Single versus dual antiplatelet therapy following peripheral arterial endovascular intervention for chronic limb threatening ischaemia: Retrospective cohort study

Abstract

Objectives Antiplatelet therapy following peripheral arterial endovascular intervention lacks high quality evidence to guide practice. The aim of this study was to assess the effect of three months of dual antiplatelet therapy on amputation-free survival following peripheral arterial endovascular intervention in patients with chronic limb threatening ischemia. Methods A retrospective review of symptomatic patients undergoing primary peripheral arterial endovascular intervention over a seven-year period was performed. The primary outcome measure was amputation-free survival. A sample size calculation based on previous cohort studies suggested that 629 limbs would be required to show a difference between single and dual therapy. Kaplan-Meier estimates and multivariate logistic regression analysis of recorded baseline characteristics was performed to determine predictors of amputation-free survival. Dual antiplatelet therapy was routinely given for 3 months. Results 754 limbs were treated with primary angioplasty and/or stenting over a 7-year period, 508 of these for chronic limb threatening ischemia. There was no difference in unadjusted amputation-free survival between patients with chronic limb threatening ischaemia taking single vs. dual antiplatelet therapy (69% vs. 74% respectively Log rank Chi 2 = 0.1, p = .72). After adjusting for confounders, at 1 year there was also no significant difference in amputationfree survival between patients taking single vs. dual antiplatelet therapy [OR 0.8, 95% CI 0.5-1.2, p = .3]. There was no difference in rates of major bleeding between single and dual antiplatelet therapy.

Short-Term Clinical Outcomes of Single Versus Dual Antiplatelet Therapy after Infrainguinal Endovascular Treatment for Peripheral Arterial Disease

“…One study showed lower 5-year MALE and MACE rates when DAPT was prescribed for >6 months compared with <6 months or SAPT [23]. A recently published study, similar to ours, compared 3-month DAPT with SAPT and showed no significant difference in amputation-free survival [24]. Different from our study, it included a high proportion of patients treated for aorta-iliac lesions and only a few patients with stents.…”

Mono or Dual Antiplatelet Therapy for Treating Patients with Peripheral Artery Disease after Lower Extremity Revascularization: A Systematic Review and Meta-Analysis

“…After careful analysis of these articles, one study without any long-term outcomes, two studies where control groups were absent, and one study designed to compare unrelated drugs, were excluded at the final stage. Finally, ten full-text articles, including three RCTs [ 23 , 24 , 25 ], three NRCTs with propensity-score-weighted matching (PSM) [ 26 , 27 , 28 ], and four NRCTs [ 29 , 30 , 31 , 32 ], were retrieved for quantitative synthesis.…”

“…In the four NRCTs, the use of an allocation method other than randomization means that these groups were unlikely to be comparable, which resulted in increased selection bias; three of the articles performed PSM to reduce treatment selection bias and adjust for confounding variables related to NRCTs [ 33 ]. The overall risk of bias was low in one NRCT [ 26 ], moderate in five NRCTs [ 27 , 28 , 29 , 30 , 31 ], and serious in one NRCT [ 32 ]. Publication bias was analyzed using funnel plots, and this revealed no obvious asymmetry regarding each investigated outcome ( Supplementary Figure S3 ).…”

Az alsó végtagi endovascularis verőér-beavatkozások során alkalmazott antithromboticus, antikoaguláns terápia szempontjai

“…A retrospektív vizsgálatok eredményei azonban nem egységesek. Egy további vizsgálatban az endovascularis beavatkozást követő három hónapos kettős gátlás nem bizonyult hatásosabbnak az amputációmentes túlélés vonatkozásában [50]. Mindazonáltal a perifériás intervenciókat követő időszakban kimutatták azt is, hogy ez a stratégia valamelyest jótékonyabb volt a túlélés vonatkozásában [51].…”