Antiplatelet agents for intermittent claudication

Wong, Peng F; Chong, Lee Yee; Mikhailidis, D.P.; Robless, Peter; Stansby, Gerard

doi:10.1002/14651858.cd001272.pub2

Cited by 51 publications

(37 citation statements)

References 110 publications

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“…29 A recent meta-analysis suggested a possible reduction in the need for subsequent limb revascularization among patients taking antiplatelet therapy, but many of these revascularizations were elective and may have been related to disease progression rather an effect on sites of previous intervention. 30 Although DAPT had not been shown to definitively affect limb-related outcomes, inhibition of other antiplatelet Rates of lower extremity bypass, major amputation, MALE, and death or major amputation are based on landmark analysis beginning 30 days after angiography. Outcomes rates are reported as total events in each column, followed by the Kaplan-Meier estimate of the event rate for each group to account for censoring.…”

Section: Discussionmentioning

confidence: 99%

Association of dual-antiplatelet therapy with reduced major adverse cardiovascular events in patients with symptomatic peripheral arterial disease

Armstrong

Anderson

Yeo

et al. 2015

Journal of Vascular Surgery

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Section: Discussionmentioning

confidence: 99%

Association of dual-antiplatelet therapy with reduced major adverse cardiovascular events in patients with symptomatic peripheral arterial disease

Armstrong

Anderson

Yeo

et al. 2015

Journal of Vascular Surgery

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“…A recent Cochrane meta-analysis suggested a 30% reduction in peripheral revascularization with antiplatelet therapy when 5 trials of patients with intermittent claudication-4 studies of ticlopidine and 1 study of picotamide-were pooled; however, none of the individual trials showed a significant reduction in revascularization. 17 …”

Section: Antiplatelet Therapy In Padmentioning

confidence: 99%

Vorapaxar in Patients With Peripheral Artery Disease

et al. 2013

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Background— Vorapaxar is a novel antagonist of protease-activated receptor-1, the primary receptor for thrombin on human platelets that is also present on vascular endothelium and smooth muscle. Patients with peripheral artery disease are at risk of systemic atherothrombotic events, as well as acute and chronic limb ischemia and the need for peripheral revascularization. Methods and Results— The Trial to Assess the Effects of SCH 530348 in Preventing Heart Attack and Stroke in Patients With Atherosclerosis (TRA2°P-TIMI 50) was a randomized, double-blind, placebo-controlled trial of vorapaxar in 26 449 patients with stable atherosclerotic vascular disease (myocardial infarction, stroke, or peripheral artery disease). Patients with qualifying peripheral artery disease (n=3787) had a history of claudication and an ankle-brachial index of <0.85 or prior revascularization for limb ischemia. The primary efficacy end point was cardiovascular death, myocardial infarction, or stroke, and the principal safety end point was Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries (GUSTO) bleeding. In the peripheral artery disease cohort, the primary end point did not differ significantly with vorapaxar (11.3% versus 11.9%; hazard ratio, 0.94; 95% confidence interval, 0.78–1.14; P =0.53). However, rates of hospitalization for acute limb ischemia (2.3% versus 3.9%; hazard ratio, 0.58; 95% confidence interval, 0.39–0.86; P =0.006) and peripheral artery revascularization (18.4% versus 22.2%; hazard ratio, 0.84; 95% confidence interval, 0.73–0.97; P =0.017) were significantly lower in patients randomized to vorapaxar. Bleeding occurred more frequently with vorapaxar compared with placebo (7.4% versus 4.5%; hazard ratio, 1.62; 95% confidence interval, 1.21–2.18; P =0.001). Conclusions— Vorapaxar did not reduce the risk of cardiovascular death, myocardial infarction, or stroke in patients with peripheral artery disease; however, vorapaxar significantly reduced acute limb ischemia and peripheral revascularization. The beneficial effects of protease-activated receptor-1 antagonism on limb vascular events were accompanied by an increased risk of bleeding. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00526474.

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“…12 Thus, renal function should be assessed in patients with even subclinical PAD, and appropriate treatment (eg, statins, antiplatelet agents, and improved glycemic control) should be appropriately introduced to preserve renal function and improve CV morbidity and mortality. 9,10,13 This is a 2-way correlation. Up to 40% of patients on hemodialysis have asymptomatic or symptomatic PAD, which is associated with a 67% increase in long-term mortality.…”

Section: Benefits Of Screeningmentioning

confidence: 99%

“…In this context, there is evidence of a decrease in CV events in patients with PAD when statins or antiplatelet agents are used. 13,29 The evidence for a decrease in CV events after using antihypertensive agents is less well documented in patients with PAD. 30 …”

Section: Disadvantages Of Screeningmentioning

confidence: 99%