Two-year follow-up after acute thromboembolic limb ischaemia: the importance of anticoagulation

Background: evidence on the effectiveness and usage of long-term anticoagulant therapy after acute thromboembolic limb ischaemia is very sparse. This study correlated medical events with administration of warfarin. Method: during a three-month audit in 1996, 287 patients with embolism or thrombosis in situ survived for 30 days, and 214 (75%) were reviewed by questionnaires returned from clinicians throughout the United Kingdom. Minimum follow-up was two years. Results: thirty-five per cent had died. Recurrent acute limb ischaemia was reported in 11%, arterial intervention in 11% and major amputation in 12%. Warfarin was given initially to 57% patients, but at follow-up only 43% were still taking warfarin (p<0.05); reasons for stopping anticoagulation were often unknown. Recurrent limb ischaemia was less common in patients given warfarin initially (7% versus 17%) and still taking warfarin (3% versus 19%) - p<0.05. Amputation was also less common in patients given warfarin initially (5% versus 21%) and still on warfarin (3% versus 21%) - p<0.05. Conclusion: long-term oral anticoagulation was associated with reduced risk of recurrent limb ischaemia and amputation, but more research is needed to define the benefits and risks, especially for thrombosis in situ. Clinicians should give clear advice about anticoagulation when patients are discharged from hospital.