| Objectives To evaluate the safety,effectiveness and difference of postoperative antithrombotic treatment in patients with lower extremity arteriosclerosis obliterans,and to explore the reasonable postoperative antithrombotic treatment.Methods A prospective cohort study was conducted in patients with lower extremity arteriosclerosis obliterans admitted to the Department of Vascular Surgery,Nanjing Drum Tower Hospital,from November 2018 to October 2019.Patients were divided into three groups according to postoperative antithrombotic treatment: double antiplatelet group(Group A),aspirin combined with cilostazol group(Group B)and rivaroxaban combined with cilostazol group(Group C).The general data,baseline data and follow-up data at 3 months and 6 months were collected and analyzed combined with variance test,chi square test and rank sum test to evaluate the safety,effectiveness and difference of three groups of treatment.Results A total of 201 patients(Group A:54,Group B:70,Group C:77)were enrolled in this study.The differences in general data and baseline data(including preoperative data,procedure type,and postoperative data)between the three groups were not significant(P > 0.05).In Group A,the follow-up rate was 96.30%(52/54),the postoperative bleeding event rate was 3.85%(2/52),arterial embolism rate was 5.77%(3/52)and the clinical-driven target vessel revascularization rate was 19.23%(10/52).The incidence of cardiovascular events was1.92%(1/52)and the rate of amputation was 1.92%(1/52)in Group A.In Group B,the follow-up rate was 95.71%(67/70),arterial embolism event rate was 1.49%(1/67),the clinical-driven target vessel revascularization rate was 10.45%(7/67)and the rate of amputation was 2.99%(2/67).There was no bleeding events and cardiovascular events in Group B.In Group C,the follow-up rate was 96.10%(74/77),the postoperative bleeding event rate was 2.70%(2/74),the clinical-driven target vessel revascularization rate was 5.41%(4/74).There was no arterial embolism,cardiovascular events and amputation in Group C.Except for the incidence of clinically driven target vessel reconstruction(P=0.046),there was no statistical difference in the endpoint events.The primary patency rate at 3months was 64.00%(32/50)for Group A,80.60%(54/67)for Group B,84.72%(61/72)for Group C,and the average ABI was 0.6 0± 0.24,0.65 ± 0.22,0.69 ± 0.19 respectively.The primary patency rate at 6 months was 57.14%(28/49)for Group A,65.67%(44/67)for Group B,77.78%(57/72)for Group C,and the average ABI was 0.56 ± 0.26,0.59 ± 0.21,0.65 ± 0.20 respectively.There was no significant difference in Rutherford classification between the data at 3 months and postoperative ones(P > 0.05),and there was a statistical difference in the ABI after the operation(P < 0.01).The Rutherford classification decreased after the 6 months(P < 0.01).There were no significant differences in Rutherford classification and ABI between the three groups of patients(P > 0.05).There was a significant difference in patency rates between groups(3 months P = 0.021,6 Month P=0.032).Conclusions 1.The three types of antithrombotic treatment are effective and safe for preventing restenosis and thrombotic event after endovascular treatment of lower extremity arteriosclerosis.The medium-long term effectiveness need be confirmed by randomized multicenter large samples and medium-long term follow-up results.2.The combination of rivaroxaban and cilostazol can reduce the probability of limb loss.Compared with other antithrombotic treatments,it has advantages in improving the primary patency,and the risk of bleeding is not statistically increased.3.Aspirin combined with cilostazol did not show an advantage over other antithrombotic treatments in release of symptoms.However,because of the low bleeding risk,no drug resistance,and the price advantage compared to rivaroxaban it can still be used as the preferred treatment plan for some patients. |
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