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Int J Cardiol. 2018 Oct 15;269:292-297. doi: 10.1016/j.ijcard.2018.07.009. Epub 2018 Jul 3.

Dual vs single antiplatelet therapy in patients with lower extremity peripheral artery disease - A meta-analysis.

Author information

1
INOVA Heart and Vascular Institute, VA, USA; Interventional Cardiology and Cardiovascular Medicine Research, Cardiovascular Research Center, Mater Dei Hospital, Bari, Italy; SIRIO MEDICINE research network. Electronic address: Eliano.Navarese@inova.org.
2
Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria.
3
Department of Cardiology, University Hospital,Campus Gasthuisberg, Leuven, Belgium.
4
Cardiovascular Institute, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland.
5
Department of Cardiology, Charité - Universitaetsmedizin Berlin, German Centre for Cardiovascular Research (DZHK), University Heart Center, Berlin, Germany.
6
Department of Cardiology, Azienda Usl Toscana Nord-Ovest Cardiologia UTIC ed Emodinamica - Ospedali Riuniti di Livorno, Italy.
7
Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.
8
Division of Cardiology and Structural Heart Diseases Medical University of Silesia, Katowice, Poland.
9
1st Department of Cardiology, University of Medical Sciences, Poznan, Poland.
10
Interventional Cardiology, Department of Cardiovascular Medicine, Humanitas Research Hospital, Milan, Italy.
11
INOVA Heart and Vascular Institute, VA, USA; SIRIO MEDICINE research network.
12
Department of Cardiology, Catholic University of Rome, Rome, Italy.
13
Interventional Cardiology and Cardiovascular Medicine Research, Cardiovascular Research Center, Mater Dei Hospital, Bari, Italy.

Abstract

AIMS:

Peripheral artery disease (PAD) is associated with increased risk of cardiovascular events. The benefits of dual antiplatelet therapy (DAPT) vs single antiplatelet therapy (SAPT) with aspirin in patients with PAD remain subject of ongoing debate.

METHODS AND RESULTS:

We performed a meta-analysis of studies comparing DAPT vs aspirin monotherapy in PAD. Incidence rate ratios (RR) and respective 95% confidence intervals (CI) were used as summary statistics. The primary outcome was mortality. Secondary endpoints were ischemic and bleeding outcomes. Ten studies including 65,675 patients have been included. Compared to SAPT, DAPT was associated with a significant reduction in mortality: RR, 0.89; 95% CI, 0.86-0.92; P < 0.001. Results were consistent across patients with symptomatic PAD and those undergoing bypass or percutaneous transluminal angioplasty (PTA). Similarly, DAPT significantly reduced the risk of repeat peripheral revascularizations (RR, 0.80; 95% CI, 0.69-0.92; P = 0.002). No significant increase of major bleeding complications was observed with DAPT as compared to SAPT (RR, 1.21; 95% CI, 0.87-1.68 P = 0.26).

CONCLUSIONS:

DAPT, as compared to SAPT, significantly reduces mortality in patients with PAD, with no significant increase in bleeding complications. These findings support DAPT as the mainstay antiplatelet therapeutic regimen in patients with PAD.

KEYWORDS:

Dual antiplatelet therapy; Peripheral artery disease; Single antiplatelet therapy

PMID:
30045826
DOI:
10.1016/j.ijcard.2018.07.009
[Indexed for MEDLINE]

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