Oral Anticoagulation in the Prevention of One-Year Vein Graft Occlusion after Aortocoronary Bypass Surgery: Optimal Therapeutic Range and Practical Limitations

J van der Meer; H L Hillege; P H J M Dunselman; B J M Mulder; H R Michels; P T Buser; W H van Gilst; K I Lie; the CABADAS Research Group of the Interuniversity Cardiology Institute of The Netherlands

doi:10.1055/s-0038-1648941

Thrombosis and Haemostasis, Inhaltsverzeichnis

Thromb Haemost 1994; 72(05): 676-681
DOI: 10.1055/s-0038-1648941

Original Article

Schattauer GmbH Stuttgart

Oral Anticoagulation in the Prevention of One-Year Vein Graft Occlusion after Aortocoronary Bypass Surgery: Optimal Therapeutic Range and Practical Limitations

J van der Meer

¹The University Hospital, Groningen, The Netherlands

,

H L Hillege

¹The University Hospital, Groningen, The Netherlands

,

P H J M Dunselman

²Ignatius Hospital, Breda, The Netherlands

,

B J M Mulder

³Academic Medical Centre, Amsterdam, The Netherlands

,

H R Michels

⁴Catharina Hospital, Eindhoven, The Netherlands

,

P T Buser

⁵University Hospital, Basel, Switzerland

,

W H van Gilst

¹The University Hospital, Groningen, The Netherlands

,

K I Lie

¹The University Hospital, Groningen, The Netherlands

,

the CABADAS Research Group of the Interuniversity Cardiology Institute of The Netherlands

› Institutsangaben

Abstract

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Summary

To assess the optimal level of oral anticoagulation to prevent occlusion of vein coronary bypass grafts, 318 patients from a graft patency trial were analysed retrospectively. Oral anticoagulant therapy was started one day before surgery and continued for one year, after which graft occlusion was assessed by angiography. The aimed level of anticoagulation was 2.8-1.8 International Normalized Ratio (INR). Clinical outcome was assessed by the incidence of myocardial infarction, thrombosis and major bleeding.

The observed anticoagulation level was 2.8-4.8 INR for 54%, and 1.8-3.8 INR for 75% of time per patient. Occlusion rates in patients who spent <35, 35-70, and ≥70% of time within INR range 2.8-1.8 were 10.5%, 10.8% and 11.8%, respectively (differences not statistically significant). Patients who spent ≥70% of time within INR range 1.8-3.8 versus 2.8-4.8 showed comparable occlusion rates. The risk of graft occlusion was not related to quality of anticoagulation early (0-3 months) or late (3-12 months) after surgery. Myocardial infarction, thrombosis and major bleeding occurred in 1.3%, 2.0% and 2.9% of patients.

To maintain vein graft patency in the first postoperative year by oral anticoagulation, a level within INR range 1.8-3.8 for ≥70% of time seems to be sufficient.

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Referenzen

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