Antithrombotic Therapy in Patients with Peripheral Artery Disease: A Focused Review on Oral Anticoagulation

Rivera-Caravaca, Jose Miguel ORCID: 0000-0003-0492-6241, Camelo-Castillo, Anny, Ramirez-Macias, Inmaculada, Gil-Perez, Pablo, Lopez-Garcia, Cecilia, Esteve-Pastor, Maria Asuncion, Orenes-Pinero, Esteban, Tello-Montoliu, Antonio and Marin, Francisco (2021) Antithrombotic Therapy in Patients with Peripheral Artery Disease: A Focused Review on Oral Anticoagulation. INTERNATIONAL JOURNAL OF MOLECULAR SCIENCES, 22 (13). 7113-.

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Official URL: http://dx.doi.org/10.3390/ijms22137113

Abstract

Peripheral artery disease (PAD) is a major cause of morbidity and mortality but it is usually underdiagnosed and undertreated. Patients with PAD present dysregulated procoagulant, anticoagulant, and fibrinolytic pathways leading to arterial and venous thrombosis. The risk of several ischemic-related complications could be mitigated with appropriate antithrombotic therapy, which plays a central role in all types of PAD. For years, antiplatelets have been indicated in patients with symptomatic PAD or those who have undergone revascularization. Unfortunately, a non-negligible proportion of patients with PAD will suffer from adverse events during the follow-up, even despite proper medical therapies for the prevention of PAD complications. Thus, there is room for improving clinical outcomes in these patients. Given the implication of both, primary and secondary hemostasis in arterial thrombosis and the pathophysiology of PAD, the combination of antiplatelets and anticoagulants has emerged as a potential antithrombotic alternative to antiplatelets alone. In this narrative review article, we have highlighted the most recent evidence about antithrombotic therapy in PAD patients, with a special focus on oral anticoagulation. Certainly, COMPASS and VOYAGER PAD trials have shown promising results. Thus, rivaroxaban in combination with aspirin seem to reduce cardiovascular outcomes with a similar bleeding risk compared to aspirin alone. Nevertheless, results from real-world studies are needed to confirm these observations, and other trials will provide novel evidence about the safety and efficacy of emerging anticoagulant agents.

Item Type:	Article
Uncontrolled Keywords:	peripheral artery disease, anticoagulation therapy, rivaroxaban, antiplatelet therapy
Divisions:	Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Faculty Management Office
Depositing User:	Symplectic Admin
Date Deposited:	10 Aug 2023 13:48
Last Modified:	10 Aug 2023 13:48
DOI:	10.3390/ijms22137113
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3172133