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Area of Science:

  • Vascular Surgery
  • Cardiology
  • Pharmacology

Background:

  • Peripheral artery disease (PAD) carries a high risk of cardiovascular and limb complications.
  • Antithrombotic strategies significantly influence long-term outcomes after revascularization.
  • The VOYAGER PAD trial demonstrated benefits of rivaroxaban plus aspirin, but safety concerns, especially in real-world populations like chronic limb-threatening ischemia (CLTI) patients, persist.

Purpose of the Study:

  • To evaluate the eligibility for dual pathway inhibition (DPI) in PAD patients undergoing revascularization.
  • To assess the distribution of bleeding risk using the OAC3PAD score in this patient cohort.
  • To determine the proportion of patients suitable for DPI based on VOYAGER PAD trial criteria.

Main Methods:

  • Retrospective single-center study of 652 patients undergoing lower limb revascularization (2020-2023).
  • Patients categorized by the OAC3PAD score to stratify bleeding risk.
  • Analysis of eligibility for DPI (rivaroxaban plus aspirin) according to VOYAGER PAD criteria.

Main Results:

  • 67.6% of patients (441/652) were potential candidates for low-dose rivaroxaban therapy.
  • Bleeding risk distribution: 12% high, 23% intermediate-high, 46% low-moderate, 19% low.
  • DPI eligibility varied significantly across OAC3PAD risk categories (p<0.001), being highest in low-intermediate risk and lowest in high-risk patients.

Conclusions:

  • Real-world PAD patients, especially those with CLTI, may have a higher bleeding risk than previously recognized.
  • Dual pathway inhibition (DPI) with rivaroxaban and aspirin warrants caution in nearly 50% of CLTI patients due to bleeding risk.
  • Risk stratification tools like OAC3PAD are essential for balancing the benefits and risks of antithrombotic therapy in frail PAD populations.