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The Effects of Oral Anticoagulation on Patients with Endovascular Abdominal Aortic Aneurysm Repair (EVAR)

OBJECTIVES: Many patients with EVAR require chronic oral anticoagulation, which may inhibit sac thrombosis and allow persistent or new endoleaks. To assess the effects of anticoagulation on EVAR outcomes, we reviewed our experience.
METHODS: Consecutive EVAR patients (October 2003-May 2006) were retrospectively reviewed. Patients with chronic anticoagulation (warfarin and/or clopidogrel (Group A)) were compared to those without (Group B) using Kaplan-Meier method with log-rank tests and Wilcoxon rank-sum test.
RESULTS: Two-hundred forty-nine patients (211 men, 38 women) (mean age 76; 51-99) had EVAR. Seventy patients (28%) were in Group A (warfarin n = 40, clopidogrel n = 29, both n = 1). Endoleaks occurred in 71: 6 Type I, 60 Type II, and 5 both. Endoleaks occurred in 29 (41%, Group A) and 42 (23%, Group B) patients. Endoleak rates at 6-months differed significantly (p = 0.004) with 44.3% ± 6.7% in Group A, compared to 28.4% ± 3.7% in Group B. Twenty (9 Group A; 11 Group B) required endovascular reintervention. Reintervention rates at 6-months were 11.3% ± 4.4% for Group A and 3.5% ± 1.6% for Group B (p = 0.06). Sac shrinkage at 14 months median follow up was less in Group A with median change of -0.2 (-2.6 cm to +1 cm) compared to -0.3 (-3.4 cm to +1.1 cm) in Group B (p = 0.03). No patient required endograft explant, and 1 Group B patient had EVAR migration at 12 months.
CONCLUSIONS: Oral anticoagulation after EVAR is associated with increased endoleak rate, decreased sac shrinkage, and a trend of more frequent reinterventions. EVAR patients on chronic anticoagulation should be informed of these risks and monitored closely.