SRS104 - A retrospective review of best medical therapy use in major lower limb amputation patients

Introduction Best medical therapy (BMT), including antithrombotic and lipid-lowering treatment, is the standard of care for patients undergoing major lower limb amputation (MLLA), aiming to reduce major adverse cardiac events (MACE) and mortality. We assessed whether patients undergoing MLLA are receiving appropriate BMT. Methods This single-centre study included patients undergoing MLLA with clinical or radiological evidence of atherosclerosis. Medication use at admission and discharge was recorded. Triglyceride and LDL-C levels were measured at baseline, 3 months, and 6 months postoperatively. Results A total of 116 patients (81.9% male) were included. Comorbidities: diabetes (67.2%), hypertension (60.3%), heart failure (17.2%), and chronic kidney disease (28.5%). High-intensity statin use (75.0 to 82.5%, P = 0.0209) and ezetimibe increased significantly (6.9 to 11.3%, P = 0.0253). No patients were prescribed inclisiran, evolocumab, or icosapent ethyl, despite 10 meeting potential eligibility criteria. Antithrombotic use improved: full dose DOACs increased from 29.0 to 42.0% and warfarin from 0.9 to 2.7% (P < 0.001), COMPASS regimen increased from 12.9 to 21.4% (P = 0.0067). No statistical difference in single dose antiplatelet use was observed; patients receiving no antithrombotic therapy declined significantly (32 to 14, P < 0.001). Median LDL-C levels were 1.4 mmol/L baseline and at 6 months (P = 0.5443). Triglycerides levels increased 1.4 baseline to 2.0 mmol/L at 6 months (P = 0.1876). Conclusions While BMT prescribing improved following MLLA, adjunct lipid-lowering therapies remain underutilised reflected in no overall change in biochemical parameters. Broader implementation of full BMT is necessary to optimise cardiovascular risk reduction.