IP017. Chronic Anticoagulation Is Associated With Increased Rates of Reintervention for Endoleak Following Endovascular Aneurysm Repair

Abstract

The literature is conflicting concerning the effect of chronic anticoagulation (AC) and antiplatelet (AP) therapy on endoleak following endovascular repair of abdominal aortic aneurysm (EVR). While there are data suggesting higher rates of endoleak in patients taking AC, it is still unknown whether AC or AP therapy predispose patients to clinically significant endoleak. The objective of this study is to evaluate the impact of these medications on the rate of both endoleak and reintervention following EVR. We included 14,798 patients abstracted from the Vascular Quality Initiative index hospitalization and long-term follow-up (LTF) datasets for EVR (2008-2016) were included in the analysis. LTF in Vascular Quality Initiative is recorded as 9 to 21 months after the index procedure (or longer if available). Patients not taking any anticoagulant, AP agent, or aspirin (ASA) postoperatively were excluded. Patients taking any combinations of anticoagulant and or AP agent (treatment) following the index procedure were compared against patients taking ASA alone (control). Primary end points were rate of follow-up endoleak and rate of reintervention for endoleak. There were 11,023 patients receiving ASA alone, 2761 receiving both ASA and another AP agent, 938 receiving ASA and AC, and 76 patients receiving all three medications. Treatment groups were different from the control for age, race, coronary artery disease and chronic obstructive pulmonary disease (Table I). Significant differences between control and treatment groups for aortic anatomy are shown in Table I. Combined endoleak (defined as any endoleak identified during index procedure or LTF) was significantly higher in every group taking more than ASA compared with the group on ASA alone (Table II). There were no statistically significant differences between any of the treatment groups and the control group for LTF endoleak. However, there is a significantly increased rate of reintervention for endoleak in the ASA + AC group, compared with ASA alone (19 [3.3%] vs 112 [1.8%]; P = .017). Additionally, analysis of variance also demonstrates a significant difference of combined endoleak between treatment groups; P = .005. This is the first study to evaluate the impact of AC and AP status on rate of reintervention for midterm endoleak following EVR. We demonstrate that the combination of ASA and AC therapy following EVR is associated with an increased rate of reintervention for endoleak. However, our findings show that dual-AP therapy has minimal effect on reintervention rate. Additional investigation may be needed to further delineate the relationship between AC and endoleak reintervention.Table IPatient demographicsControl (ASA alone)ASA + APASA + ACASA + AP and ACNo. (SE or %)No. (SE or %)P valueNo. (SE or %)P valueNo. (SE or %)P valueAge73.1 (0.08)72.6 (0.16).00475.9 (0.27).00073.1 (0.87).979White race9923 (90%)2475 (90%).548875 (93%).00166 (87%).288Hypertension9009 (81.8%)2463 (89.2%)<.001849 (90.6%)<.00168 (89.5%).099Coronary artery disease2890 (26.2%)1320 (47.8)<.001374 (39.9%)<.00151 (67.1%)<.001Chronic obstructive pulmonary disease3453 (31.3%)978 (35.4%)<.001367 (39.1%)<.00128 (36.8%).321AAA diameter, mm55.5 (0.14)54.7 (0.3).01555.9 (0.4).47255.5 (1.2).971Neck AAA angle <45°4249 (38.5%)925 (33.5%)<.001352 (37.5%).55233 (43.4%).409AAA, Abdominal aortic aneurysm; AC, anticoagulant; AP, antiplatelet; ASA, aspirin; SE, standard error.Boldface entries indicate statistical significance. Open table in a new tab Table IIEndoleak outcomesControl (ASA alone)ASA + APASA + ACASA + AP and ACNo. (%)No. (%)P valueNo. (%)P valueNo. (%)P valueCombined endoleak2978 (27)681 (24.7).012283 (30.2).03931 (40.8).009LTF endoleak781 (12.5)189 (12.3).86378 (13.4).5137 (17.1).345LTF endoleak requiring reintervention112 (1.8)24 (1.6).58819 (3.3).0170 (0)1.0AAA, Abdominal aortic aneurysm; AC, anticoagulant; AP, antiplatelet; ASA, aspirin; LTF, long-term follow-up.Boldface entries indicate statistical significance. Open table in a new tab