The CLEAR (Considering Leading Experts’ Antithrombotic Regimes around peripheral angioplasty) survey: an international perspective on antiplatelet and anticoagulant practice for peripheral arterial endovascular intervention

Abstract

Background Antiplatelet and anticoagulant therapy are commonly used before, during and after peripheral arterial endovascular intervention. This survey aimed to establish antiplatelet and anticoagulant choice for peripheral arterial endovascular intervention in contemporary clinical practice. Methods Pilot-tested questionnaire distributed via collaborative research networks. Results One hundred and sixty-two complete responses were collected from responders in 22 countries, predominantly the UK (48%) and the rest of the European Union (44%). Antiplatelet monotherapy was the most common choice pre-procedurally (62%). In the UK, there was no difference between dual and single antiplatelet therapy use post procedure (50% vs. 37% p = 0.107). However, a significant majority of EU respondents used dual therapy (68% vs. 20% p < 0.001). There was variation in choice of antiplatelet therapy by the device used and the anatomical location of the intervention artery. The majority (82%) of respondents believed there was insufficient evidence to guide antithrombotic therapy after peripheral endovascular intervention and most (92%) would support a randomised trial. Conclusions There is widespread variation in the use of antiplatelet therapy, especially post peripheral arterial endovascular intervention. Clinicians would support the development of a randomised trial comparing dual antiplatelet therapy with monotherapy.

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

“…There were difference in use of single and dual therapy by both anatomical location and endovascular device used. This is in keeping with a previous international survey of practice [4] and would potentially confound previous unadjusted studies.…”

“…The trend in increasing use of dual therapy over time is in keeping with previous work showing this to be the case [4]. It may be that clinical practice is being extrapolated from cardiology or from randomised trials of newer technologies such as drug eluting stents, where dual therapy was often specified in the protocol with no justification [28].…”

“…This is surprising given the large number of randomised trials to guide antiplatelet practice in other areas of treatment for peripheral arterial disease, and causes conflict between recommendations in guidelines [2,3]. It has also resulted in a variation in clinical practice between clinicians, centers and countries [4].…”

Groin wound infection after vascular exposure (GIVE) multicentre cohort study

“…GIVE was designed and run by the Vascular and Endovascular Research Network (VERN; https://vascularresearch.net/), a multidisciplinary trainee-led vascular research collaborative, 19 with a track record for delivering on multicentre research projects. [20][21][22][23][24] The study was conducted in hospitals providing emergency and/or elective vascular surgery. Invitations to participate were disseminated by VERN using social media, email, and personal contacts.…”

Correction to: The CLEAR (Considering Leading Experts’ Antithrombotic Regimes around peripheral angioplasty) survey: an international perspective on antiplatelet and anticoagulant practice for peripheral arterial endovascular intervention

“…Following the publication of the original article (Wong et al 2019 ), the authors have discovered error in on one the collaborators. Coscas Raphael should be Raphael Coscas.…”