Antithrombotic Therapy After Peripheral Vascular Intervention.

Area of Science:

• Vascular Surgery
• Cardiology
• Interventional Cardiology

Background:

• Peripheral artery disease (PAD) management involves cardioprotective medications and risk-factor modification.
• Revascularization (endovascular or surgical) is considered for severe PAD symptoms, with a rise in Peripheral Vascular Interventions (PVI) shifting care to outpatient settings.
• Despite advancements in PVI, optimal antithrombotic therapy post-procedure is not well-established.

Purpose of the Study:

• To review current practices and identify knowledge gaps in antithrombotic therapy following PVI.
• To highlight the need for evidence-based guidelines on the duration and type of antithrombotic agents post-PVI.

Main Methods:

• Review of current treatment protocols for antithrombotic therapy post-PVI in the USA.
• Analysis of existing data on the use of aspirin and P2Y12 inhibitors (e.g., clopidogrel) with variable durations.
• Identification of the need for further observational studies and randomized clinical trials.

Main Results:

• Current antithrombotic strategies post-PVI typically involve indefinite aspirin with variable clopidogrel duration (1 month, 3 months, or indefinite).
• There is a lack of robust data from clinical trials evaluating clinically relevant outcomes, including cardiovascular events and bleeding risk, associated with different antithrombotic regimens.
• The shift towards outpatient PVI necessitates clear guidelines for antithrombotic management.

Conclusions:

• Optimal antithrombotic therapy following PVI requires further investigation.
• More research, including randomized clinical trials, is essential to guide the role and duration of antithrombotic agents post-PVI.
• Evidence is needed to balance the benefits of preventing thrombotic events against the risks of bleeding in PAD patients undergoing PVI.