Evidence or Theory? Antiaggregation Scheme after Peripheral Vascular Intervention

Antiaggregation indication after peripheral intervention (PVI) can vary up to 50% depending on center, operator, and procedure. 

This highlights the huge variation in indication and the scarce evidence there is on this matter. 

Most cardiologists would like to simply transfer the information from the coronaries to the superficial femoral, but we can confirm this does not a one size fit all. Why should it work for antiaggregation? 

The guidelines recommend dual antiaggregation therapy, though based on little to no information. 

This retrospective analysis included 16,597 patients undergoing peripheral vascular intervention (PVI) between 2017 and 2018. Patients with prior anticoagulation or dual antiaggregation indication were excluded. 

Read also: Consensus on How to Conduct Follow-Up in Peripheral Vascular Disease.

Antiaggregation schemes at discharge were classified in dual antiaggregation therapy (DAPT), aspirin monotherapy, P2Y12 receptor inhibitor monotherapy, or no drug.

49% of the population was discharged with DAPT. Being a man, a smoker and having a history of CAD were clinical predictors of DAPT. 

Requiring multiple procedures, receiving a stent, and presenting any complication also resulted DAPT predictors.

Read also: Peripheral Artery Disease: Underestimated and Undertreated.

There are both clinical and technical variables that influence indication; even whim, since operators will do whatever they deem necessary given the lack of evidence. 

On June 2020 we pointed out a similar trend towards chaos showed by a study published in Eur. J Vasc. Endovasc Surg. 

The VOYAGER PAD outcomes and its subanalysis presented at ACC 2020 and ESC 2020 only add to the prior heterogeneity on this matter.

Read also: Antiaggregation vs. Anticoagulation after Peripheral PCI.

Both studies, together with the COMPASS, support the use of rivaroxaban in patients with peripheral vascular disease.  

It will take time for all this information to appear in the guidelines. On the other hand, we clearly need more studies.

Original Title: Discharge Prescription Patterns for Antiplatelet Therapy Following Lower Extremity Peripheral Vascular Intervention.

Reference: Nikhil Singh et al. Circ Cardiovasc Interv. 2020;13:e008791.  DOI: 10.1161/CIRCINTERVENTIONS.119.008791.

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