Effect Of Anticoagulant And Antiplatelet Therapy Before The Intracavitary Therapy Of Lower Limb Atherosclerosis Occlusion On Clinical Outcomes

OBJECTIVE To detect the influence of pretreatment withpreoperative low molecular heparin anticoagulation and aspirin antiplateleton the patients’ no-reflow phenomenon and efficacy after interventionaltherapy of lower limb atherosclerosis occlusion.METHODS126patients (126lmbs) with lower limbatherosclerosis occlusion undergoing interventional therapy wererandomly divided into aspirin group (44patients) with aspirin for3-5daysprior to interventional therapy, low molecular heparin group (40patients)with low molecular heparin for3-5days prior to interventionaltherapy and control group (42patients) without aspirin and low molecularheparin before interventional therapy. Plasma thrombomodulin(PTM),soluble fibrin monomer complex(sFMC), platelet α-granule membraneglycoprotein140(GM P-140), D-dimer(DD) and plasma viscosity levels ofplasma were measured at four different time points: on admission, before PTA, immediately after the last PTA and at24hours after PTA, while theABI were detected at two different time points: on admission and at3daysafter PTA. The changes with in groups at different time points and thedifferences between groups at same time points was compared. Recorded atthe same time the number of postoperative cases of no-reflow occurredlimbs, puncture site bleeding or hematoma, acute arterial thrombosis orembolism.RESULTS○1In control group, sFMC,GMP-140,DD and plasmaviscosity levels of plasma increased significantly(P <0.05; P <0.001)immediately after the last PTA and rose to peak values, and slightlydecreased at24hours after PTA, which were still highter than the valuesbefore PTA (P <0.05; P <0.001).○2Compared with control group, sFMC,GMP-140, DD and plasma viscosity of the two treatments groupdecreased significantly before PTA(P <0.05).○3In the two treatmentsgroup,there were no remarkable elevation in the levels of sFMC andplasma viscosity of plasma at different time points, copared with the valuesbefore PTA (P>0.05). However, DD still elevated(P <0.001), comparedwith the values before PTA, which were much lower than the values atsame time points in control group (P <0.001). Comparison between thetwo treatment groups:GMP-140and DD of the low molecular heparinincreased greatly immediately after the last PTA and at24hours after PTA.○4In the two treatments group, postoperative ABI increased significantly, compared with the values at same time points in control group (P <0.05).○5There were no remarkable difference at different time points in all groupsfor the levels of plasma PTM before PTA(P>0.05).6○The aspirin grouppostoperative limb no-reflow rate and acute arterial thrombosis orembolism rate was significantly lower than the control group (P <0.05),There were no remarkable difference in the incidence of complications ofpuncture site bleeding or hematoma.CONCLUSION Anticoagulant therapy or antiplatelet therapybefore the intracavitary therapy of lower limb atherosclerosis occlusion toreduce prothrombotic state, reduce the rate of no-reflow and acute arterialthrombosis effectively, without increasing the incidence of bleedingcomplications. The antiplatelet better than anticoagulant.