Two-year follow-up after acute thromboembolic lower limb ischaemia: the importance of continuing warfarin treatment

Abstract

Abstract Background The Vascular Surgical Society carried out an audit of follow-up after acute thromboembolic lower limb ischaemia. Methods The audit of acute lower limb ischaemia was done between 1 January and 31 March 1996 and included 474 patients. This report describes a 2-year follow-up of patients with a diagnosis of thrombosis or embolism who survived 30 days. Details were obtained for 214 (75 per cent) of 287 patients: half (107) were men, and the age range was 21–96 (mean 74) years. Results Amputation of the leg affected initially had been required (after 30 days) in 12 per cent. Further acute leg ischaemia had occurred in 11 per cent, and 9 per cent had undergone arterial reconstruction (11), angioplasty (seven) or thrombolysis (two). Major medical events were reported in 31 per cent and 35 per cent had died during the 2-year period. After the episode of acute ischaemia, warfarin was started in 57 per cent of patients, but was continued in only 43 per cent. Reasons for stopping were seldom known, nor was duration of treatment (range 1–22 (median 6) months in reported cases). Significantly more patients who were not on warfarin suffered recurrent acute limb ischaemia (19 versus 3 per cent; P< 0·01). No significant association was found between recurrent acute ischaemia and initial diagnosis of embolism, thrombosis or atrial fibrillation (but numbers of recurrences in each group were small). Conclusion The incidence of recurrent acute thromboembolic limb ischaemia up to 2 years was significantly lower in patients treated with warfarin. Warfarin treatment is often stopped for no clear reason, especially in the elderly. Explicit advice about long-term warfarin therapy should be given when these patients are discharged from hospital.