Is aspirin still the drug of choice for management of patients with peripheral arterial disease?

VASA ◽  
2013 ◽  
Vol 42 (2) ◽  
pp. 88-95 ◽  
Author(s):  
Pavel Poredos ◽  
Mateja K. Jezovnik
Keyword(s):  
Cardiovascular Events ◽  
Meta Analysis ◽  
Ankle Brachial Index ◽  
Arterial Disease ◽  
Antiplatelet Drugs ◽  
Antiplatelet Drug ◽  
Diabetic Patients ◽  
Vascular Events ◽  
Artery Disease ◽  
Peripheral Arterial

Antiplatelet drugs represent one of the basic options for management of patients with different atherosclerotic diseases. Aspirin is the oldest and most often prescribed antiplatelet drug. The efficacy of aspirin depends on the clinical characteristics of the treated population and probably also on the type or location of atherosclerotic disease. It seems that it is most effective in coronary patients with clinically unstable disease, less effective in prevention of cerebrovascular incidents, and its efficacy is uncertain in peripheral artery disease (PAD) patients. One of the first meta-analyses (Antithrombotic Trialists’ Collaboration - ATC) indicated that antiplatelet drugs also significantly reduce cardiovascular events in patients with PAD. However, only one third of the PAD patients included were treated with aspirin, while the rest received other anti-platelet drugs. The latest ATC meta-analysis of randomized control trials of aspirin therapy involving patients with diabetes and PAD demonstrated no benefit of aspirin in reducing cardiovascular events. Also in patients with preclinical PAD (pathological ankle brachial index) aspirin did not result in a significant reduction of vascular events. The new anti-platelet drugs prasugrel, ticagrelor and picotamide seem to be more effective than aspirin in PAD patients, particularly in diabetic patients with PAD. In conclusion, antiplatelet drugs are effective in prevention of cardiovascular events in different atherosclerotic diseases, including PAD. However, recent studies indicated that in PAD patients aspirin is less effective than in coronary artery disease. New anti-platelet drugs showed marginal superiority over aspirin without definite advantages. Aspirin thus remains the first line of antiplatelet drug for secondary prevention of cardiovascular events in PAD patients and clopidogrel as its effective alternative. Further, new studies on PAD patients are necessary to better define the role of anti-platelet agents in these patients and one of the promising ways of access to anti-platelet treatment would be personalized anti-platelet therapy.

scholarly journals To Study the Sensitivity and Specificity of Ankle Brachial Index in Diagnosis of Peripheral Arterial Disease in Diabetics With Coronary Artery Disease at a Large Tertiary Care Teaching Hospital

2020 ◽  
pp. 29-33
Author(s):  
Dr. Sajad Hussain Bhat ◽  
Dr. Adil Majeed ◽  
Dr. Mohd Yousuf Dar ◽  
Mohd Yousuf Dar
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Peripheral Arterial Disease ◽  
Sensitivity And Specificity ◽  
Teaching Hospital ◽  
Ankle Brachial Index ◽  
Arterial Disease ◽  
Diabetic Patients ◽  
Artery Disease ◽  
Peripheral Arterial

The aim of study was to determine the sensitivity and specificity of ankle brachial index in diagnosis of peripheral arterial disease in diabetics with coronary artery disease at a teaching hospital in North India. Materials and methods: All diabetic patients admitted with coronary artery disease who undergo coronary angiography irrespective of their presentation (stable angina, unstable angina, NSTEMI, STEMI) were included in the study. Systolic blood pressures of both arms at the brachial arteries and both lower limbs at the dorsalis pedis arteries were taken with the help of sphygmomanometer and a hand held doppler probe and recorded in the proforma. The higher of the two systolic pressures recorded at the ankle was divided by the highest of the systolic pressures recorded in the arms to get the ankle brachial index. The results of ABI were compared with peripheral angiography.

D-dimer as a marker for cardiovascular and arterial thrombotic events in patients with peripheral arterial disease

2013 ◽  
Vol 110 (08) ◽  
pp. 233-243 ◽  
Author(s):  
Hugo Cate ◽  
Arina ten Cate-Hoek ◽  
Marie-Claire Kleinegris
Keyword(s):  
Cardiovascular Events ◽  
Meta Analysis ◽  
Arterial Disease ◽  
Specific Information ◽  
Increased Risk ◽  
Near Term ◽  
Artery Disease ◽  
Peripheral Arterial ◽  
D Dimer

SummaryPeripheral artery disease (PAD) is associated with an increased risk for cardiovascular events. D-dimers are a marker for hypercoagulability and are linked with thrombotic events in patients with venous as well as arterial thrombosis. The predictive value of plasma D-dimer levels in relation to cardiovascular events in patients with PAD is not unambiguously established. It was our objective to gather evidence evaluating the value of D-dimer as a predictor of arterial thrombotic events patients with PAD. The Pubmed, Embase, and Cochrane databases were searched (January 1980-November 2012), and 65 abstracts were found. The strategy was supplemented with manual review of reference lists. Case-control, cohort or prospective cohort studies that measured fibrin D-dimer in patients with PAD, were included. Studies were excluded if there was no follow-up for arterial thrombotic events or when no specific information on D-dimer was available. The search yielded 10 studies for our analysis, comprising 2,420 patients with PAD, with a total of 1,036 cardiovascular events in 10,599 patient-years. Two studies with a follow-up of one year showed that fibrin D-dimer predicts both deterioration of PAD and subsequent thrombotic events. Five out of six studies with a median follow-up of 2–4 years revealed that an increased D-dimer is predictive of various arterial thrombotic events including mortality. Two studies with a longer follow-up (over 6 years) did not show an independent association between increased D-dimer levels, arterial thrombotic events and CVD mortality. In conclusion, an increased D-dimer appeared to be independently associated with a two times increased risk of near-term cardiovascular events (relative risk 2.30, 95% confidence interval 1.43–3.68). However formal meta-analysis was only feasible for four out of 10 included studies. Due to the extended heterogeneity of the included studies cautious interpretation of these data is warranted.

scholarly journals Anticoagulation in Patients with Ischaemic Heart Disease and Peripheral Arterial Disease: Clinical Implications of COMPASS Study

2018 ◽  
Vol 13 (2) ◽  
pp. 115 ◽  
Author(s):  
Josep Gradolí ◽  
Verónica Vidal ◽  
Adrian JB Brady ◽  
Lorenzo Facila ◽  
◽  
...  
Keyword(s):  
Cardiovascular Events ◽  
Arterial Disease ◽  
Platelet Inhibition ◽  
Clinical Implications ◽  
Peripheral Artery ◽  
Everyday Clinical Practice ◽  
Major Cardiovascular Events ◽  
Novel Oral Anticoagulant ◽  
Artery Disease ◽  
Peripheral Arterial

Patients with established cardiovascular disease may suffer further cardiovascular events, despite receiving optimal medical treatment. Although platelet inhibition plays a central role in the prevention of new events, the use of anticoagulant therapies to reduce events in atheromatous disease has, until recently, been overlooked. The recent Rivaroxaban for the Prevention of Major Cardiovascular Events in Coronary or Peripheral Artery Disease (COMPASS) study showed an important reduction in cardiovascular events without increasing the risk of fatal and intracranial bleeding when using rivaroxaban, a novel oral anticoagulant, combined with aspirin. This article reviews the available evidence regarding the use of anticoagulant therapies for prevention of cardiovascular events, the results of the COMPASS study and how these results may affect patient management in everyday clinical practice.

scholarly journals The accuracy of toe brachial index and ankle brachial index in the diagnosis of lower limb peripheral arterial disease: A systematic review and meta-analysis

2020 ◽  
Vol 315 ◽  
pp. 81-92
Author(s):  
Ángel Herraiz-Adillo ◽  
Iván Cavero-Redondo ◽  
Celia Álvarez-Bueno ◽  
Diana P. Pozuelo-Carrascosa ◽  
Montserrat Solera-Martínez
Keyword(s):  
Systematic Review ◽  
Peripheral Arterial Disease ◽  
Lower Limb ◽  
Meta Analysis ◽  
Ankle Brachial Index ◽  
Arterial Disease ◽  
Toe Brachial Index ◽  
Peripheral Arterial

scholarly journals Association between Peripheral Arterial Disease and Coronary Artery Disease among Tobacco User Diabetic Patients

2017 ◽  
Vol 32 (1) ◽  
pp. 3-9 ◽  
Author(s):  
Syed Dawood Md Taimur ◽  
M Maksumul Haq ◽  
MA Rashid ◽  
SM Keramat Ali ◽  
Md Shahjahan ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Peripheral Arterial Disease ◽  
Arterial Disease ◽  
Diabetic Patients ◽  
Peripheral Artery ◽  
Tobacco User ◽  
Group I ◽  
Artery Disease ◽  
Peripheral Arterial

Background: Peripheral arterial disease (PAD) is a marker of increased risk for cardiovascular events and of poorer prognosis in patients with coronary artery disease (CAD). The prevalence of unknown PAD amongst patients with ACS varies between studies according to the mode of diagnosis.Aims: To evaluate the prevalence of peripheral arterial disease (PAD) in diabetic ACS patients with or without tobacco user by using ankle brachial index (ABI).We also assess the probable predictors of PAD among these patients.Methodology: This prospective observational study was conducted in the Department of Cardiology, Ibrahim Cardiac Hospital and Research Institute, Dhaka, Bangladesh starting from 1st January 2016 to 30th April 2016 over a period of four months. A total of 60 patients were studied. They were grouped on the basis of their smoking habit. Diabetic patients with ACS and tobacco user (smoke and smoke less) in group I and without tobacco user in group II.Results: The mean age of the studied patients was 56.63 ± 8.95 years, range from 25-90 years. 73.30% was male and 26.70% was female. Twenty three patients of tobacco user in group-I (n=30) had peripheral artery disease and ten patients of group-II (n=30) had peripheral artery disease. It was statistically significant (p=0.003).Conclusion: There is correlation between peripheral arterial disease and coronary artery disease. Diagnosis and supervision of patients with PAD is important for preventing the local progression of the disease and effective secondary prevention of future coronary and cerebrovascular events.Bangladesh Heart Journal 2017; 32(1) : 3-9

scholarly journals The accuracy of an oscillometric ankle-brachial index in the diagnosis of lower limb peripheral arterial disease: A systematic review and meta-analysis

2017 ◽  
Vol 71 (9) ◽  
pp. e12994 ◽  
Author(s):  
Ángel Herráiz-Adillo ◽  
Iván Cavero-Redondo ◽  
Celia Álvarez-Bueno ◽  
Vicente Martínez-Vizcaíno ◽  
Diana P. Pozuelo-Carrascosa ◽  
...  
Keyword(s):  
Systematic Review ◽  
Peripheral Arterial Disease ◽  
Lower Limb ◽  
Meta Analysis ◽  
Ankle Brachial Index ◽  
Arterial Disease ◽  
Peripheral Arterial

scholarly journals Meta-analysis on the safety and efficacy of Lumbrokinase in peripheral arterial disease

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
A Agoncillo
Keyword(s):  
Peripheral Arterial Disease ◽  
Meta Analysis ◽  
Ankle Brachial Index ◽  
Drug Efficacy ◽  
Risk Groups ◽  
Arterial Disease ◽  
Duration Of Treatment ◽  
Standard Regimen ◽  
Safety And Efficacy ◽  
Peripheral Arterial

Abstract Funding Acknowledgements Type of funding sources: None. Background Lumbrokinase, an oral anti-thrombotic and fibrinolytic agent, was not yet part of the recommendations of any recommendations but had shown in two studies that it could increase the Ankle Brachial Index (ABI). ABI was used to evaluate the drug efficacy for PAD. Purpose Peripheral Arterial Disease was one of the most neglected, under-screened, and undertreated high-risk groups among cardiovascular diseases like myocardial infarction and stroke. Few studies were done to evaluate the treatment of fibrinolytic such as Lumbrokinase for this population.  Methods We appraised two randomized control trials that evaluated the safety and efficacy of Lumbrokinase compared to placebo with the standard regimen and another study of Lumbrokinase compared to placebo with standard regimen versus Lumbrokinase with Prostaglandin E1 (PGE1) among adult patients for the reduction of symptoms of PAD and increase in ABI. Both trials treatment period lasted for 2 weeks. Two independent reviewers assess the identified trials for inclusion by applying the selection criteria and quality was assessed using the JADAD scale. The data was analyzed using Meta analyst statistical software. Main results After weeks of treatment, the effect size is 0.90; this is an increase of at least +0.06 from the baseline that supports the trend in increasing the ankle-brachial index. The study did not show significant side effects by Lumbrokinase Conclusions Lumbrokinase at 460 to 490 mg three times a day for 2 weeks to 3 months has no significant relationship but has a trend in increasing the ankle-brachial index to a borderline level compared to placebo. Additional studies regarding the effect of Lumbrokinase in increasing ABI must be done with larger sample size.  Further research is needed to illuminate whether a longer duration of treatment with Lumbrokinase can increase the ankle-brachial index more. Eligible Trials Table 1. Eligible trials, characteristics, and demographics.AuthorYearControlPatient enrolled (N)Patient Analysed (%)Age Mean SDMales %Diabetes %Dyslipidemia %1. NDRAHA2013PlaceboL = 10 C= 10L = 100 C = 100L = 55.8 C = 53.2L = 5 C = 5L = 35 C = 25L = 30 C = 302. LUL= 31 C = 31L = 100 C = 100L = 68 C = 68.4L = 74 C = 74NANASUM/RAW MEANSL= 41 C = 41L = 100 C = 100L = 61.9 C = 60.8L = 39.4 C = 39.4NANAL= Lumbrokinase groupC= Control groupNA = not availableAbstract Figure. Efficacy of Lumbrokinase

scholarly journals Ankle Brachial Index Screening for Peripheral Arterial Disease in Asymptomatic Diabetic Patients

2021 ◽  
Vol 83 (1) ◽  
pp. 1575-1581
Author(s):  
Heba A . El-Malky ◽  
Alaa El Deen Dawood ◽  
Mahmoud S. El-Desoky ◽  
Mai A. Kamel
Keyword(s):  
Peripheral Arterial Disease ◽  
Ankle Brachial Index ◽  
Arterial Disease ◽  
Diabetic Patients ◽  
Peripheral Arterial
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