Tailored Antiplatelet Therapy After Lower Extremity Endovascular Intervention is Cost Effective

Antiplatelet therapy is commonly prescribed following endovascular interventions. However, there is limited data regarding the regimen and duration of antiplatelet therapy following lower extremity endovascular interventions. The aim of this study was to investigate the practice patterns of dual antiplatelet therapy (DAPT) after lower extremity endovascular interventions. We identified all patients who received an endovascular intervention in the Vascular Study Group of New England (VSGNE) registry from 2010 through 2018. The antiplatelet regimen was examined at the time of discharge and follow-up. Variables predicting discharge antiplatelet therapy and duration of antiplatelet therapy were investigated. There were 13,510 (57.69%) patients discharged on DAPT, 8618 (36.80%) patients discharged on single antiplatelet therapy, and 1292 (5.51%) patients discharged without antiplatelet therapy. Patients with coronary artery disease (CAD), prior vascular bypass and endovascular intervention, preoperative statin use, stent placement compared with angioplasty, and femoropopliteal and tibial treatment were associated with higher odds of being discharged with DAPT compared with no antiplatelet therapy and single antiplatelet therapy. Of the patients discharged on DAPT who were followed up at 9–12 months and 21–24 months, 56.49% and 49.63% remained on DAPT, respectively. Only a narrow margin of the patient majority undergoing endovascular interventions was discharged with DAPT, suggesting that only a small proportion of patients undergoing endovascular intervention remain on DAPT long-term. As the number of peripheral vascular interventions continues to grow, further studies are crucial to identify the optimal duration of DAPT.

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Evaluating Practice Patterns and Effects on One-Year Patency and Reintervention of Single Versus Dual Antiplatelet Therapy After Lower Extremity Endovascular Intervention

Journal of Vascular Surgery ◽

10.1016/j.jvs.2020.04.242 ◽

2020 ◽

Vol 72 (1) ◽

pp. e135-e136

Author(s):

Nathan Belkin ◽

Scott Damrauer ◽

Benjamin M. Jackson ◽

Paul J. Foley ◽

Julia D. Glaser ◽

...

Keyword(s):

Lower Extremity ◽

Antiplatelet Therapy ◽

Practice Patterns ◽

Dual Antiplatelet Therapy ◽

Endovascular Intervention ◽

One Year ◽

Single Versus

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Antithrombotic Therapy in Lower Extremity Artery Disease

Current Vascular Pharmacology ◽

10.2174/1570161117666190206230516 ◽

2020 ◽

Vol 18 (3) ◽

pp. 215-222 ◽

Cited By ~ 1

Author(s):

Mislav Vrsalovic ◽

Victor Aboyans

Keyword(s):

Lower Extremity ◽

Antiplatelet Therapy ◽

Antithrombotic Therapy ◽

Cardiovascular Events ◽

Cardiovascular Outcomes ◽

Lower Limbs ◽

Stent Type ◽

Increased Risk ◽

Artery Disease ◽

Lower Extremity Artery Disease

Lower extremity artery disease (LEAD) is a marker of a more advanced atherosclerotic process often affecting multiple vascular beds beyond the lower limbs, with a consequent increased risk for all-cause and cardiovascular mortality. Antithrombotic therapy is the cornerstone of management of these patients to prevent ischaemic cardiovascular and limb events and death. In patients with symptomatic LEAD, the efficacy of aspirin has been established long ago for the prevention of cardiovascular events. In the current guidelines, clopidogrel may be preferred over aspirin following its incremental ability to prevent cardiovascular events, while ticagrelor is not superior to clopidogrel in reducing cardiovascular outcomes. Dual antiplatelet therapy (DAPT, aspirin with clopidogrel) is currently recommended for at least 1 month after endovascular interventions irrespective of the stent type. Antiplatelet monotherapy is recommended after infra-inguinal bypass surgery, and DAPT may be considered in below-the-knee bypass with a prosthetic graft. In symptomatic LEAD, the addition of anticoagulant (vitamin K antagonists) to antiplatelet therapy increased the risk of major and life-threatening bleeding without benefit regarding cardiovascular outcomes. In a recent trial, low dose of direct oral anticoagulant rivaroxaban plus aspirin showed promising results, not only to reduce death and major cardiovascular events, but also major limb events including amputation. Yet, this option should be considered especially in very high risk patients, after considering also the bleeding risk. Despite all the evidence accumulated since >40 years, many patients with LEAD remain undertreated and deserve close attention and implementation of guidelines advocating the use of antithrombotic therapies, tailored according to their level of risk.

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Clinical success using patient-oriented outcome measures after lower extremity bypass and endovascular intervention for ischemic tissue loss

Yearbook of Vascular Surgery ◽

10.1016/s0749-4041(10)79382-9 ◽

2010 ◽

Vol 2010 ◽

pp. 207-208

Author(s):

M.A. Passman

Keyword(s):

Lower Extremity ◽

Outcome Measures ◽

Clinical Success ◽

Endovascular Intervention ◽

Tissue Loss ◽

Ischemic Tissue

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P6: ANTIPLATELET AND ANTICOAGULANT USE IN RANDOMISED TRIALS OF PATIENTS UNDERGOING ENDOVASCULAR INTERVENTION FOR PERIPHERAL ARTERIAL DISEASE: SYSTEMATIC REVIEW

British Journal of Surgery ◽

10.1093/bjs/znab117.091 ◽

2021 ◽

Vol 108 (Supplement_1) ◽

Author(s):

MI Qureshi ◽

HL Li ◽

GK Ambler ◽

KHF Wong ◽

S Dawson ◽

...

Keyword(s):

Systematic Review ◽

Peripheral Arterial Disease ◽

Antiplatelet Therapy ◽

Dual Antiplatelet Therapy ◽

Arterial Intervention ◽

Arterial Disease ◽

Endovascular Intervention ◽

Randomised Trials ◽

Peripheral Arterial ◽

High Level

Abstract Introduction Guideline recommendations for antithrombotic (antiplatelet and anticoagulant) therapy during and after endovascular intervention are patchy and conflicted, in part due to a lack of evidence. The aim of this systematic review was to examine the antithrombotic specifications in randomised trials for peripheral arterial endovascular intervention. Method This review was conducted according to PRISMA guidelines. Randomised trials including participants with peripheral arterial disease undergoing endovascular arterial intervention were included. Trial methods were assessed to determine whether an antithrombotic protocol had been specified, its completeness, and the agent(s) prescribed. Antithrombotic protocols were classed as periprocedural (preceding/during intervention), immediate postprocedural (up to 14 days following intervention) and maintenance postprocedural (therapy continuing beyond 14 days). Trials were stratified according to type of intervention. Result Ninety-four trials were included. Only 29% of trials had complete periprocedural antithrombotic protocols, and 34% had complete post-procedural protocols. In total, 64 different periprocedural protocols, and 51 separate postprocedural protocols were specified. Antiplatelet monotherapy and unfractionated heparin were the most common choices of regimen in the periprocedural setting, and dual antiplatelet therapy (55%) was most commonly utilised postprocedure. There is an increasing tendency to use dual antiplatelet therapy with time or for drug-coated technologies. Conclusion Randomised trials comparing different types of peripheral endovascular arterial intervention have a high level of heterogeneity in their antithrombotic regimens, and there has been an increasing tendency to use dual antiplatelet therapy over time. Antiplatelet regimes need to be standardised in trials comparing endovascular technologies. Take-home message To determine the benefits of any endovascular intervention within a randomised trial, antithrombotic regimens should be standardised to prevent confounding. This systematic review demonstrates a high level of heterogeneity of antithrombotic prescribing in randomised trials of endovascular intervention, and an increasing tendency to utilise dual antiplatelet therapy, despite a lack of evidence of benefit, but an increased risk of harm.

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