Peripheral interventions and antiplatelet therapy: Role in current practice

Abstract

Peripheral arterial disease (PAD) is a common disorder associated with a high risk of cardiovascular mortality and continues to be under-recognized. The major risk factors for PAD are similar to those for coronary and cerebrovascular disease. Management includes exercise program, pharmacologic therapy and revascularization including endovascular and surgical approach. The optimal revascularization strategy, endovascular or surgical intervention, is often debated due to the paucity of head to head randomized controlled studies. Despite significant advances in endovascular interventions resulting in increased utilization over surgical bypass, significant challenges still remain. Platelet activation and aggregation after percutaneous transluminal angioplasty of atherosclerotic arteries are important risk factors for re-occlusion/restenosis and life-threatening thrombosis following endovascular procedures. Antiplatelet agents are commonly prescribed to reduce the risk of myocardial infarction, stroke and death from cardiovascular causes in patients with PAD. Despite an abundance of data demonstrating efficacy of antiplatelet therapy in coronary artery disease and cerebrovascular disease, there is a paucity of clinical information, clinical guidelines and randomized controlled studies in the PAD population. Hence, data on antiplatelet therapy in coronary interventions is frequently extrapolated to peripheral interventions. The aim of this review article is to elucidate the current data on revascularization and the role and duration of antiplatelet and anticoagulant therapy in re-vascularized lower limb PAD patients.

Umbrella review and meta-analysis of antiplatelet therapy for peripheral artery disease

“…The past decade has seen a huge expansion in peripheral angioplasty procedures, with interventions increasing threefold in England from around 12 000 in 2004–2005 to over 33 000 in 2014–2015 according to Hospital Episode Statistics. There is a trend towards dual antiplatelet prescribing after peripheral artery intervention; this practice is extrapolated from coronary intervention data. However, there is currently no clear evidence of benefit for dual antiplatelets compared with monotherapy after peripheral intervention, but a clear risk of major bleeding: 37 more bleeds per 1000 patients ( P = 0·005).…”

Endovascular resolution of giant popliteal pseudoaneurysm

“…La elección de la anticoagulación frente a la terapia doble antiagregante o terapia triple plantea un escenario complejo en situaciones como esta. Debe considerarse la clínica del paciente, el riesgo de hemorragia y los beneficios a largo plazo propios de la doble antiagregación en la permeabilidad del stent (10).…”

Coagulation Factor Activity and Hemostatic Markers of Endothelial Dysfunction in Patients with Peripheral Arterial Disease

“…Post-procedural patency rates of peripheral vessels after reconstruction in patients with atherosclerotic peripheral arterial disease (PAD) may vary due to the development of thrombotic complications, restenosis, and disease progression. While peripheral procedures using autologous vein grafts have rather satisfactory results, prosthetic grafts tend to occlude within the first year for up to 20% of above-knee procedures and 75% of below-knee interventions [ 1 ]. Thrombosis rates reach 12.5% within one year after peripheral procedures involving endovascular stents [ 2 ].…”