Antithrombotic Therapy for Symptomatic Peripheral Arterial Disease: A Systematic Review and Network Meta-Analysis

Area of Science:

• Cardiovascular Medicine
• Pharmacology
• Clinical Trials

Background:

• Limited evidence directly compares antiplatelet therapies in symptomatic peripheral arterial disease (PAD).
• Network meta-analysis is needed to evaluate various antithrombotic regimens in PAD patients.

Approach:

• Systematic search and meta-analysis of randomized controlled trials (RCTs) comparing antithrombotic regimens in PAD.
• Primary endpoints included major adverse cardiovascular events (MACE) and major bleeding.
• Secondary endpoints were major adverse limb events (MALE) and acute limb ischemia (ALI).

Key Points:

• Clopidogrel, ticagrelor, aspirin plus ticagrelor, and aspirin plus low-dose rivaroxaban demonstrated superior MACE reduction compared to aspirin monotherapy.
• Aspirin plus low-dose rivaroxaban was more effective in preventing ALI.
• Post-peripheral revascularization (≥3 months), aspirin plus low-dose rivaroxaban showed superiority in preventing MACE and MALE compared to aspirin.

Conclusions:

• Clopidogrel is a potential first-line antithrombotic therapy for most PAD patients.
• Aspirin plus low-dose rivaroxaban may be considered for long-term prevention of MACE and MALE after peripheral vascular intervention, despite increased bleeding risk.
• Further research is needed for antithrombotic strategies within 3 months post-intervention.