Trends in embolectomy of the extremities: a population-based study

Background: There is anecdotal evidence that fewer brachial and femoral embolectomies are being carried out. This may be because of the greater use of anticoagulation in patients with atrial fibrillation. The aim of the present study was to assess community-wide temporal trends in embolectomy of the extremities and of warfarin usage.Methods: The Western Australian Linked Data System was used to identify cases of extremity embolectomy with a combination of diagnosis (upper or lower limb embolus) and procedure (embolectomy and revascularization) codes. Trends in age-specific and age-standardized rates were assessed over the period 1992-2003. Data regarding warfarin prescriptions were acquired from the Pharmaceutical Benefits Schedule database for the period 2000-2005.Results: One thousand and five patients aged 30 years and more underwent an embolectomy of the extremity during the study period. The age-specific rate of embolectomy increased from 0.78 per 100 000 in the 30- to 49-year-old group to 46.1 per 100 000 for those aged 80 years and more. There was a significant downward trend between 1992 and 2003 (Cuzik's trend test P = 0.015). This pattern was seen for all age groups. Prescriptions for warfarin increased by 50.4% over the period 2000-2005.Conclusion: The rates of embolectomy of the extremity appear to be falling. Although the cause for this trend is not known, one possible explanation is increasing prescription of warfarin.