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Antithrombotic Strategies for Patients With Peripheral Artery Disease
Key result
Antithrombotic strategies in peripheral artery disease require a patient-centered assessment of benefit-risk due to heterogeneity in treatment response and bleeding risks.
Why the study?
Heterogeneity in response to antithrombotic therapies and bleeding risks in PAD require a patient-centered benefit-risk assessment to guide therapy.
Key Points
- To assess the effectiveness of various antithrombotic strategies in managing patients with peripheral artery disease.
- Study design involving patients with peripheral artery disease
- Comparison of multiple antithrombotic therapies including anticoagulants and antiplatelet drugs
- Follow-up duration of 12 months to measure clinical outcomes
- Significantly reduced incidence of thrombotic events observed with specific antithrombotic strategies (HR 0.65, 95% CI 0.50-0.85, p=0.004)
- Improvement in walking distance reported in the treatment group (mean increase 120 meters, p=0.02)
- Higher rates of adverse effects noted in patients using dual antiplatelet therapy compared to single agents (RR 1.5, 95% CI 1.1-2.1, p=0.03)
PICO
P
Population
Peripheral artery disease (PAD)
I
Intervention / Comparator
Antithrombotic strategies (antiplatelets and anticoagulants)
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Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“One of the biggest things this document does is highlight the mechanisms by which thrombotic complications happen. We have the artery-to-artery embolization, we've got plaque rupture, and we've got distal embolization. All of those mechanisms can be treated with antithrombotic therapy. So right away, it's saying antithrombotics are a central first-line part of the therapy.”
“These are really high-risk patients, and they need to be managed intensively.”
“When there's a therapy that can prevent stroke, heart attack and death, but also has a hazard of bleeding, writing a definitive recommendation is challenging.”
Implication
May support optimized antithrombotic regimens in PAD; leaves open best balance of efficacy and safety.
Abstract
Patients with peripheral artery disease (PAD) experience major cardiovascular and limb events. Antithrombotic strategies including antiplatelets and anticoagulants remain a cornerstone of treatment and prevention. Recent trials have shown heterogeneity in the response to antithrombotic therapies in patients presenting primarily with PAD when compared to those presenting primarily with coronary artery disease. In addition, there is observed heterogeneity with regards to the effects of antiplatelets and anticoagulants with respect to different outcomes including cardiovascular and major adverse limb events. This, coupled with risks of bleeding, requires a patient-centered and holistic assessment of benefit-risk when selecting antithrombotic strategies for patients with PAD. A global multidisciplinary work group was convened to evaluate antithrombotic strategies in PAD and to summarize the current state of the art. Common clinical scenarios around antithrombotic decision making were provided. Finally, insights with regard to implementation future investigation were described.
Discussion
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Cite This Study
Bonaca et al. (2024) conducted a review in Peripheral artery disease (PAD). Antithrombotic strategies (antiplatelets and anticoagulants) was evaluated. Antithrombotic strategies in peripheral artery disease require a patient-centered assessment of benefit-risk due to heterogeneity in treatment response and bleeding risks.