Prevention of arterial and venous thrombotic events in symptomatic peripheral arterial disease patients after lower extremity revascularization in the VOYAGER PAD trial: Dual anticoagulant/antiplatelet regimen vs antiplatelet therapy alone

Abstract

Background Vascular disease burden after lower extremity revascularization (LER) comprises more than the first event, more vascular beds than the local arteries, and more than one clinical event type. Objectives Assess total arterial and venous thrombotic burden after LER for symptomatic peripheral artery disease (PAD) and effect of low‐dose anticoagulation added to low‐dose antiplatelet therapy. Patients/Methods VOYAGER PAD randomized 6564 symptomatic PAD patients undergoing LER to rivaroxaban 2.5 mg twice‐daily or placebo on aspirin background. Marginal proportional‐hazards models used to generate treatment hazard ratios and associated 95% CIs for first and total events; non‐thrombotic deaths treated as competing terminal events. Incidence rates calculated as number of events per 100 patient‐years follow‐up. Results Over 2.5 years (median), first and total thrombotic event rates: 7.1 and 10.3 events/100 patient‐years, respectively, in placebo group. Two‐thirds (925/1372) of total thrombotic events (arterial 95%, venous 5%) were nonfatal first events. Nearly one‐third of patients with first event had a second arterial or venous thrombotic event. Rivaroxaban plus aspirin reduced first and total arterial and venous thrombotic events to 5.4 and 7.9 events/100 patient‐years, respectively, a reduction in total thrombotic events over aspirin of 23% (HR: 0.77, 95%CI: 0.67–0.89, p = .0005), preventing 6.1 total arterial and venous thrombotic events at 3 years. Conclusions Assessing total arterial and venous thrombotic events, not just first events, provides more complete information about disease burden and absolute on‐treatment impact. Following LER, judicious modulation of more than one coagulation pathway can provide broader benefit than intensifying inhibition of one hemostatic system component.

Compreendendo a existência da Doença Arterial Periférica no Brasil: revisão sistemática

“…No contexto da doença arterial periférica, a aterosclerose nas artérias coronárias compromete a capacidade do coração de receber um suprimento sanguíneo adequado. Isso pode resultar em angina durante o esforço físico ou, em casos mais graves, em eventos cardíacos agudos, como o infarto do miocárdio 4,5 .…”

“…Periférica incluem tabagismo, diabetes, hipertensão arterial, hipercolesterolemia e envelhecimento. A prevalência da doença arterial periférica aumenta com a idade, destacando a importância da conscientização e intervenções preventivas em populações mais suscetíveis 4,5 .…”

“…A claudicação intermitente não apenas impacta a qualidade vida, limitando a capacidade de mobilidade e atividade física, mas também serve como um sinal de alerta para um risco cardiovascular mais amplo. A Doença Arterial Periférica está intrinsicamente ligada a distúrbios sistêmicos, como a aterosclerose, que afetam não apenas as artérias periféricas, mas também as coronárias e cerebrais 4,5 .…”

“…Compreender essa interconexão entre a Doença Arterial Periférica e eventos cardiovasculares é fundamental não apenas para o diagnóstico precoce e manejo eficaz da Doença Arterial Periférica, mas também para a implementação de medidas preventivas abrangentes 4,5 .…”

Assessing the Suitability of CHA2DS2-VASc for Predicting Adverse Limb Events and Cardiovascular Outcomes in Peripheral Artery Disease Patients with Percutaneous Transluminal Angioplasty: A Retrospective Cohort Study

“…Based on the findings, CHA 2 DS 2- VASc classification can be used to screen PAD patients, as early as possible, who are potentially at a moderate to very high risk of developing MACEs. Early diagnosis of PAD may allow physicians to prescribe dual pathway inhibition (DPI) treatment, as demonstrated through the COMPASS trial and Voyager trial [ 7 , 37 ]. DPI with rivaroxaban (novel oral anticoagulant (NOAC) drug) plus acetylsalicylic acid (ASA), commonly known as aspirin, can be used for secondary cardiovascular disease prevention, which would be beneficial for patients with PAD, who have been known to be at extremely high risk of developing MACEs, in comparison to the risk of MALEs [ 38 ].…”