Oral factor Xa inhibitor underutilization following lower extremity peripheral vascular intervention
Sapan Bhuta1, Robert W Ariss2, Li Ding3
1Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH.
Journal of Vascular Surgery
|April 26, 2023
Summary
Initiation of factor Xa inhibitors after peripheral vascular intervention (PVI) increased but remains low. Most eligible patients do not receive this treatment, indicating limited adoption of dual pathway inhibition (DPI) post-PVI.
Area of Science:
- Cardiovascular Medicine
- Vascular Surgery
- Pharmacology
Background:
- Peripheral vascular intervention (PVI) for lower extremity peripheral artery disease carries high risks of adverse limb and cardiovascular events.
- Dual pathway inhibition (DPI), using a factor Xa inhibitor with single antiplatelet therapy, is proven to reduce these major adverse events.
Purpose of the Study:
- To analyze trends in factor Xa inhibitor use after PVI.
- To identify patient and procedural factors influencing factor Xa inhibitor prescription.
- To compare antithrombotic therapy patterns before and after the VOYAGER PAD trial.
Main Methods:
- Retrospective analysis of the Vascular Quality Initiative PVI registry (January 2018 - June 2022).
- Multivariate logistic regression used to identify predictors of factor Xa inhibitor initiation.
- Analysis included 91,569 PVI procedures.
Main Results:
- Factor Xa inhibitor initiation rose from 3.5% in 2018 to 9.1% in 2022.
- Non-elective or emergent PVI status strongly predicted factor Xa inhibitor use.
- Postoperative dual antiplatelet therapy significantly decreased factor Xa inhibitor initiation, suggesting hesitancy towards DPI.
Conclusions:
- Factor Xa inhibitor use post-PVI has increased but remains low.
- The findings suggest limited clinical practice adoption of VOYAGER PAD trial recommendations for DPI.
- Most eligible patients are not receiving factor Xa inhibitors, highlighting a gap in optimal antithrombotic therapy.
Keywords:
Anti-platelet therapyAnti-thrombotic therapyAnticoagulationDual-pathway inhibition (DPI)Factor Xa inhibitorPeripheral artery disease (PAD)Peripheral vascular interventionSociety for Vascular Surgery (SVS)Vascular Quality Initiative (VQI)More Related Videos
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