Novel Oral Anticoagulants in Peripheral Artery Disease: Current Evidence

Abstract

Background: Peripheral artery disease is a common manifestation of systemic atherosclerosis which strongly correlates to cardiovascular morbidity and mortality. In addition, the progression of peripheral artery disease leads to an increased risk of limb loss. In order to reduce these events, the benchmark of treatment and research over the last years has been the antiplatelet therapy which aims at inhibition of platelet aggregation. Over the last years, new studies combining antiplatelet agents in different therapeutic schemes have been proven efficacious. Unfortunately, patients remain still at high risk of CV events. Novel Oral Anticoagulants have been introduced as alternatives to warfarin, in the prevention and treatment of venous thromboembolism. The rationale of using medication which acts on platelet activation and the coagulation pathway of thrombosis has led investigators to examine the role of Noac's in preventing CV events in patients with peripheral artery disease, stable or unstable. Methods: The aim of this study is to review the current evidence with respect to recently published studies concerning the use of Novel anticoagulants in peripheral artery disease. Results: The Compass trial has shown that a combination of rivaroxaban with traditional therapy may produce promising results in reducing amputation rates, stroke, cardiac events, and mortality, however, there are still safety issues with bleeding requiring acute care. The ePAD study has provided us with insight concerning safety and efficacy after peripheral angioplasty or stenting and actually the need for further research. The Voyager Pad study, following the steps of Compass, is studying the effect and safety of the addition of rivaroxaban to traditional therapy in the highest risk population aka patients undergoing peripheral revascularization. The evidence concerning patients with concomitant atrial fibrillation appears to be insufficient, however, recent guidelines propose the use of novel oral anticoagulants. Conclusion: For the time being, novel oral anticoagulants in combination with aspirin may provide an alternative treatment in PAD, however, it is deemed necessary to identify patient subgroups who will benefit the most.

Use of Oral Anticoagulation and Diabetes Do Not Inhibit the Angiogenic Potential of Hypoxia Preconditioned Blood-Derived Secretomes

“…As previously mentioned, many patients requiring angiogenesis-promoting therapies for central/peripheral vasculopathy and chronic wounds, who would greatly benefit from new generation bioactive treatments such as hypoxia preconditioned blood-derived secretomes, routinely receive OA [ 27 , 40 , 41 ]. A better understanding of the effects that OA administration may have on the angiogenic potential of blood-derived secretomes is therefore a key prerequisite for advancing their clinical utility.…”

Oral Anticoagulant and Antiplatelet Therapy for Peripheral Arterial Disease: A Meta-analysis of Randomized Controlled Trials

“…Platelet inhibition plus low-dose anticoagulant would depend on status to balance ischemic and bleeding risks when selecting type, dose, and intensity of antithrombotic treatment for PAD. [21][22][23] Our study has some limitations. In this meta-analysis, the number of RCT trials was low and major bleeding events are a severe problem for antithrombotic therapy.…”

No Histological Difference between Large Atherosclerotic and Cardiogenic Embolic Thrombus

“…Antiplatelet therapy has been the mainstay of treatment in the past few years, but the incidence of cardiovascular events remains high. Studies have shown that new oral anticoagulants combined with aspirin can improve the patient benefit rate [22]. Therapeutic doses of warfarin reduce recurrent ischemic events after myocardial infarction but also increase the risk of bleeding [23].…”