[Antithrombotic therapy after peripheral vascular treatment: what is evidence-based?]

Area of Science:

• Vascular Surgery
• Cardiology
• Pharmacology

Background:

• Peripheral arterial occlusive disease (PAOD) is a manifestation of systemic atherosclerosis.
• Initial management focuses on cardiovascular risk factor reduction through lifestyle changes and medication.

Purpose of the Study:

• To outline differentiated antiplatelet and anticoagulation strategies following surgical revascularization for PAOD.
• To emphasize the importance of tailored therapy based on revascularization technique and vascular territory.

Main Methods:

• Review of current therapeutic guidelines for antiplatelet and anticoagulation therapy post-revascularization.
• Differentiation of treatment protocols based on surgical procedures (thrombendarterectomy, alloplastic bypass, venous graft) and anatomical location (above/below knee).

Main Results:

• For alloplastic bypass grafts (aortic, aorto-iliac, aorto-femoral, femoro-popliteal above knee), long-term aspirin (ASA) 100 mg/day or clopidogrel 75 mg/day is recommended.
• For alloplastic bypass grafts below the knee, combination therapy with ASA 100 mg/day and clopidogrel 75 mg/day is advised.
• For venous grafts, anticoagulation with vitamin K antagonists (INR 2-3) is preferred if bleeding risk is low; otherwise, ASA 100 mg/day is used.

Conclusions:

• Post-revascularization therapy for PAOD necessitates individualized antiplatelet or anticoagulation regimens.
• Structured surveillance programs are crucial for managing risk factors and monitoring vascular status and medication efficacy.