Key result
Antithrombotic therapy, particularly dual pathway inhibition with low-dose rivaroxaban and aspirin, reduces major adverse cardiovascular and limb events in patients with peripheral arterial disease.
Why the study?
Patients with peripheral arterial disease face high risks of MACE and MALE, making prevention of thrombotic events crucial to improve their prognosis.
Does antithrombotic therapy reduce major adverse cardiovascular and limb events in patients with peripheral arterial disease?
Does antithrombotic therapy reduce major adverse cardiovascular and limb events in patients with peripheral arterial disease?
This review highlights that antithrombotic therapy, specifically dual pathway inhibition, significantly reduces cardiovascular and limb events in PAD patients, emphasizing the need for individualized bleeding risk assessment.
Background: Patients with peripheral arterial disease (PAD) are at increased risk for major adverse cardiovascular events (MACE) such as cardiovascular death, myocardial infarction, and stroke as well as major adverse limb events (MALE) such as amputation and acute limb ischemia. Therefore, prevention of thrombotic events is crucial to improve the prognosis of PAD patients. This review article concludes current evidence and guideline recommendations about antithrombotic therapy in PAD patients.Antithrombotic therapy is highly effective to reduce MACE and MALE events in PAD patients. Recently, the concept of dual pathway inhibition (low-dose rivaroxaban plus acetylic salicylic acid (ASA) has been tested in the COMPASS and VOYAGER-PAD trial. Compared to ASA alone dual pathway inhibition was superior to prevent MACE and MALE. After peripheral revascularization, in particular the risk for acute limb ischemia was reduced. In contrast, the risk for major bleeding is increased. Therefore, current guidelines recommend the combination of low-dose rivaroxaban and ASA in PAD patients with low bleeding risk. In patients with high bleeding risk, a single antiplatelet drug (preferable clopidogrel) is indicated. In patients with atherosclerotic vascular disease and indication for oral anticoagulation, no additional antiplatelet drug is necessary, as this would increase the risk of bleeding without improving the prognosis. Conclusion: Antithrombotic treatment reduces MACE and MALE and is recommended in all patients with PAD. Individual bleeding risk should always be considered based on the current data situation and an individual benefit-risk assessment must be carried out.
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Espinola–Klein et al. (2022) conducted a review in Peripheral arterial disease (PAD). Antithrombotic therapy (antiplatelet and anticoagulant drugs) was evaluated. Antithrombotic therapy, particularly dual pathway inhibition with low-dose rivaroxaban and aspirin, reduces major adverse cardiovascular and limb events in patients with peripheral arterial disease.
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