Antithrombotic therapy after femoropopliteal artery stenting: 12-month results from Japan Postmarketing Surveillance

Abstract

ObjectiveTo investigate the effects of antithrombotic therapy on target lesion revascularisation (TLR) and major adverse cardiovascular and cerebrovascular events (MACCEs) at 12 months after femoropopliteal intervention with second-generation bare metal nitinol stents.MethodsA total of 277 lesions in 258 limbs of 248 patients with de novo atherosclerosis in the above-the-knee femoropopliteal segment were analysed from the Japan multicentre postmarketing surveillance.ResultsAt discharge, dual antiplatelet therapy (DAPT) was prescribed in 68.5% and cilostazol in 30.2% of patients. At 12 months of follow-up, prescriptions of DAPT significantly (p=0.0001) decreased to 51.2% and prescription of cilostazol remained unchanged (p=0.592) at 28.0%. Prescription of warfarin also remained unchanged (14.5% at discharge, 13.3% at 12 months, p=0.70). At 12 months, freedoms from TLR and MACCE were 89.4% and 89.7%, respectively. In a multivariate Cox proportional hazards model, neither DAPT nor cilostazol at discharge was associated with both TLR and MACCE at 12 months. However, warfarin at discharge was only independently associated with TLR at 12 months. Kaplan-Meier estimates demonstrated that warfarin at discharge yielded a significantly (p=0.013) lower freedom from TLR at 12 months than no warfarin at discharge. Freedom from TLR at 12 months by the Kaplan-Meier estimates was 77.8% (95% CI 59.0% to 88.8%) in patients with warfarin at discharge and 91.2% (95% CI 86.3% to 94.3%) in those without warfarin at discharge.ConclusionsClinical benefits of DAPT or cilostazol might be small in terms of TLR and MACCE at 12 months. Anticoagulation with warfarin at discharge might increase TLR at 12 months.

Antiplatelet and anticoagulation therapy after revascularization for lower extremity artery disease: a national survey and literature overview

“…This resulted in final inclusion of 24 articles, subdivided in studies comparing antiplatelet therapies [8][9][10][11][12][13][14][15][16][17][18][19][20][21] (Table 9.4), studies comparing anticoagulation drugs or anticoagulation and antiplatelet drugs [22][23][24][25][26][27] (Table 9.5), and studies comparing various duration of dual antiplatelet therapy [28][29][30][31] (Table 9.6). There is no doubt about the necessity of APT in LEAD patients for reducing the risk of cardiovascular events.…”

Peak systolic velocity ratio derived from quantitative vessel analysis for restenosis after femoropopliteal intervention: a multidisciplinary review from Endovascular Asia

“…The femoropopliteal (FP) artery is the most common site of PAD involvement. With technological improvements in the endovascular armamentarium, catheter-based FP intervention has gained popularity during the last decade [2][3][4][5][6][7]. Although the need for quantitative vessel analysis (QVA) for objective evaluation in FP intervention outcomes has been emphasized for over a decade [8], a standard methodology for assessing restenosis has yet to be established.…”