Medical Therapy for Critical Limb Ischemia

Rigatelli, Gianluca; Shah, Sara R.; Arshad, Amsa; Arshad, Nisa; Nguyen, Thach

doi:10.1007/978-3-319-31991-9_48

Cited by 1 publication

(1 citation statement)

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“…Cilostazol has been shown to improve the walking distance in patients with intermittent claudication (Fontaine's stage IIA or IIB) [10], and is now recommended as the first choice in lower extremity PAD up to advanced stage IIB. Moreover, it consistently reduced restenosis/reocclusion after surgical and endovascular interventions in patients with critical ischemia, providing middle long term efficacy and decreased risk of hemorrhagic complications [11,12]. In patients undergoing femoropopliteal stenting, cilostazol significantly reduced the rate of restenosis/ reocclusion and improved the primary patency rate, especially in subjects at high risk of in stent restenosis [13].…”

Section: Introductionmentioning

confidence: 98%

Long term efficacy and safety of rivaroxaban plus cilostazol in the treatment of critical ischemia of the lower limbs in a frail, elderly patient with non valvular atrial fibrillation

Trani¹,

Benedetto²,

Leo³

et al. 2020

J Pharm Health Care Sci

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Background: Many patients with critical lower limb ischemia are not eligible for revascularization procedures. Still, given the emerging role of both platelet and coagulation activation in the formation of arterial thrombi, they may benefit from the novel anticoagulant and antiplatelet drugs. Case presentation: We describe the case of a male with critical lower limb ischemia complicated by older age, frailty, polymorbidity and non valvular atrial fibrillation, who was deemed as non eligible for surgery. The patient was successfully treated with the combination of rivaroxaban and cilostazol, and the clinical benefit was maintained throughout 32 months, with no occurrence of major or minor hemorrhagic or thrombotic events. Conclusions: To our knowledge, this is the first report on the efficacy and safety of such a combination therapy in critical lower limb ischemia. In a clinical setting in which alternative pharmacological approaches are urgently needed, the association of rivaroxaban and cilostazol warrants further investigations.

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