Impact of long-term warfarin treatment on EVAR durability: a meta-analysis

J Endovasc Ther. 2014 Feb;21(1):148-53. doi: 10.1583/13-4462R.1.


Purpose: To evaluate whether postoperative long-term oral anticoagulation affects the durability of endovascular aneurysm repair (EVAR) and whether it is associated with an increased incidence of endoleak and subsequent need for reintervention.

Methods: A literature search was performed to identify studies of abdominal aortic aneurysm patients undergoing EVAR including an arm receiving warfarin postoperatively and reporting the frequency of any endoleaks and/or persistent type II endoleaks and reinterventions. The search identified 81 articles, of which 5 observational cohort studies ultimately met the inclusion criteria.

Results: Postoperative anticoagulation was required in 219 (14.6%) of the 1499 patients in the selected studies. The pooled effects analysis found that EVAR patients receiving long-term warfarin postoperatively had significantly more endoleaks of any type (OR 1.77, 95% CI 1.26 to 2.48, p=0.001) as well as persistent type II endoleaks (OR 1.58, 95% CI 1.05 to 2.37, p=0.03) compared with patients not on anticoagulation; however, there was no statistically significant difference in the reintervention rate between the groups.

Conclusion: Long-term anticoagulation in EVAR patients was associated with a statistically significant increase in any endoleak and persisting type II endoleaks, although it was not linked to an increased risk of reintervention. Close monitoring for EVAR patients who require long-term oral anticoagulation is advised.

Publication types

  • Meta-Analysis
  • Review

MeSH terms

  • Administration, Oral
  • Anticoagulants / administration & dosage
  • Anticoagulants / adverse effects*
  • Aortic Aneurysm, Abdominal / diagnosis
  • Aortic Aneurysm, Abdominal / surgery*
  • Blood Vessel Prosthesis Implantation / adverse effects*
  • Chi-Square Distribution
  • Endoleak / diagnosis
  • Endoleak / etiology*
  • Endoleak / therapy
  • Endovascular Procedures / adverse effects*
  • Humans
  • Odds Ratio
  • Retreatment
  • Risk Assessment
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • Warfarin / administration & dosage
  • Warfarin / adverse effects*


  • Anticoagulants
  • Warfarin