Peripheral

Antithrombotic strategies for patients with peripheral artery disease

Selected in JACC Scientific Statement by Xavier Devoisin

Patients with peripheral artery disease (PAD) face significant cardiovascular and limb risks, requiring tailored antithrombotic strategies balancing efficacy and bleeding risk. A multidisciplinary work group reviewed current evidence, highlighted differences in treatment responses between PAD and coronary artery disease, and provided guidance on clinical decision-making and future research directions.
 

References:

Authors: Marc P. Bonaca, Geoffrey D. Barnes, Rupert Bauersachs, Youssef Bessada, Michael S. Conte, Anahita Dua, Connie N. Hess, Maya Serhal, Carlos Mena-Hurtado, Jeffrey I. Weitz, and Joshua A. Beckman

Reference: JACC. 2024 Sep, 84 (10) 936–952

DOI: doi/10.1016/j.jacc.2024.06.027

Read the abstract

Objective:

The objective is to define an antithrombotic treatment strategy for patients with distal arterial disease after revascularisation.

Study:

Literature review on antithrombotic strategies for preventing cardiovascular and lower limb events in patients with distal arterial disease, supplemented by the analysis of typical clinical cases.

Endpoint: 

The primary endpoint was mainly MACE (view tables below for more details).

Outcomes and conclusion:

Limited data is available on the effectiveness of antithrombotic therapies following revascularisation in patients with distal arterial disease. 

Two studies (VOYAGER and COMPASS) support the routine use of a combination of low-dose aspirin and rivaroxaban after revascularisation.

Antithrombotic strategies for patients with peripheral artery disease
Source: JACC Scientific Statement
Antithrombotic strategies for patients with peripheral artery disease
Source: JACC Scientific Statement

Comments:

  1. Continued Research on New Antithrombotics:
    • Focus on Factor XI/XIa inhibitors, based on the idea that selective inhibition of the contact pathway could decouple thrombosis prevention from bleeding risk.
  2. Potential Applications:
    • Could be particularly beneficial for prosthetic bypasses with high postoperative bleeding risk.
  3. Current Gaps:
    • Few clinical trials exist to demonstrate the efficacy and safety of antithrombotic treatments in patients with critical limb ischemia or following acute limb ischemia.

Key Consideration:
The importance of addressing cardiovascular risk factors in parallel with antithrombotic strategies.