Anticoagulation and antiplatelet therapy in patients with peripheral arterial disease of the femoropopliteal arteries

J Cardiovasc Surg (Torino). 2018 Apr;59(2):164-171. doi: 10.23736/S0021-9509.17.10210-7. Epub 2017 Sep 20.

Abstract

Peripheral arterial disease (PAD) is associated with a substantial cardiovascular risk and secondary prevention is recommended for all patients. In this report, the literature on anticoagulant and antiplatelet drugs for patients with PAD in the femoro-popliteal segment is reviewed. PubMed/MEDLINE and Cochrane Database was searched for studies published between January 1966 and August 2017. Meta-analyses and randomized controlled trials describing outcome of anticoagulants or antiplatelet drugs for secondary prevention or following vascular interventions in patients with PAD were included. All patients with PAD should receive antiplatelet therapy to reduce cardiovascular risk with a slight preference for clopidogrel monotherapy. Following intervention, most patients will continue to benefit from this treatment. Patients receiving a venous bypass graft will benefit from VKA treatment and those with a below-knee prosthetic bypass graft should receive dual antiplatelet therapy (acetylsalicylic acid combined with clopidogrel). Further sufficiently powered studies are needed to further explore the optimal medical treatment for patients that undergo vascular interventions.

Publication types

  • Review

MeSH terms

  • Anticoagulants / adverse effects
  • Anticoagulants / therapeutic use*
  • Blood Coagulation / drug effects*
  • Blood Platelets / drug effects*
  • Blood Platelets / metabolism
  • Blood Vessel Prosthesis Implantation* / adverse effects
  • Blood Vessel Prosthesis Implantation* / mortality
  • Femoral Artery / physiopathology
  • Femoral Artery / surgery*
  • Hemorrhage / chemically induced
  • Humans
  • Odds Ratio
  • Peripheral Arterial Disease / blood
  • Peripheral Arterial Disease / mortality
  • Peripheral Arterial Disease / physiopathology
  • Peripheral Arterial Disease / therapy*
  • Platelet Aggregation Inhibitors / adverse effects
  • Platelet Aggregation Inhibitors / therapeutic use*
  • Popliteal Artery / physiopathology
  • Popliteal Artery / surgery*
  • Risk Factors
  • Secondary Prevention / methods*
  • Treatment Outcome
  • Vascular Patency

Substances

  • Anticoagulants
  • Platelet Aggregation Inhibitors