Optimal Antithrombotic Therapy for Peripheral Artery Disease: A Systematic Review and Network Meta-Analysis.

Area of Science:

• Cardiovascular Medicine
• Pharmacology
• Clinical Trials

Background:

• Optimal antithrombotic therapy for peripheral artery disease (PAD) is unclear, requiring a balance between preventing thromboembolic events and minimizing bleeding risks.
• Existing research lacks comprehensive comparisons of various antithrombotic regimens in PAD patients.

Purpose of the Study:

• To compare the efficacy and safety of different antithrombotic regimens in patients diagnosed with peripheral artery disease.
• To identify optimal treatment strategies for managing cardiovascular and limb-related events in PAD.

Main Methods:

• A network meta-analysis was conducted on seventeen randomized controlled trials involving 44,532 participants.
• Evaluated antithrombotic therapies included aspirin, P2Y12 inhibitors (clopidogrel, ticagrelor), cilostazol, and rivaroxaban.
• Primary outcome: major adverse cardiac events (MACE); Secondary outcomes: major adverse limb events (MALE); Safety outcome: major bleeding.

Main Results:

• Clopidogrel plus cilostazol significantly reduced major adverse cardiac events (MACE) compared to aspirin monotherapy (HR, 0.37).
• Other regimens like clopidogrel monotherapy, aspirin plus low-dose rivaroxaban, and aspirin plus ticagrelor also showed reduced MACE.
• Aspirin plus rivaroxaban or ticagrelor decreased major adverse limb events (MALE), but rivaroxaban monotherapy and certain combination therapies increased bleeding risk.

Conclusions:

• Clopidogrel combined with cilostazol or clopidogrel monotherapy presents a potentially balanced antithrombotic approach for peripheral artery disease patients.
• These strategies may offer improved cardiovascular and limb event prevention while considering safety profiles.