Dual vs single antiplatelet therapy in patients with lower extremity peripheral artery disease – A meta-analysis

Navarese, Eliano Pio; Wernly, Bernhard; Lichtenauer, Michael; Petrescu, Aniela; Kołodziejczak, Michalina; Lauten, Alexander; Frediani, Lara; Veulemanns, V.; Wańha, Wojciech; Wojakowski, Wojciech; Lesiak, Maciej; Ferrante, Giuseppe; Zeus, Tobias; Tantry, Udaya S.; Bliden, Kevin P.; Buffon, Antonino; Contegiacomo, Gaetano; Jung, Christian; Kubica, Jacek; Pestrichella, Vincenzo; Gurbel, Paul A.

doi:10.1016/j.ijcard.2018.07.009

Cited by 15 publications

(11 citation statements)

References 31 publications

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“…Moreover, also the intake of antiplatelet drugs might have influenced VCAM-1 levels. Antiplatelet therapy is recommended in all patients with symptomatic PAD [ 9 , 37 , 38 ]; however, in subclinical PAD, the usefulness and clinical benefit for patients remain elusive.…”

Section: Discussionmentioning

confidence: 99%

Disease-specific characteristics of vascular cell adhesion molecule-1 levels in patients with peripheral artery disease

et al. 2018

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Peripheral arterial disease (PAD) is one of the most common manifestations of systemic atherosclerosis. The prevalence of unrecognized PAD is high, leading to a lack of opportunity to detect subjects at a high risk for cardiovascular events. Inflammatory processes play an important role in the disease initiation as well as in the disease progression. Vascular cell adhesion molecule 1 (VCAM-1), a biomarker of endothelial dysfunction, appears to be an important mediator in inflammatory processes. Therefore, we hypothesized that in patients with PAD, circulating VCAM-1 might be elevated due to its function in mediating adhesion of immune cells to the vascular endothelium in the process of endothelial dysfunction and inflammation, and, therefore, applicable as a diagnostic biomarker. A total of 126 non-consecutive patients were enrolled in this study, of whom 51 patients had typical clinical manifestations of PAD and as controls 75 patients with no history of PAD or cardiovascular disease. All serum samples were obtained either during hospitalization or during out-patient visits and analyzed for VCAM-1 by the ELISA. Compared with controls, median levels of VCAM-1 were significantly elevated in patients suffering from PAD (953 vs. 1352 pg/ml; p < 0.001). Furthermore, VCAM-1 appeared to be highly discriminative for the detection of PAD (AUC = 0.76; CI 0.67–0.83). We could not observe dynamics related to increasing disease stages according to Rutherford classes in patients with apparent PAD. VCAM-1 was shown to be a potential discriminator and biomarker for the severity of systemic atherosclerosis. In a logistic regression analysis, VCAM-1 was robustly associated with the diagnosis of PAD, even after correction for clinically relevant cofounders (namely age, arterial hypertension, diabetes and LDL levels). Thusly, VCAM-1 might serve as a biomarker for PAD screening and detection.

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Section: Discussionmentioning

confidence: 99%

Disease-specific characteristics of vascular cell adhesion molecule-1 levels in patients with peripheral artery disease

et al. 2018

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“…The various aspects of antiplatelet treatment in PAD, from the pathophysiology of thrombosis to the choice of antithrombotic regimen following peripheral revascularisation, were most recently reviewed in a Special Issue of this journal [ 59 - 61 ]. Previous meta-analyses reviewed the therapeutic evidence of antiplatelets for PAD [ 62 ], and compared antiplatelet therapies using pairwise meta-analyses in patients with claudication [ 63 ] or performed NMA in the overall PAD population [ 64 ]. However, the latter analysis also involved asymptomatic PAD patients and did not include the latest evidence ( e.g .…”

Section: Discussionmentioning

confidence: 99%

“…In fact, DAPT with clopidogrel and aspirin carries a higher risk of overall bleeding events compared with aspirin and with picotamide monotherapy. These findings contradict those of the meta-analysis by Navarese et al ., comparing a pool of different DAPT regimens vs single antiplatelet therapy; in this study, DAPT significantly reduces mortality compared with single antiplatelet therapy, without increasing bleeding complications [ 62 ]. However, this meta-analysis has major limitations; firstly, the results are driven by non-adjusted estimates from 2 retrospective studies contributing 92.8% of the population, while relevant trials such as CASPAR [ 29 ] were not included; secondly, 93% of the patients had undergone a recent peripheral revascularisation, limiting the applicability of findings to the wider population of symptomatic PAD; thirdly, none of the studies included was an RCT of DAPT vs single antiplatelet therapy, with DAPT indication being unclear and its duration varying from 3 days to 60 months.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Antiplatelet Therapies in Symptomatic Peripheral Artery Disease: A Systematic Review and Network Meta-Analysis

Carlo

Minno

Sayre³

et al. 2021

CVP

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Background: Clopidogrel monotherapy is guideline-recommended in symptomatic peripheral artery disease (PAD). The advent of new antithrombotic strategies prompts an updated analysis of available evidence on antiplatelet therapy for PAD. Methods: We searched MEDLINE, Embase and CENTRAL through January 2019 for randomised controlled trials and observational studies comparing antiplatelet therapies as monotherapy, dual therapy, or combination with anticoagulants. Efficacy (major adverse cardiovascular events, acute or chronic limb ischaemia, vascular amputation, peripheral revascularisation) and safety (all-cause mortality and overall bleeding) outcomes were evaluated via Bayesian network meta-analyses. Results: We analysed 26 randomised controlled trials. Clopidogrel (hazard ratio, HR, 0.78; 95% credible interval [CrI] 0.65- 0.93) and ticagrelor (HR 0.80; 95%CrI 0.65-0.98) significantly reduced major adverse cardiovascular events risk compared with aspirin. No significant difference was observed for dual antiplatelet therapy with clopidogrel and aspirin. Vorapaxar significantly reduced limb ischaemia and revascularisation compared with placebo, while dual antiplatelet therapy with clopidogrel and aspirin showed a trend for reduced risk of amputation compared with aspirin (risk ratio 0.68; 95%CrI 0.43- 1.04). For all-cause mortality, picotamide, vorapaxar, dipyridamole with aspirin, and ticlopidine showed significantly lower risk of all-cause mortality vs aspirin. Clopidogrel and ticagrelor showed similar overall bleeding risk vs aspirin, while dual antiplatelet therapy with clopidogrel and aspirin significantly increased bleeding risk. Conclusion: This updated network meta-analysis confirms that clopidogrel significantly decreases the risk of major adverse cardiovascular events compared with aspirin, without increasing bleeding risk. Clopidogrel should remain a mainstay of PAD treatment, at least in patients at higher bleeding risk.

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“…According to the current guidelines DAPT with a P2Y12 receptor inhibitor and aspirin is recommended for 12 months to reduce adverse thrombotic events [10,12,19,20]. DAPT can be modified, its duration can be shortened or extended depending on the patient's ischemic and bleeding risk, the occurrence of adverse events, comorbidities, co-medications, and drugs availability [12].…”

Section: Wacław Kochamn 1 Salvatore DI Sommamentioning

confidence: 99%

De-escalation of antiplatelet therapy — an approach to improve safety and efficacy of treatment in patients after acute coronary syndrome

Kochman¹,

Somma

2021

Medical Research Journal

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Dual vs single antiplatelet therapy in patients with lower extremity peripheral artery disease – A meta-analysis

Cited by 15 publications

References 31 publications

Disease-specific characteristics of vascular cell adhesion molecule-1 levels in patients with peripheral artery disease

Disease-specific characteristics of vascular cell adhesion molecule-1 levels in patients with peripheral artery disease

Efficacy and Safety of Antiplatelet Therapies in Symptomatic Peripheral Artery Disease: A Systematic Review and Network Meta-Analysis

De-escalation of antiplatelet therapy — an approach to improve safety and efficacy of treatment in patients after acute coronary syndrome

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