Skip to main content

Lund University Publications

LUND UNIVERSITY LIBRARIES

Role of Antiplatelet Therapy in Patients Managed for Complex Aortic Aneurysms using Fenestrated or Branched Endovascular Repair

Nana, Petroula ; Spanos, Konstantinos ; Tsilimparis, Nikolaos ; Haulon, Stéphan ; Sobocinski, Jonathan ; Gallitto, Enrico ; Dias, Nuno LU orcid ; Eilenberg, Wolf ; Wanhainen, Anders and Mani, Kevin , et al. (2024) In European journal of vascular and endovascular surgery
Abstract

Objective: Despite the increasing number of fenestrated and branched endovascular aortic repair (F/B-EVAR) procedures, evidence on post-operative antiplatelet therapy is very limited. This study aimed to investigate the role of single antiplatelet therapy (SAPT) vs. double antiplatelet therapy (DAPT) after F/B-EVAR in 30 day and follow up outcomes. Methods: A multicentre retrospective analysis was conducted, including F/B-EVAR patients managed from 1 January 2018 to 31 December 2022. Comparative outcomes were assessed according to post-operative antiplatelet therapy. The cohort was divided into the SAPT group (acetylsalicylic acid [ASA] or clopidogrel) and DAPT group (ASA and clopidogrel). The duration of SAPT or DAPT was one to six... (More)

Objective: Despite the increasing number of fenestrated and branched endovascular aortic repair (F/B-EVAR) procedures, evidence on post-operative antiplatelet therapy is very limited. This study aimed to investigate the role of single antiplatelet therapy (SAPT) vs. double antiplatelet therapy (DAPT) after F/B-EVAR in 30 day and follow up outcomes. Methods: A multicentre retrospective analysis was conducted, including F/B-EVAR patients managed from 1 January 2018 to 31 December 2022. Comparative outcomes were assessed according to post-operative antiplatelet therapy. The cohort was divided into the SAPT group (acetylsalicylic acid [ASA] or clopidogrel) and DAPT group (ASA and clopidogrel). The duration of SAPT or DAPT was one to six months. Primary outcomes were 30 day death, and cardiovascular ischaemic and major haemorrhagic events. Secondary outcomes were survival and target vessel (TV) patency during follow up. Results: A total of 1 430 patients were included: 955 under SAPT and 475 under DAPT. The 30 day mortality rate was similar (SAPT 2.1% vs. DAPT 1.5%; p =.42). Cardiovascular ischaemic events were lower in the DAPT group (SAPT 11.9% vs. DAPT 8.2%; p =.040), with DAPT being an independent protector for acute mesenteric (p =.009) and lower limb ischaemia (p =.020). No difference was found in 30 day major haemorrhagic events (SAPT 7.5% vs. DAPT 6.3%; p =.40). The mean follow up was 21.8 ± 2.9 months. Cox regression showed no survival confounders, with similar rates between groups (log rank p =.71). DAPT patients enjoyed higher TV patency (SAPT 93.4%, standard error [SE] 0.7% vs. DAPT 97.0%, SE 0.6%; log rank p =.007) at thirty six months. Cox regression revealed B-EVAR as a predictor of worse TV patency (hazard ratio 2.03, 95% confidence interval 1.36 – 3.03; p <.001). DAPT was related to higher patency within B-EVAR patients (SAPT 87.2%, SE 2.1% vs. DAPT 94.9%, SE 1.9%; p <.001). Conclusion: DAPT after F/B-EVAR was associated with lower risk of cardiovascular ischaemic events and higher TV patency, especially in B-EVAR cases. No difference in major haemorrhagic events was observed at 30 days.

(Less)
Please use this url to cite or link to this publication:
author
; ; ; ; ; ; ; ; and , et al. (More)
; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; and (Less)
contributor
LU orcid and LU orcid
author collaboration
organization
publishing date
type
Contribution to journal
publication status
epub
subject
keywords
Antiplatelet therapy, Aortic aneurysm, Branched, Endovascular repair, Fenestrated, Outcomes
in
European journal of vascular and endovascular surgery
publisher
Elsevier
external identifiers
  • pmid:39321954
  • scopus:85209098339
ISSN
1078-5884
DOI
10.1016/j.ejvs.2024.09.030
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2024 The Author(s)
id
4b379981-483f-48c1-8677-0f984a72dfbe
date added to LUP
2025-01-31 14:35:31
date last changed
2025-07-05 03:18:37
@article{4b379981-483f-48c1-8677-0f984a72dfbe,
  abstract     = {{<p>Objective: Despite the increasing number of fenestrated and branched endovascular aortic repair (F/B-EVAR) procedures, evidence on post-operative antiplatelet therapy is very limited. This study aimed to investigate the role of single antiplatelet therapy (SAPT) vs. double antiplatelet therapy (DAPT) after F/B-EVAR in 30 day and follow up outcomes. Methods: A multicentre retrospective analysis was conducted, including F/B-EVAR patients managed from 1 January 2018 to 31 December 2022. Comparative outcomes were assessed according to post-operative antiplatelet therapy. The cohort was divided into the SAPT group (acetylsalicylic acid [ASA] or clopidogrel) and DAPT group (ASA and clopidogrel). The duration of SAPT or DAPT was one to six months. Primary outcomes were 30 day death, and cardiovascular ischaemic and major haemorrhagic events. Secondary outcomes were survival and target vessel (TV) patency during follow up. Results: A total of 1 430 patients were included: 955 under SAPT and 475 under DAPT. The 30 day mortality rate was similar (SAPT 2.1% vs. DAPT 1.5%; p =.42). Cardiovascular ischaemic events were lower in the DAPT group (SAPT 11.9% vs. DAPT 8.2%; p =.040), with DAPT being an independent protector for acute mesenteric (p =.009) and lower limb ischaemia (p =.020). No difference was found in 30 day major haemorrhagic events (SAPT 7.5% vs. DAPT 6.3%; p =.40). The mean follow up was 21.8 ± 2.9 months. Cox regression showed no survival confounders, with similar rates between groups (log rank p =.71). DAPT patients enjoyed higher TV patency (SAPT 93.4%, standard error [SE] 0.7% vs. DAPT 97.0%, SE 0.6%; log rank p =.007) at thirty six months. Cox regression revealed B-EVAR as a predictor of worse TV patency (hazard ratio 2.03, 95% confidence interval 1.36 – 3.03; p &lt;.001). DAPT was related to higher patency within B-EVAR patients (SAPT 87.2%, SE 2.1% vs. DAPT 94.9%, SE 1.9%; p &lt;.001). Conclusion: DAPT after F/B-EVAR was associated with lower risk of cardiovascular ischaemic events and higher TV patency, especially in B-EVAR cases. No difference in major haemorrhagic events was observed at 30 days.</p>}},
  author       = {{Nana, Petroula and Spanos, Konstantinos and Tsilimparis, Nikolaos and Haulon, Stéphan and Sobocinski, Jonathan and Gallitto, Enrico and Dias, Nuno and Eilenberg, Wolf and Wanhainen, Anders and Mani, Kevin and Böckler, Dittmar and Bertoglio, Luca and van Rijswijk, Carla and Modarai, Bijan and Seternes, Arne and Enzmann, Florian K. and Giannoukas, Athanasios and Gargiulo, Mauro and Kölbel, Tilo and Debus, Eike Sebastian and Blessing, Erwin and Panuccio, Giuseppe and Rohlffs, Fiona and Torrealba, José I. and Ali, Ahmed and Stana, Jan and Le Houérou, Thomas and Mesnard, Thomas and Cappiello, Antonio and Sotir, Anna and Arzola, Luis Hector and Bresler, Alina Marilena and Melloni, Andrea and Bonardelli, Stefano and van Schaik, Jan and Rasiah, Michael Greshan and Conradsen, Rebecca Andrea and Dakis, Konstantinos and Kouvelos, George and Matsagkas, Miltiadis}},
  issn         = {{1078-5884}},
  keywords     = {{Antiplatelet therapy; Aortic aneurysm; Branched; Endovascular repair; Fenestrated; Outcomes}},
  language     = {{eng}},
  publisher    = {{Elsevier}},
  series       = {{European journal of vascular and endovascular surgery}},
  title        = {{Role of Antiplatelet Therapy in Patients Managed for Complex Aortic Aneurysms using Fenestrated or Branched Endovascular Repair}},
  url          = {{http://dx.doi.org/10.1016/j.ejvs.2024.09.030}},
  doi          = {{10.1016/j.ejvs.2024.09.030}},
  year         = {{2024}},
}