Impact of Long-Term Warfarin Treatment on EVAR Durability: A Meta-Analysis

• Published in: Journal of endovascular therapy 2014-02, Vol.21 (1), p.148-153
• Main Authors: Lazarides, Miltos K., Georgiadis, George S., Charalampidis, Dimitrios G., Antoniou, George A., Georgakarakos, Efstratios I., Trellopoulos, George
• Format: Article
• Language: English
• Subjects: Administration, Oral; Anticoagulants; Anticoagulants - administration & dosage; Anticoagulants - adverse effects; Aortic Aneurysm, Abdominal - diagnosis; Aortic Aneurysm, Abdominal - surgery; Blood Vessel Prosthesis Implantation - adverse effects; Chi-Square Distribution; Confidence intervals; Drug therapy; Endoleak - diagnosis; Endoleak - etiology; Endoleak - therapy; Endovascular Procedures - adverse effects; Humans; Meta-analysis; Odds Ratio; Retreatment; Risk Assessment; Risk Factors; Studies; Time Factors; Treatment Outcome; Ultrasonic imaging; Warfarin - administration & dosage; Warfarin - adverse effects
• ISSN: 1526-6028; 1545-1550
• DOI: 10.1583/13-4462R.1

Purpose To evaluate whether postoperative long-term oral anticoagulation affects the durability of endovascular aneurysm repair (EVAR) and whether it is associated with an increased incidence of endoleak and subsequent need for reintervention. Methods A literature search was performed to identify studies of abdominal aortic aneurysm patients undergoing EVAR including an arm receiving warfarin postoperatively and reporting the frequency of any endoleaks and/or persistent type II endoleaks and reinterventions. The search identified 81 articles, of which 5 observational cohort studies ultimately met the inclusion criteria. Results Postoperative anticoagulation was required in 219 (14.6%) of the 1499 patients in the selected studies. The pooled effects analysis found that EVAR patients receiving long-term warfarin postoperatively had significantly more endoleaks of any type (OR 1.77, 95% CI 1.26 to 2.48, p=0.001) as well as persistent type II endoleaks (OR 1.58, 95% CI 1.05 to 2.37, p=0.03) compared with patients not on anticoagulation; however, there was no statistically significant difference in the reintervention rate between the groups. Conclusion Long-term anticoagulation in EVAR patients was associated with a statistically significant increase in any endoleak and persisting type II endoleaks, although it was not linked to an increased risk of reintervention. Close monitoring for EVAR patients who require long-term oral anticoagulation is advised.