Management of thrombosis in peripheral arterial disease
G D Lowe1, A W Reid, D P Leiberman
1University Department of Medicine, Department of Radiology, Glasgow Royal Infirmary, UK.
Insights
Thrombosis significantly impacts peripheral arterial disease, necessitating antithrombotic therapy across symptomatic stages. Treatment varies by condition, from antiplatelet drugs for claudication to anticoagulation for critical limb ischemia.
Area of Science:
- Vascular Medicine
- Thrombosis Research
- Cardiovascular Surgery
Background:
- Thrombosis is increasingly recognized as a key factor in the development and progression of peripheral arterial disease (PAD).
- Antithrombotic therapies are crucial for managing symptomatic PAD, but their optimal use varies depending on the specific clinical presentation.
Purpose of the Study:
- To review the role of antithrombotic therapy in different stages of symptomatic peripheral arterial disease.
- To outline current therapeutic strategies for managing thrombosis in claudication and critical limb ischemia.
Main Methods:
- Literature review of evidence regarding antithrombotic treatments for PAD.
- Analysis of treatment protocols for claudication, chronic critical limb ischemia, and acute critical limb ischemia.
Main Results:
- Antiplatelet therapy is standard for claudication, alongside lifestyle changes and revascularization procedures.
- For chronic critical limb ischemia, low-dose heparin for venous thromboembolism prophylaxis during hospitalization and long-term antiplatelet therapy are recommended; local thrombolysis and prostanoid infusions are options.
- Acute critical limb ischemia requires full heparinization followed by interventions like thromboembolectomy, thrombolysis, angioplasty, or surgery, with post-procedure antiplatelet/anticoagulation based on individual risk.
Conclusions:
- Antithrombotic therapy is essential throughout symptomatic peripheral arterial disease management.
- Multidisciplinary collaboration among vascular surgeons, radiologists, and physicians ensures comprehensive patient care for thrombosis-related PAD.
Abstract:
There is accumulating evidence that thrombosis contributes to peripheral arterial disease, and that antithrombotic therapy should be considered at all symptomatic stages. In claudication, antiplatelet therapy is indicated in addition to lifestyle advice and sometimes surgery or angioplasty; the place of thrombolysis is unproven. In chronic critical limb ischaemia, prophylaxis of venous thromboembolism by low-dose heparin is indicated during hospitalisation, as is long-term antiplatelet therapy; local thrombolysis or systemic prostanoid infusions are increasingly used. In acute critical limb ischaemia, full dose heparinisation is followed by thromboembolectomy, local thrombolysis, angioplasty and surgery as appropriate. Antiplatelet therapy and/or anticoagulation are employed following such procedures, according to risk factors in the individual patient. Collaboration between vascular surgeons, radiologists and physicians is important in comprehensive patient care.
More Related Videos
07:50An In vitro System to Gauge the Thrombolytic Efficacy of Histotripsy and a Lytic Drug
Published on: June 4, 2021
13:48Reduction of Radiation Exposure during Endovascular Treatment of Peripheral Arterial Disease Combining Fiber Optic RealShape Technology and Intravascular Ultrasound
Published on: April 21, 2023
Related Concept Videos
01:30Peripheral Artery Disease I: Introduction
01:27Peripheral Artery Disease III: Interprofessional Care
01:26Peripheral Artery Disease IV: Nursing Management
01:23Peripheral Artery Disease V: Postoperative Nursing Management
01:29Venous Thrombosis III: Interprofessional Care
01:30Venous Thrombosis IV: Nursing Management