Dual antiplatelet therapy in peripheral arterial disease and after peripheral percutaneous revascularization

Peripheral arterial disease (PAD) is common and is associated with a high cardiovascular mortality. While dual antiplatelet therapy (DAT) does not appear superior to antiplatelet monotherapy in preventing myocardial infarction, stroke, and death in the general PAD population, a subgroup of patients with peripheral percutaneous revascularization, particularly superficial femoral artery (SFA) stenting, may benefit from prolonged DAT (>3 months). One to 3 months of DAT appears reasonable after percutaneous revascularization of SFA in low-risk settings, and 1 month of DAT appears reasonable after iliac stenting or carotid stenting, but definite randomized trial data are lacking. Individualized therapy, taking into account the diffuseness of the disease, the quality of the inflow and the outflow, the presence of critical limb ischemia, the extent of stenting, the use of covered stents, and the stent fracture risk is reasonable.