Anticoagulation in Peripheral Artery Disease: Are We There Yet?

Abstract

Thromboembolism in patients with peripheral artery disease (PAD) represents a common cause of morbidity and mortality. In this article, the authors analyse the use of anticoagulants for patients with PAD. Anticoagulants have been used to reduce the risk of venous thromboembolism, but have recently been applied to the arterial circulation. Heparins were introduced to reduce short-term major adverse limb events in patients undergoing arterial revascularisation. Low molecular weight heparins have allowed easier management and carry a lower risk of bleeding than unfractioned heparin. Vitamin K anticoagulants have been tested in trials that included patients with PAD, showing an increased risk of bleeding when compared with aspirin alone, but longer patency rates for venous surgical bypass, although the evidence remains weak. Those anticoagulants are currently recommended only in patients with PAD who need anticoagulation for other diseases. Direct oral anticoagulants have only recently been investigated for use in patients with PAD. Promising results from low dose rivaroxaban plus aspirin have been recently outlined by a randomised controlled trial and supported by international guidelines.

Oral anticoagulation challenges and therapeutic dilemmas in the very elderly: to treat and how to treat octogenarians and nonagenarians?

“…76 Regarding dabigatran and apixaban, there is a limited long -term or randomized evidence supporting their use in the patients with PAD. 77 From a clinical point of view, daily use of low-dose DOACs along with aspirin in stable and postrevascularization elderly PAD patients with AF at a low or intermediate risk for bleeding and without indications for full-dose long--term OAC treatment seems a rather safe and effective approach. 78 However, the optimal OAC strategy for the elderly patients with PAD is still characterized by a notable lack of consensus guidelines and large regional disparity in treatment patterns.…”