Clopidogrel and 1-year freedom from amputation after endovascular lower extremity revascularization in the Medicare...

Area of Science:

• Vascular Surgery
• Pharmacology
• Health Services Research

Background:

• Peripheral artery disease (PAD) affects millions, with lower extremity revascularization (LER) being a common treatment.
• Clopidogrel is an antiplatelet medication often prescribed post-LER to prevent thrombotic events.
• Understanding clopidogrel's impact on amputation rates after LER is crucial for optimizing patient outcomes.

Purpose of the Study:

• To evaluate the association between clopidogrel use and freedom from amputation following LER in elderly Medicare beneficiaries.
• To identify patient subgroups that may benefit most from post-LER clopidogrel therapy.

Main Methods:

• Retrospective analysis of Medicare data (Provider Analysis and Review and Carrier files) for patients aged 65+ undergoing LER.
• Identification of clopidogrel use via the National Drug Code directory.
• Comparison of amputation rates at 30 days, 90 days, and 1 year between clopidogrel users and non-users.

Main Results:

• A total of 14,353 patients were analyzed; 5,416 (37.7%) received clopidogrel post-LER.
• Clopidogrel users exhibited significantly lower amputation rates at all time points: 30 days (10.34% vs. 14.09%), 90 days (14.05% vs. 18.71%), and 1 year (19.68% vs. 24.06%).
• Patients with ulceration/tissue loss showed the greatest benefit from clopidogrel, with improved amputation-free survival and overall survival.

Conclusions:

• Clopidogrel utilization following LER is associated with reduced amputation rates in the elderly Medicare population.
• A significant proportion of eligible patients (62%) did not receive clopidogrel post-LER, indicating potential underutilization.
• Targeted clopidogrel therapy, particularly for patients with critical limb ischemia (ulceration/tissue loss), may significantly improve limb salvage and survival outcomes.