Antiplatelet and anticoagulation therapy after revascularization for lower extremity artery disease: a national survey and literature overview

BACKGROUND: Antiplatelet therapy (APT) after interventions for lower extremity artery disease (LEAD) is recommended. However, (inter)national guidelines vary on type and duration of APT. This report aimed to present the results of a survey on antithrombotic prescribing patterns after lower limb interventions in the Netherlands and an overview of the available literature on this topic. METHODS: Vascular surgeons from the Dutch Society for Vascular Surgery and interventional radiologists from the Dutch Society for Interventional Radiology received an online survey on the type and duration of antithrombotic medication after lower limb interventions. RESULTS: Surveys were completed by 139 of 285 vascular surgeons (49%) and 24 of 288 (8%) interventional radiologists. Clopidogrel was the most prescribed drug after iliac percutaneous transluminal angioplasty (PTA) (77%), femoral PTA (77%), femoral PTA with drug-coated balloon (66%), and femoropopliteal (80%) and femorocrural (51%) prosthetic bypasses. Dual APT (DAPT), consisting of aspirin and clopidogrel, was most often prescribed after femoral PTA with stenting (56%) and crural PTAs (55% without stent, 73% with stent). Vitamin K antagonists were most often prescribed after femoropopliteal (83%) and femorocrural (80%) venous bypasses. Aspirin monotherapy prescription varied from 1% to 8% after interventions. Many interventional radiologists responded that they only advise in medication prescription but do not prescribe themselves. CONCLUSIONS: Prescription of antiplatelet and anticoagulation therapy in LEAD patients after femoral and crural interventions varies widely among Dutch vascular surgeons, mostly between clopidogrel and DAPT. The duration of DAPT is also highly variable. These results reflect low-level evidence and discrepancy in current guideline recommendations.