[Use of antithrombotic agents in peripheral arterial diseases]

Antithrombotic agents are frequently used in patients with peripheral arterial occlusive disease. This use is based on controlled clinical trials but also (mainly) on empirical experience of clinicians or on extrapolation from data obtained in coronary patients. The present paper reviews briefly the indications of anti-platelet and anticoagulant treatments in the settings of primary prevention, and secondary prevention in chronic or acute arterial insufficiency of lower limbs, after revascularization surgery, and following angioplastic procedures. Many recommendations are derived from corresponding situations in the coronary setting although analogies are not always pertinent. In summary, aspirin is indicated in almost all patients with peripheral arterial occlusive disease, at least for preventing acute coronary or cerebrovascular events. Heparin is used (or even indicated) during vascular surgical or interventional radiologic procedures. The place of oral anticoagulants is less well established, except after an acute arterial obstruction from an embolus of cardiac origin. Nonetheless, they are frequently prescribed after distal bypasses (below the knee) or in case of poor run-off.