Cargando…

Preventing Lower Limb Graft Thrombosis after Infrainguinal Arterial Bypass Surgery with Antithrombotic Agents (PATENT Study): An International Expert Based Delphi Consensus

(1) Background: High-level evidence on antithrombotic therapy after infrainguinal arterial bypass surgery in specific clinical scenarios is lacking. (2) Methods: A modified Delphi procedure was used to develop consensus statements. Experts voted on antithrombotic treatment regimens for three types o...

Descripción completa

Detalles Bibliográficos
Autores principales: Meuli, Lorenz, Stadlbauer, Thomas, Stähli, Barbara E., Espinola-Klein, Christine, Zimmermann, Alexander
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10178874/
https://www.ncbi.nlm.nih.gov/pubmed/37176663
http://dx.doi.org/10.3390/jcm12093223
_version_ 1785040963268247552
author Meuli, Lorenz
Stadlbauer, Thomas
Stähli, Barbara E.
Espinola-Klein, Christine
Zimmermann, Alexander
author_facet Meuli, Lorenz
Stadlbauer, Thomas
Stähli, Barbara E.
Espinola-Klein, Christine
Zimmermann, Alexander
author_sort Meuli, Lorenz
collection PubMed
description (1) Background: High-level evidence on antithrombotic therapy after infrainguinal arterial bypass surgery in specific clinical scenarios is lacking. (2) Methods: A modified Delphi procedure was used to develop consensus statements. Experts voted on antithrombotic treatment regimens for three types of infrainguinal arterial bypass procedures: above-the-knee popliteal artery; below-the-knee popliteal artery; and distal, using vein, prosthetic, or biological grafts. The treatment regimens for these nine procedures were then voted on in three clinical scenarios: isolated PAOD, atrial fibrillation, and recent coronary intervention. (3) Results: The survey was conducted with 28 experts from 15 European countries, resulting in consensus statements on 25/27 scenarios. Experts recommended single antiplatelet therapy after above-the-knee popliteal artery bypasses regardless of the graft material used. For below-the-knee popliteal artery bypasses, experts suggested combining single antiplatelet therapy with low-dose rivaroxaban if the graft material used was autologous or biological. They did not recommend switching to triple therapy for patients on oral anticoagulants for atrial fibrillation or dual antiplatelet therapy in any scenario. (4) Conclusions: Great inconsistency in the antithrombotic therapy administered was found in this study. This consensus offers guidance for scenarios that are not covered in the current ESVS guidelines but must be interpreted within its limitations.
format Online
Article
Text
id pubmed-10178874
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-101788742023-05-13 Preventing Lower Limb Graft Thrombosis after Infrainguinal Arterial Bypass Surgery with Antithrombotic Agents (PATENT Study): An International Expert Based Delphi Consensus Meuli, Lorenz Stadlbauer, Thomas Stähli, Barbara E. Espinola-Klein, Christine Zimmermann, Alexander J Clin Med Article (1) Background: High-level evidence on antithrombotic therapy after infrainguinal arterial bypass surgery in specific clinical scenarios is lacking. (2) Methods: A modified Delphi procedure was used to develop consensus statements. Experts voted on antithrombotic treatment regimens for three types of infrainguinal arterial bypass procedures: above-the-knee popliteal artery; below-the-knee popliteal artery; and distal, using vein, prosthetic, or biological grafts. The treatment regimens for these nine procedures were then voted on in three clinical scenarios: isolated PAOD, atrial fibrillation, and recent coronary intervention. (3) Results: The survey was conducted with 28 experts from 15 European countries, resulting in consensus statements on 25/27 scenarios. Experts recommended single antiplatelet therapy after above-the-knee popliteal artery bypasses regardless of the graft material used. For below-the-knee popliteal artery bypasses, experts suggested combining single antiplatelet therapy with low-dose rivaroxaban if the graft material used was autologous or biological. They did not recommend switching to triple therapy for patients on oral anticoagulants for atrial fibrillation or dual antiplatelet therapy in any scenario. (4) Conclusions: Great inconsistency in the antithrombotic therapy administered was found in this study. This consensus offers guidance for scenarios that are not covered in the current ESVS guidelines but must be interpreted within its limitations. MDPI 2023-04-30 /pmc/articles/PMC10178874/ /pubmed/37176663 http://dx.doi.org/10.3390/jcm12093223 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Meuli, Lorenz
Stadlbauer, Thomas
Stähli, Barbara E.
Espinola-Klein, Christine
Zimmermann, Alexander
Preventing Lower Limb Graft Thrombosis after Infrainguinal Arterial Bypass Surgery with Antithrombotic Agents (PATENT Study): An International Expert Based Delphi Consensus
title Preventing Lower Limb Graft Thrombosis after Infrainguinal Arterial Bypass Surgery with Antithrombotic Agents (PATENT Study): An International Expert Based Delphi Consensus
title_full Preventing Lower Limb Graft Thrombosis after Infrainguinal Arterial Bypass Surgery with Antithrombotic Agents (PATENT Study): An International Expert Based Delphi Consensus
title_fullStr Preventing Lower Limb Graft Thrombosis after Infrainguinal Arterial Bypass Surgery with Antithrombotic Agents (PATENT Study): An International Expert Based Delphi Consensus
title_full_unstemmed Preventing Lower Limb Graft Thrombosis after Infrainguinal Arterial Bypass Surgery with Antithrombotic Agents (PATENT Study): An International Expert Based Delphi Consensus
title_short Preventing Lower Limb Graft Thrombosis after Infrainguinal Arterial Bypass Surgery with Antithrombotic Agents (PATENT Study): An International Expert Based Delphi Consensus
title_sort preventing lower limb graft thrombosis after infrainguinal arterial bypass surgery with antithrombotic agents (patent study): an international expert based delphi consensus
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10178874/
https://www.ncbi.nlm.nih.gov/pubmed/37176663
http://dx.doi.org/10.3390/jcm12093223
work_keys_str_mv AT meulilorenz preventinglowerlimbgraftthrombosisafterinfrainguinalarterialbypasssurgerywithantithromboticagentspatentstudyaninternationalexpertbaseddelphiconsensus
AT stadlbauerthomas preventinglowerlimbgraftthrombosisafterinfrainguinalarterialbypasssurgerywithantithromboticagentspatentstudyaninternationalexpertbaseddelphiconsensus
AT stahlibarbarae preventinglowerlimbgraftthrombosisafterinfrainguinalarterialbypasssurgerywithantithromboticagentspatentstudyaninternationalexpertbaseddelphiconsensus
AT espinolakleinchristine preventinglowerlimbgraftthrombosisafterinfrainguinalarterialbypasssurgerywithantithromboticagentspatentstudyaninternationalexpertbaseddelphiconsensus
AT zimmermannalexander preventinglowerlimbgraftthrombosisafterinfrainguinalarterialbypasssurgerywithantithromboticagentspatentstudyaninternationalexpertbaseddelphiconsensus
AT preventinglowerlimbgraftthrombosisafterinfrainguinalarterialbypasssurgerywithantithromboticagentspatentstudyaninternationalexpertbaseddelphiconsensus