Dual antiplatelet therapy is associated with prolonged survival after lower extremity revascularization

A systematic review of the efficacy of aspirin monotherapy versus other antiplatelet therapy regimens in peripheral arterial disease.

Background: Despite current guidelines suggesting a benefit for dual antiplatelet therapy (DAPT) following peripheral vascular intervention (PVI), there are limited data on antiplatelet prescribing...

Discharge Prescription Patterns for Antiplatelet Therapy Following Lower Extremity Peripheral Vascular Intervention

Antiplatelet therapy is commonly prescribed following endovascular interventions. However, there is limited data regarding the regimen and duration of antiplatelet therapy following lower extremity endovascular interventions. The aim of this study was to investigate the practice patterns of dual antiplatelet therapy (DAPT) after lower extremity endovascular interventions. We identified all patients who received an endovascular intervention in the Vascular Study Group of New England (VSGNE) registry from 2010 through 2018. The antiplatelet regimen was examined at the time of discharge and follow-up. Variables predicting discharge antiplatelet therapy and duration of antiplatelet therapy were investigated. There were 13,510 (57.69%) patients discharged on DAPT, 8618 (36.80%) patients discharged on single antiplatelet therapy, and 1292 (5.51%) patients discharged without antiplatelet therapy. Patients with coronary artery disease (CAD), prior vascular bypass and endovascular intervention, preoperative statin use, stent placement compared with angioplasty, and femoropopliteal and tibial treatment were associated with higher odds of being discharged with DAPT compared with no antiplatelet therapy and single antiplatelet therapy. Of the patients discharged on DAPT who were followed up at 9-12 months and 21-24 months, 56.49% and 49.63% remained on DAPT, respectively. Only a narrow margin of the patient majority undergoing endovascular interventions was discharged with DAPT, suggesting that only a small proportion of patients undergoing endovascular intervention remain on DAPT long-term. As the number of peripheral vascular interventions continues to grow, further studies are crucial to identify the optimal duration of DAPT.

https://journals.sagepub.com/doi/pdf/10.1177/1358863X19880602

Practice patterns of dual antiplatelet therapy after lower extremity endovascular interventions

Purpose of review Although antiplatelet agents are frequently prescribed to patients with lower extremity peripheral artery disease (PAD), there is an overall lack of consensus among published evidence and guidelines with respect to this practice. Recent findings Antiplatelet agents are prescribed to patients with PAD to reduce both cardiovascular and limb-based events during the follow-up period. A large evidence base supports the use of antiplatelet monotherapy with aspirin or clopidogrel in patients with symptomatic PAD or a history of peripheral artery revascularization. However, antiplatelet monotherapy has not proven beneficial in patients with asymptomatic PAD. Dual antiplatelet therapy has not demonstrated a clear benefit in reducing the risk of cardiovascular events in patients with symptomatic PAD. Its role in reducing the risk of adverse limb events following endovascular or surgical revascularization also remains unclear. Recently, the use of vorapaxar in addition to aspirin and/or clopidogrel has been associated with a significant reduction in the need for repeat revascularization procedures and hospitalization for limb ischemia in patients with established PAD. Summary Eligible patients with symptomatic PAD or with a history of peripheral artery revascularization should be prescribed antiplatelet monotherapy for secondary prevention of both cardiovascular and limb events, using aspirin, clopidogrel, and/or vorapaxar. Given the significant overlap of PAD and coronary artery disease, the evidence presented in this article may have important implications for management of patients with coronary artery disease.

The role of antiplatelet therapy in patients with peripheral artery disease and lower extremity peripheral artery revascularization.

Comparison of Dual-Antiplatelet Therapy Durations after Endovascular Revascularization of Infrainguinal Arteries

TCT-529 Comparison of Peripheral Arterial Chronic Total Occlusion Crossing Strategies in the XLPAD Registry

There is limited data regarding differences in patency and clinical outcomes of patients with life style limiting claudication and Critical Limb Ischemia (CLI).

Retrospective data analysis was conducted from the ongoing XL PAD registry between July, 2005-October, 2013 to report clinical and

CRT-213 Comparison of Revascularization Outcomes for Patients with Lifestyle Limiting Claudication to Critical Limb Ischemia

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Comparison of Dual-Antiplatelet Therapy Durations after Endovascular Revascularization of Infrainguinal Arteries

TCT-529 Comparison of Peripheral Arterial Chronic Total Occlusion Crossing Strategies in the XLPAD Registry

CRT-213 Comparison of Revascularization Outcomes for Patients with Lifestyle Limiting Claudication to Critical Limb Ischemia