We Should Indicate More than 6 Months of DAPT in Lower Limb Disease

Courtesy of Dr. Carlos Fava.

Advanced peripheral vascular disease is frequently associated with cardiovascular events and amputation. It has been proven that mono-antiplatelet therapy (MAPT) offers some benefit (with either aspirin or clopidogrel), but there are scarce data on the role of dual antiplatelet therapy (DAPT) in these patients.

Researchers analyzed 404 patients who received MAPT for <6 months and 289 who received DAPT for ≥6 months.

Groups were similar, but the DAPT ≥6-month group included more men, smokers, dyslipidemia, coronary disease, and prior angioplasty. Alternatively, patients who received DAPT for <6 months were younger, had severe renal impairment and critical limb ischemia.

Read also: Angioplasty vs. Surgery in Lower Limb Ischemia.

The indication of statins, beta-blockers, and angiotensin or angiotensin-converting enzyme inhibitors was higher for patients who received DAPT for ≥6 months.

The presence of infrapopliteal lesions was higher in patients who received DAPT for <6 months.

After 5 years of follow-up, the rates of major adverse cardiac events (MACE) were lower among patients who received DAPT for ≥6 months (17.3 % vs. 31.3%; hazard ratio: 0.44; 95% confidence interval [CI]: 0.30 to 0.65; p < 0.001), and so were the rates of major adverse limb events (MALE) (21.5% vs. 43.7%; hazard ratio: 0.42; 95% CI: 0.30 to 0.58; p < 0.001). Additionally, the rates of all-cause death, reintervention, and major amputation were also lower in the DAPT ≥6-month group.

Read also: Improved Outcomes after Lower Limb Revascularization.

The rates of acute myocardial infarction and stroke were similar for both groups.

Results were consistent after variable adjustment and propensity score matching.

Conclusion

Following endovascular revascularization for lower limb atherosclerosis, DAPT for ≥6 months was associated with a decrease in major adverse cardiovascular events and major adverse limb events.

Gentileza del Dr. Carlos Fava.

Original title: Optimal Strategy for Antiplatelet Therapy After Endovascular Revascularization for Lower Extremity Peripheral Artery Disease.

Reference: Sungsoo Cho, et al. JACC cardiovasc Intev.

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