searched the Cochrane Peripheral Vascular Diseases Group Specialised Register (January 2008) and the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2007, Issue 4). Additional trials were sought through reference lists of papers and proceedings from the vascular surgical society meetings. For this update the methodological quality of each original trial was assessed independently by review authors (JB, HM, AW) with emphasis on concealment of allocation. Details of the selected studies were extracted independently by JB and HM for the update. The treatment and control groups were compared for important prognostic factors and differences described. If any data were unavailable, further information was sought from authors. Data were synthesised by comparing group results. Unit of analysis issues were addressed by subgroup analysis. The administration of a variety of platelet inhibitors resulted in improved venous and artificial graft patency when compared to no treatment. However, analysing patients for graft-type indicated that those patients receiving a prosthetic graft were more likely to benefit from administration of platelet inhibitors than patients treated with venous grafts. Antiplatelet therapy with aspirin had a slight beneficial effect on the patency of peripheral bypass grafts but seemed to have an inferior effect on venous graft patency compared with artificial grafts. The effect of aspirin on cardiovascular outcomes and survival was small and not statistically significant. This might be due to the fact that the majority of patients receiving a peripheral graft have an advanced stage of PAD with critical ischaemia. They are usually seriously ill as a result of cardiovascular disease and have high mortality rates, of 20% per year. Additionally, the number of patients included in this analysis might be too small to reach a statistically significant effect for mortality and cardiovascular morbidity.

Mendeley readers

The data shown below were compiled from readership statistics for 16 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Canada 1 6%
Unknown 15 94%

Demographic breakdown

Readers by professional status Count As %
Student > Master 4 25%
Student > Ph. D. Student 3 19%
Researcher 2 13%
Professor > Associate Professor 2 13%
Professor 1 6%
Other 3 19%
Unknown 1 6%
Readers by discipline Count As %
Medicine and Dentistry 11 69%
Agricultural and Biological Sciences 1 6%
Nursing and Health Professions 1 6%
Unknown 3 19%