Background:
Peripheral artery disease is a common manifestation of systemic atherosclerosis which
strongly correlates to cardiovascular morbidity and mortality. In addition, the progression of peripheral artery
disease leads to an increased risk of limb loss. In order to reduce these events, the benchmark of treatment and
research over the last years has been the antiplatelet therapy which aims at inhibition of platelet aggregation. Over
the last years, new studies combining antiplatelet agents in different therapeutic schemes have been proven efficacious.
Unfortunately, patients remain still at high risk of CV events. Novel Oral Anticoagulants have been
introduced as alternatives to warfarin, in the prevention and treatment of venous thromboembolism. The rationale
of using medication which acts on platelet activation and the coagulation pathway of thrombosis has led investigators
to examine the role of Noac's in preventing CV events in patients with peripheral artery disease, stable or
unstable.
Methods:
The aim of this study is to review the current evidence with respect to recently published studies concerning
the use of Novel anticoagulants in peripheral artery disease.
Results:
The Compass trial has shown that a combination of rivaroxaban with traditional therapy may produce
promising results in reducing amputation rates, stroke, cardiac events, and mortality, however, there are still
safety issues with bleeding requiring acute care. The ePAD study has provided us with insight concerning safety
and efficacy after peripheral angioplasty or stenting and actually the need for further research. The Voyager Pad
study, following the steps of Compass, is studying the effect and safety of the addition of rivaroxaban to traditional
therapy in the highest risk population aka patients undergoing peripheral revascularization. The evidence
concerning patients with concomitant atrial fibrillation appears to be insufficient, however, recent guidelines
propose the use of novel oral anticoagulants.
Conclusion:
For the time being, novel oral anticoagulants in combination with aspirin may provide an alternative
treatment in PAD, however, it is deemed necessary to identify patient subgroups who will benefit the most.
Ankle-brachial index: more than a diagnostic test?
