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Effects of three months of low molecular weight heparin (dalteparin) treatment after bypass surgery for lower limb ischemia--a randomised placebo-controlled double blind multicentre trial.

Artikel i vetenskaplig tidskrift
Författare Lennart Jivegård
C Drott
Johan Gelin
O Groth
M Hensäter
N Jensen
G Johansson
P Konrad
B Lindberg
A Lindhagen
B Lundqvist
A Oden
L Smith
B Stenberg
E Thornell
Urban Wingren
Per Örtenwall
Publicerad i European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery
Volym 29
Nummer/häfte 2
Sidor 190-8
ISSN 1078-5884
Publiceringsår 2005
Publicerad vid Institutionen för de kirurgiska disciplinerna
Institutionen för invärtesmedicin
Institutionen för de kirurgiska disciplinerna, Avdelningen för kirurgi
Sidor 190-8
Språk en
Länkar dx.doi.org/10.1016/j.ejvs.2004.11.0...
Ämnesord Aged, Dalteparin, therapeutic use, Double-Blind Method, Drug Administration Schedule, Female, Fibrinolytic Agents, therapeutic use, Foot, pathology, Foot Ulcer, etiology, prevention & control, Gangrene, etiology, prevention & control, Graft Occlusion, Vascular, complications, prevention & control, Humans, Injections, Subcutaneous, Ischemia, surgery, Leg, blood supply, surgery, Male, Postoperative Care, Prospective Studies, Thrombolytic Therapy, Treatment Outcome, Vascular Patency
Ämneskategorier Kirurgi

Sammanfattning

OBJECTIVES: To test the hypothesis that long-term postoperative dalteparin (Fragmin), Pharmacia Corp) treatment improves primary patency of peripheral arterial bypass grafts (PABG) in lower limb ischemia patients on acetylsalicylic acid (ASA) treatment. DESIGN: Prospective randomised double blind multicenter study. MATERIALS AND METHODS: Using a computer algorithm 284 patients with lower limb ischemia, most with pre-operative ischemic ulceration or partial gangrene, from 12 hospitals were randomised, after PABG, to 5000 IU dalteparin or placebo injections once daily for 3 months. All patients received 75 mg of ASA daily for 12 months. Graft patency was assessed at 1, 3 and 12 months. RESULTS: At 1 year, 42 patients had died or were lost to follow-up. Compliance with the injection schedule was 80%. Primary patency rate, in the dalteparin versus the control group, respectively, was 83 versus 80% (n.s.) at 3 months and 59% for both groups at 12 months. Major complication rates and cardiovascular morbidity were not different between the two groups. CONCLUSIONS: In patients on ASA treatment, long-term postoperative dalteparin treatment did not improve patency after peripheral artery bypass grafting. Therefore, low molecular weight heparin treatment cannot be recommended for routine use after bypass surgery for critical lower limb ischemia.

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