Antiaggregation vs. Anticoagulation after Peripheral PCI

The truth is this question has no clear answer and what with do with peripheral stenting is transfer the evidence we have on coronary stenting, given the lack of standards and poor reporting on antithrombotic therapy outcomes in randomized studies on endovascular intervention. 

Heterogeneity is worse when it comes to venous territory. Some time ago we published an article about this on our website focusing on the fact that all the document provided was a list of recommendations made by experts, with no serious studies supporting these antithrombotic strategies.

Seeing the lack of answers, this study soon to be published in Eur J Vasc Endovasc Surg tries to show us a few trends. 

New randomized studies on innovative peripheral devices are constantly coming out. However, they focus on survival free of reintervention or amputation, walking distance, etc. Few of them (or none) will make antithrombotic therapy part of their protocol. Normally, treatment duration and type of drug (or drug combination) is up to operator criteria, and this information is never reported. 

Read also: Should We Finalize TAVR with Atrial Pacing in Some Patients?

This study included all randomized studies on peripheral artery disease and aimed at gathering information on the drugs used during procedure, 30 days after procedure and at longer term. 

Over 90 studies were included, but only one third of them reported the type of antithrombotic therapy used, and neither of them would justify their scheme. 

Antiplatelet monotherapy and anticoagulation with sodium heparin was the most frequent scheme during procedure and dual antiaggregation was the most frequent post procedural therapy (55% of studies). Over time, there was a trend towards the use of dual antiplatelet antiaggregation vs. other possible schemes (p<0.001). This correlated with the introduction of new technologies and studies focused on the treatment of infrapatellar arteries. 

Conclusion

Randomized studies looking at different endovascular intervention techniques in peripheral territory have an exceedingly high level of heterogeneity when it comes to antithrombotics. Antithrombotic therapy should be standardized in studies comparing different technologies to reduce possible confounders. We need at least one randomized study to specifically compare different antithrombotic schemes after peripheral intervention. 

Original Title: Antiplatelet and Anticoagulant Use in Randomised Trials of Patients Undergoing Endovascular Intervention for Peripheral Arterial Disease: Systematic Review and Narrative Synthesis.

Reference: Mahim I. Qureshi et al. Eur J Vasc Endovasc Surg. Article in press. https://doi.org/10.1016/j.ejvs.2020.03.010.

We are interested in your opinion. Please, leave your comments, thoughts, questions, etc., below. They will be most welcome.