Variability in Antithrombotic Therapy after Infrainguinal Lower Extremity Bypass.

Area of Science:

• Vascular Surgery
• Pharmacology
• Health Services Research

Background:

• Antiplatelet monotherapy is recommended post infrainguinal lower extremity bypass (LEB).
• Limited high-quality data exists to guide antithrombotic therapy choices.
• Current practice often involves combination therapy with anticoagulation.

Purpose of the Study:

• To assess variability in antithrombotic therapy use after infrainguinal LEB.
• To identify predictors of combination therapy versus monotherapy.
• To quantify physician and center-level practice variations.

Main Methods:

• Retrospective review of the Vascular Quality Initiative dataset (2015-2021).
• Analysis of discharge patterns: monotherapy (SAPT, SAC) vs. combination therapy (DAPT, ACAP, triple).
• Multivariable logistic regression and median odds ratios (MOR) to identify predictors and variability.

Main Results:

• Over 29,500 LEB patients analyzed; 10,634 received monotherapy, 18,873 received combination therapy.
• SAPT was most common monotherapy; DAPT and ACAP were most common combination therapies.
• Significant physician (MOR: 1.65) and center (MOR: 1.64) variability observed in therapy selection, independent of patient factors.

Conclusions:

• Wide variability in antithrombotic regimens post-LEB highlights a lack of evidence-based guidelines.
• Physician and center-level variations underscore the need for standardized therapeutic approaches.
• Pragmatic trials are essential to guide optimal antithrombotic strategies for LEB patients.