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Antiplatelet therapy for peripheral arterial disease and critical limb ischemia: guidelines abound, but where are the

Amir Azarbal1, Leonardo Clavijo2, Michael A Gaglia3

  • 1Department of Internal Medicine, University of Alabama-Huntsville, Huntsville, AL, USA.

Journal of Cardiovascular Pharmacology and Therapeutics
|August 1, 2014
PubMed

Insights

Antiplatelet therapy is standard for peripheral arterial disease but lacks strong evidence in this high-risk group. Current treatments show limited effectiveness for peripheral vascular outcomes.

Area of Science:

  • Vascular Medicine
  • Pharmacology
  • Clinical Guidelines

Background:

  • Antiplatelet therapy is a cornerstone in managing peripheral arterial disease (PAD) and critical limb ischemia (CLI).
  • Major society guidelines recommend antiplatelet agents for these high-risk patients.
  • However, robust clinical trial data supporting these recommendations in PAD/CLI populations is often limited.

Purpose of the Study:

  • To summarize current guidelines on antiplatelet therapy for PAD and CLI.
  • To review existing studies on antiplatelet agents in PAD.
  • To provide perspective on newer agents and discuss overall efficacy.

Main Methods:

  • Systematic review of major guidelines for antiplatelet therapy in PAD/CLI.
  • Comprehensive literature search of clinical trials evaluating aspirin, clopidogrel, dipyridamole, cilostazol, and prostanoids in PAD.
  • Analysis of data on newer agents like ticagrelor, vorapaxar, and rivaroxaban.

Main Results:

  • Guidelines consistently recommend antiplatelet therapy for PAD and CLI.
  • Evidence for established agents like aspirin and clopidogrel in PAD shows variable results.
  • Data on newer agents is emerging, but definitive efficacy in peripheral vascular outcomes remains uncertain.

Conclusions:

  • Despite guideline recommendations, high-quality evidence for antiplatelet therapy in PAD/CLI is scarce.
  • Established antiplatelet agents demonstrate a relative lack of efficacy for peripheral vascular outcomes.
  • Further research is needed to clarify the role and optimal use of antiplatelet therapy in PAD and CLI.

Keywords:
antiplatelet therapyaspirinclopidogrelcritical limb ischemiaperipheral arterial disease heart disease

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