Antithrombotic therapy in peripheral arterial disease

Area of Science:

• Cardiology
• Vascular Medicine
• Pharmacology

Background:

• Peripheral arterial disease (PAD) patients face elevated risks of major adverse cardiovascular events (MACE) and major adverse limb events (MALE).
• Preventing thrombotic events is critical for improving outcomes in PAD.
• This review synthesizes current evidence and guidelines on antithrombotic therapy for PAD.

Purpose of the Study:

• To review current evidence and guideline recommendations for antithrombotic therapy in patients with peripheral arterial disease (PAD).
• To evaluate the efficacy and safety of dual pathway inhibition in PAD management.

Main Methods:

• Review of current evidence and guideline recommendations.
• Analysis of data from trials such as COMPASS and VOYAGER-PAD evaluating dual pathway inhibition (low-dose rivaroxaban plus aspirin).

Main Results:

• Dual pathway inhibition demonstrated superiority over aspirin alone in preventing MACE and MALE.
• Dual pathway inhibition reduced the risk of acute limb ischemia, particularly after peripheral revascularization.
• Major bleeding risk is increased with dual pathway inhibition.

Conclusions:

• Antithrombotic therapy is effective in reducing MACE and MALE in PAD patients.
• Current guidelines recommend low-dose rivaroxaban plus aspirin for PAD patients with low bleeding risk.
• For high bleeding risk patients, single antiplatelet therapy (preferably clopidogrel) is advised.
• In PAD patients with atherosclerotic vascular disease requiring oral anticoagulation, additional antiplatelet therapy is not recommended due to increased bleeding risk without prognostic benefit.