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Dual-pathway inhibition in patients with chronic limb-threatening ischemia requiring reintervention for
Burak Teymen1, Mehmet Emin Öner2, Yiğit Erdağ3
1Department of Cardiology, Emsey Hospital, Kurtköy Pendik, 34912, Istanbul, Turkey. burakteymen@yahoo.com.
Heart and Vessels
|April 22, 2024
Summary
New oral anticoagulant (NOAC) therapy significantly improved outcomes for patients undergoing below-the-knee intervention, reducing reocclusion and revascularization rates compared to dual-antiplatelet therapy (DAPT). This NOAC approach offers a promising alternative for managing chronic limb-threatening ischemia.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Pharmacology
Background:
- Chronic limb-threatening ischemia (CLTI) poses significant challenges, often requiring complex interventions.
- Endovascular intervention for below-the-knee (BTK) occlusions necessitates strategies to maintain patency and prevent reintervention.
- Optimizing antithrombotic therapy after BTK intervention is crucial for long-term clinical success.
Purpose of the Study:
- To evaluate the impact of new oral anticoagulant (NOAC) therapy on clinical outcomes following endovascular intervention for BTK occlusions requiring reintervention.
- To compare the efficacy and safety of NOAC plus clopidogrel versus dual-antiplatelet therapy (DAPT) in patients with CLTI undergoing BTK reintervention.
Main Methods:
- Retrospective analysis of 64 patients undergoing endovascular reintervention for BTK occlusions.
- Patients were divided into two groups: NOAC (rivaroxaban 2.5 mg BID + clopidogrel) and DAPT (clopidogrel + aspirin).
- Primary endpoints included target vessel reocclusion and target lesion revascularization (TLR) at 1-year follow-up; secondary endpoints were amputation rates and major bleeding events.
Main Results:
- The NOAC group demonstrated significantly lower rates of TLR (10.7% vs. 32.4%, p=0.043) and target vessel reocclusion (17.8% vs. 41.2%, p=0.048) at 1 year compared to the DAPT group.
- Amputation rates were numerically lower in the NOAC group (3.6% vs. 11.7%), although not statistically significant (p=0.245).
- No significant difference in major bleeding events was observed between the NOAC and DAPT groups.
Conclusions:
- Incorporating NOAC therapy (rivaroxaban + clopidogrel) significantly improves patency and reduces revascularization rates after endovascular BTK reintervention in CLTI patients.
- NOAC-based therapy appears to be a safe and effective alternative to DAPT, with comparable bleeding risk.
- Further prospective studies are warranted to confirm these findings and optimize antithrombotic strategies for BTK interventions.
