Preventing atherothrombotic events in peripheral arterial disease: the use of antiplatelet therapy

Hiatt WR (University of Colorado Health Sciences Center and the Colorado Prevention Center, Denver, CO, USA). Preventing atherothrombotic events in peripheral arterial disease: the use of antiplatelet therapy (Review). J Intern Med 2002; 251: 193–206. Patients with peripheral arterial disease (PAD) are at increased risk of generalized atherothrombotic events. Epidemiologic data shows a high rate of co‐prevalence of PAD and atherosclerosis in other vascular beds. Aggressive risk‐factor modification and antiplatelet therapy has become the cornerstone of treatment to prevent ischaemic events associated with PAD. Recent clinical trials have confirmed the clinical benefit of clopidogrel and ticlopidine in patients with PAD, agents that irreversibly inhibit the binding of adenosine diphosphate to its platelet receptor. In the clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE) trial, clopidogrel was associated with an overall risk reduction of 8.7% (compared with aspirin, P =0.043) in myocardial infarction (MI), ischaemic stroke and vascular death. These results demonstrated that long‐term administration of clopidogrel was effective in preventing ischaemic events in patients with atherosclerotic vascular disease including PAD. Aspirin and/or clopidogrel are the antiplatelet agents of choice for the reduction of atherothrombotic events in patients with PAD.