Editor's Choice – Dual Antiplatelet Therapy Improves Outcome in Diabetic Patients Undergoing Endovascular Femoropopliteal Stenting for Critical Limb Ischaemia

Abstract

DAPT with aspirin and clopidogrel compared to aspirin alone was associated with a lower amputation rate but not a higher bleeding rate in patients with diabetes and CLI after endovascular femoropopliteal stenting.

Single versus dual antiplatelet therapy following peripheral arterial endovascular intervention for chronic limb threatening ischaemia: Retrospective cohort study

“…The main finding is interesting for a number of reasons. Although the study had appropriate statistical power to detect differences similar to the previously published literature, the case mix is different with fewer diabetics in our study than one of the large cohort studies used for the calculation [7]. As event rates were higher in the diabetic cohort in this study it may be no effect is shown in our data as a result.…”

“…In the previously published case series the rate of dual antiplatelet therapy varied: 31% in a Swedish registry study [7], 55% in a single centre study from America [8] and 69% in an American registry study [9]. The benefits of dual therapy also varied between the studies; with a hazard ratio [HR 0.54] in favour of dual antiplatelet therapy in the Armstrong et al single centre study, HR 0.89 for mortality in the American registry, and HR 0.72 and HR 0.77 for survival and amputation respectively in the Swedish registry.…”

“…Inclusion/exclusion and endpoint criteria were prespecified and adhered to and follow-up reporting was robust, as demonstrated by the mean follow-up index of 0.94. This research alone is not high enough quality to make recommendations for practice, nor is any other cohort study or previously published randomized trial in the area [5][6][7][8][9]. The conflicting results make it clear that an adequately powered randomised trial in this area is required to make practice recommendations.…”

“…There is case-series evidence to support a benefit of dual antiplatelet therapy in patients undergoing peripheral endovascular intervention [7][8][9]. However, these series included a heterogenous patient mix including patients undergoing intervention for claudication and patients undergoing secondary intervention.…”

Marcadores no invasivos de aterosclerosis en pacientes con isquemia crítica de las extremidades inferiores

“…pacientes tratados con angioplastia simple. (70) En los pacientes con isquemia crítica, la progresión hacia gangrena se produce en un 40% de los pacientes diabéticos comparado con el 9% de los pacientes no diabéticos. Es más, la tasa de salvamento de extremidad en pacientes diabéticos con isquemia crítica ha demostrado ser menor que en los pacientes no diabéticos, y la diabetes es un factor de riesgo independiente de amputación y complicaciones postoperatorias en isquemia crítica.…”