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Anticoagulation in the Surgical Management of Peripheral Arterial Embolic Disease

Introduction: Low-molecular-weight heparin has been showed to be effective for veno-occlusive disease and acute coronary syndrome. It is frequently used for peripheral arterial embolic disease but this is not a licensed use and there is little evidence or guidelines for this. This article aims to review the peri-operative use and outcomes of LMWH and unfractionated heparin (UFH) following arterial embolectomy in a district general hospital.

Methods: Retrospective case review of peri-operative anticoagulation in 55 patients undergoing peripheral arterial embolectomy between 2007-2012 in North Devon District Hospital.

Results: Patients received a wide variety of anti-coagulation in the peri-operative period. The overall complication rate was 38%. The total complication rate was 70% in patients receiving UFH compared to 42% in those receiving LMWH (p=0.16). The risk of re-occlusion was 60% in the UFH group compared to 18% in the LMWH group (p=0.21). The risk of amputation was higher in the UFH group (30% compared to 12% p=0.32).

Conclusion: LMWH is a safe and convenient alternative to UFH in acute peripheral arterial thromboembolic disease.


Martha E Nixon, Keith Gomes Pinto, Marcos S Kostalas, David J Williams and John V Taylor

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