The Use of Antithrombotics Is Not Beneficial for Conservative Management of Spontaneous Isolated Dissection of the Superior Mesenteric Artery

A Meta-analysis

Sanghyun Ahn, Hyejin Mo, Ahram Han, Sang Il Min, Seung Kee Min, Jongwon Ha, Chang Hyun Lee, Myoung jin Jang, In Mok Jung

Research output: Contribution to journalReview articleResearchpeer-review

Abstract

Background: Conservative treatment is feasible in most patients with spontaneous isolated dissection of the superior mesenteric artery (SID-SMA). However, the role of antiplatelet agents and anticoagulants is not well defined in either symptomatic or asymptomatic SID-SMA. This study aimed to conduct a meta-analysis, including a single-arm study, comparing the resolution rate of conservative management with versus without antithrombotics for symptomatic and asymptomatic SID-SMA. Methods: A systematic search of electronic databases, including PubMed, EMBASE, and Cochrane Library, on August 22nd, 2018, was performed to identify studies concerning SID-SMA. Meta-analyses were conducted to determine the primary resolution rate, long-term aneurysmal change for symptomatic SID-SMA, and any event for asymptomatic SID-SMA. We calculated pooled risk ratios and 95% confidence intervals (CIs) using random-effects model in studies with two arms and in studies with two arms or a single arm. Results: We included data from 35 articles involving 727 patients with SID-SMA (symptomatic 693, asymptomatic 134). No significant differences were observed in the successful resolution rate between conservative management with and without antithrombotics (random-effects model, risk ratio [RR] 0.96; 95% CI, 0.87–1.05]). The pooled resolution rate from combining single-arm studies was 91% (95% CI, 85–95) and 95% (95% CI, 88–100) in conservative management with and without antithrombotic, respectively, which was not statistically significant (RR, 0.97; 95% CI, 0.91–1.02). The pooled morphologic progression rate from combining single-arm studies was 3% (95% CI, 0–8) and 11% (95% CI, 2–26) in conservative management with and without antithrombotics, respectively, which was not statistically significant (RR, 0.44; 95% CI, 0.12–1.64). The adverse event was 0% for both groups for asymptomatic SID-SMA. Conclusions: Additional antithrombotic therapy for both symptomatic and asymptomatic SID-SMA did not benefit the outcomes. We do not recommend the use of antithrombotics for SID-SMA, unless further evidence shows any beneficial effect.

Original languageEnglish
Pages (from-to)415-423.e4
JournalAnnals of Vascular Surgery
Volume60
DOIs
StatePublished - 1 Oct 2019

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Superior Mesenteric Artery
Meta-Analysis
Dissection
Confidence Intervals
Odds Ratio
Conservative Treatment
Platelet Aggregation Inhibitors
PubMed
Anticoagulants
Libraries
Databases

Cite this

@article{c47653a06906441f8a7f9621818e06b0,
title = "The Use of Antithrombotics Is Not Beneficial for Conservative Management of Spontaneous Isolated Dissection of the Superior Mesenteric Artery: A Meta-analysis",
abstract = "Background: Conservative treatment is feasible in most patients with spontaneous isolated dissection of the superior mesenteric artery (SID-SMA). However, the role of antiplatelet agents and anticoagulants is not well defined in either symptomatic or asymptomatic SID-SMA. This study aimed to conduct a meta-analysis, including a single-arm study, comparing the resolution rate of conservative management with versus without antithrombotics for symptomatic and asymptomatic SID-SMA. Methods: A systematic search of electronic databases, including PubMed, EMBASE, and Cochrane Library, on August 22nd, 2018, was performed to identify studies concerning SID-SMA. Meta-analyses were conducted to determine the primary resolution rate, long-term aneurysmal change for symptomatic SID-SMA, and any event for asymptomatic SID-SMA. We calculated pooled risk ratios and 95{\%} confidence intervals (CIs) using random-effects model in studies with two arms and in studies with two arms or a single arm. Results: We included data from 35 articles involving 727 patients with SID-SMA (symptomatic 693, asymptomatic 134). No significant differences were observed in the successful resolution rate between conservative management with and without antithrombotics (random-effects model, risk ratio [RR] 0.96; 95{\%} CI, 0.87–1.05]). The pooled resolution rate from combining single-arm studies was 91{\%} (95{\%} CI, 85–95) and 95{\%} (95{\%} CI, 88–100) in conservative management with and without antithrombotic, respectively, which was not statistically significant (RR, 0.97; 95{\%} CI, 0.91–1.02). The pooled morphologic progression rate from combining single-arm studies was 3{\%} (95{\%} CI, 0–8) and 11{\%} (95{\%} CI, 2–26) in conservative management with and without antithrombotics, respectively, which was not statistically significant (RR, 0.44; 95{\%} CI, 0.12–1.64). The adverse event was 0{\%} for both groups for asymptomatic SID-SMA. Conclusions: Additional antithrombotic therapy for both symptomatic and asymptomatic SID-SMA did not benefit the outcomes. We do not recommend the use of antithrombotics for SID-SMA, unless further evidence shows any beneficial effect.",
author = "Sanghyun Ahn and Hyejin Mo and Ahram Han and Min, {Sang Il} and Min, {Seung Kee} and Jongwon Ha and Lee, {Chang Hyun} and Jang, {Myoung jin} and Jung, {In Mok}",
year = "2019",
month = "10",
day = "1",
doi = "10.1016/j.avsg.2019.02.022",
language = "English",
volume = "60",
pages = "415--423.e4",
journal = "Annals of Vascular Surgery",
issn = "0890-5096",
publisher = "Elsevier Inc.",

}

The Use of Antithrombotics Is Not Beneficial for Conservative Management of Spontaneous Isolated Dissection of the Superior Mesenteric Artery : A Meta-analysis. / Ahn, Sanghyun; Mo, Hyejin; Han, Ahram; Min, Sang Il; Min, Seung Kee; Ha, Jongwon; Lee, Chang Hyun; Jang, Myoung jin; Jung, In Mok.

In: Annals of Vascular Surgery, Vol. 60, 01.10.2019, p. 415-423.e4.

Research output: Contribution to journalReview articleResearchpeer-review

TY - JOUR

T1 - The Use of Antithrombotics Is Not Beneficial for Conservative Management of Spontaneous Isolated Dissection of the Superior Mesenteric Artery

T2 - A Meta-analysis

AU - Ahn, Sanghyun

AU - Mo, Hyejin

AU - Han, Ahram

AU - Min, Sang Il

AU - Min, Seung Kee

AU - Ha, Jongwon

AU - Lee, Chang Hyun

AU - Jang, Myoung jin

AU - Jung, In Mok

PY - 2019/10/1

Y1 - 2019/10/1

N2 - Background: Conservative treatment is feasible in most patients with spontaneous isolated dissection of the superior mesenteric artery (SID-SMA). However, the role of antiplatelet agents and anticoagulants is not well defined in either symptomatic or asymptomatic SID-SMA. This study aimed to conduct a meta-analysis, including a single-arm study, comparing the resolution rate of conservative management with versus without antithrombotics for symptomatic and asymptomatic SID-SMA. Methods: A systematic search of electronic databases, including PubMed, EMBASE, and Cochrane Library, on August 22nd, 2018, was performed to identify studies concerning SID-SMA. Meta-analyses were conducted to determine the primary resolution rate, long-term aneurysmal change for symptomatic SID-SMA, and any event for asymptomatic SID-SMA. We calculated pooled risk ratios and 95% confidence intervals (CIs) using random-effects model in studies with two arms and in studies with two arms or a single arm. Results: We included data from 35 articles involving 727 patients with SID-SMA (symptomatic 693, asymptomatic 134). No significant differences were observed in the successful resolution rate between conservative management with and without antithrombotics (random-effects model, risk ratio [RR] 0.96; 95% CI, 0.87–1.05]). The pooled resolution rate from combining single-arm studies was 91% (95% CI, 85–95) and 95% (95% CI, 88–100) in conservative management with and without antithrombotic, respectively, which was not statistically significant (RR, 0.97; 95% CI, 0.91–1.02). The pooled morphologic progression rate from combining single-arm studies was 3% (95% CI, 0–8) and 11% (95% CI, 2–26) in conservative management with and without antithrombotics, respectively, which was not statistically significant (RR, 0.44; 95% CI, 0.12–1.64). The adverse event was 0% for both groups for asymptomatic SID-SMA. Conclusions: Additional antithrombotic therapy for both symptomatic and asymptomatic SID-SMA did not benefit the outcomes. We do not recommend the use of antithrombotics for SID-SMA, unless further evidence shows any beneficial effect.

AB - Background: Conservative treatment is feasible in most patients with spontaneous isolated dissection of the superior mesenteric artery (SID-SMA). However, the role of antiplatelet agents and anticoagulants is not well defined in either symptomatic or asymptomatic SID-SMA. This study aimed to conduct a meta-analysis, including a single-arm study, comparing the resolution rate of conservative management with versus without antithrombotics for symptomatic and asymptomatic SID-SMA. Methods: A systematic search of electronic databases, including PubMed, EMBASE, and Cochrane Library, on August 22nd, 2018, was performed to identify studies concerning SID-SMA. Meta-analyses were conducted to determine the primary resolution rate, long-term aneurysmal change for symptomatic SID-SMA, and any event for asymptomatic SID-SMA. We calculated pooled risk ratios and 95% confidence intervals (CIs) using random-effects model in studies with two arms and in studies with two arms or a single arm. Results: We included data from 35 articles involving 727 patients with SID-SMA (symptomatic 693, asymptomatic 134). No significant differences were observed in the successful resolution rate between conservative management with and without antithrombotics (random-effects model, risk ratio [RR] 0.96; 95% CI, 0.87–1.05]). The pooled resolution rate from combining single-arm studies was 91% (95% CI, 85–95) and 95% (95% CI, 88–100) in conservative management with and without antithrombotic, respectively, which was not statistically significant (RR, 0.97; 95% CI, 0.91–1.02). The pooled morphologic progression rate from combining single-arm studies was 3% (95% CI, 0–8) and 11% (95% CI, 2–26) in conservative management with and without antithrombotics, respectively, which was not statistically significant (RR, 0.44; 95% CI, 0.12–1.64). The adverse event was 0% for both groups for asymptomatic SID-SMA. Conclusions: Additional antithrombotic therapy for both symptomatic and asymptomatic SID-SMA did not benefit the outcomes. We do not recommend the use of antithrombotics for SID-SMA, unless further evidence shows any beneficial effect.

UR - http://www.scopus.com/inward/record.url?scp=85066941998&partnerID=8YFLogxK

U2 - 10.1016/j.avsg.2019.02.022

DO - 10.1016/j.avsg.2019.02.022

M3 - Review article

VL - 60

SP - 415-423.e4

JO - Annals of Vascular Surgery

JF - Annals of Vascular Surgery

SN - 0890-5096

ER -