The Role for Combined Antithrombotic Therapy With Platelet and Coagulation Inhibition After Lower Extremity Revascularization

JACC Cardiovasc Interv. 2021 Apr 12;14(7):796-802. doi: 10.1016/j.jcin.2021.01.035.

Abstract

Evidence for antithrombotic treatment following lower extremity revascularization (LER) for peripheral artery disease (PAD) is limited, leading to weak and conflicting guideline recommendations and heterogeneous practice patterns. This variability in post-LER antithrombotic treatment raises quality-of-care issues that have long been under-studied. This Viewpoint reviews the most updated guidelines, currently-available evidence, and contemporary data about practice patterns and practitioner opinions in this area. Particular attention is paid to distinctions between antiplatelet therapy, anticoagulant therapy, and combination therapy in light of the recent VOYAGER-PAD (Vascular Outcomes Study of ASA [acetylsalicylic acid] Along with Rivaroxaban in Endovascular or Surgical Limb Revascularization for PAD) trial. The implications of VOYAGER-PAD pertaining to various subgroups of patients undergoing LER are explored. Overall, this Viewpoint argues for consideration of post-LER therapy targeted at both platelet function and the coagulation cascade, though further LER-specific analyses, including expected VOYAGER-PAD sub-analyses, are needed.

Keywords: anticoagulant; antiplatelet; antithrombotic; endovascular procedures; peripheral artery disease; vascular surgical procedures.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Fibrinolytic Agents* / therapeutic use
  • Humans
  • Lower Extremity
  • Peripheral Arterial Disease* / diagnostic imaging
  • Peripheral Arterial Disease* / drug therapy
  • Treatment Outcome
  • Vascular Surgical Procedures

Substances

  • Fibrinolytic Agents