Rationale for the use of antiplatelet drugs in patients with peripheral vascular disease

Area of Science:

• Vascular Medicine
• Cardiology
• Pharmacology

Background:

• Peripheral vascular disease (PVD) involves atherosclerotic progression in lower limbs, increasing risks of cardiac and cerebral events.
• Antiplatelet agents are hypothesized to slow atherosclerotic progression in peripheral vessels.

Purpose of the Study:

• To evaluate the efficacy of antiplatelet treatment in retarding atherosclerotic progression in peripheral vessels.
• To assess the impact of antiplatelet therapy on cardiovascular complications in patients with PVD.

Main Methods:

• Review of angiographic studies demonstrating aspirin's benefit in reducing surgical intervention needs for PVD.
• Analysis of three large clinical trials assessing antiplatelet treatment's effect on cardiovascular complications.
• Comparison of intention-to-treat versus on-treatment analyses for cardiovascular event reduction.

Main Results:

• Intention-to-treat analyses from clinical trials did not show a significant benefit of antiplatelet treatment.
• On-treatment analyses revealed a significant reduction in global cardiovascular events with antiplatelet therapy.
• Current studies lack the statistical power to definitively assess antiplatelet effects on major cardiovascular events.

Conclusions:

• Antiplatelet treatment shows potential in managing PVD complications, particularly in reducing overall cardiovascular events.
• Future clinical trials should focus on high-risk patients to evaluate the impact of antiplatelet therapy on major cardiovascular events.