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Oral anticoagulant therapy in patients with peripheral artery disease

F L J Visseren1, B C Eikelboom

  • 1Department of Internal and Vascular Medicine, University Medical Center Utrecht, The Netherlands. F.Visseren@azu.nl

Seminars in Vascular Medicine
|June 17, 2004
PubMed

Insights

For peripheral artery disease patients, oral anticoagulants may prevent bypass graft occlusion but increase bleeding risks. Aspirin and clopidogrel are effective for atherothrombotic complications.

Area of Science:

  • Vascular Surgery
  • Cardiology
  • Pharmacology

Background:

  • Peripheral artery disease (PAD) patients experience frequent ischemic vascular complications.
  • Aspirin and clopidogrel effectively reduce atherothrombotic events in PAD.
  • The utility of oral anticoagulants in symptomatic PAD remains limited.

Purpose of the Study:

  • To compare the efficacy and safety of oral anticoagulants versus aspirin in PAD patients.
  • To evaluate the role of oral anticoagulants in preventing infrainguinal bypass occlusion.

Main Methods:

  • Review of randomized controlled trials comparing aspirin with oral anticoagulants.
  • Analysis of outcomes including ischemic events, bypass occlusion, and bleeding complications.

Main Results:

  • Oral anticoagulants (INR 2.5-4.5) are more effective than aspirin in preventing venous infrainguinal bypass occlusion in high-risk cases.
  • The impact of oral anticoagulants on all-cause morbidity and mortality in PAD is not definitively established.
  • Increased bleeding complications are associated with oral anticoagulant use.

Conclusions:

  • Oral anticoagulants offer a potential benefit for specific high-risk infrainguinal bypass grafts in PAD.
  • The increased risk of bleeding complications limits the widespread adoption of oral anticoagulants in PAD management.
  • Further research is needed to clarify the overall risk-benefit profile of oral anticoagulants in PAD.

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