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Antithrombotic Therapy in Lower Extremity Artery Disease
Mislav Vrsalovic1,2, Victor Aboyans3,4
1University of Zagreb, School of Medicine, Zagreb, Croatia.
Current Vascular Pharmacology
|February 8, 2019
Summary
Antithrombotic therapy is crucial for managing lower extremity artery disease (LEAD) to prevent cardiovascular and limb events. A combination of rivaroxaban and aspirin shows promise for high-risk patients, reducing mortality and amputation risk.
Area of Science:
- Cardiovascular Medicine
- Vascular Surgery
- Pharmacology
Background:
- Lower extremity artery disease (LEAD) signifies advanced atherosclerosis with elevated mortality risk.
- Antithrombotic therapy is essential for preventing ischemic events and death in LEAD patients.
Purpose of the Study:
- To review current antithrombotic strategies for symptomatic lower extremity artery disease.
- To evaluate the efficacy and safety of novel antithrombotic regimens, including direct oral anticoagulants.
Main Methods:
- Review of established guidelines and recent clinical trials on antithrombotic therapy in LEAD.
- Analysis of comparative effectiveness of aspirin, clopidogrel, ticagrelor, and dual antiplatelet therapy (DAPT).
- Assessment of the role of anticoagulants, including vitamin K antagonists and direct oral anticoagulants like rivaroxaban, in combination with antiplatelet agents.
Main Results:
- Aspirin and clopidogrel are mainstays, with DAPT recommended post-intervention.
- Adding vitamin K antagonists to antiplatelet therapy increases bleeding risk without cardiovascular benefit.
- Low-dose rivaroxaban plus aspirin demonstrated potential in reducing cardiovascular and limb events in high-risk patients, balanced against bleeding risk.
Conclusions:
- Optimal antithrombotic therapy for LEAD requires risk stratification and guideline adherence.
- Novel combinations like rivaroxaban plus aspirin warrant consideration in carefully selected high-risk LEAD patients.
- Despite evidence, many LEAD patients remain undertreated, necessitating improved guideline implementation.
Keywords:
Lower extremity artery diseaseantiplatelet therapyantithrombotic therapyatherosclerosisdirect oral
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