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Antithrombotic Therapy and Major Adverse Limb Events in Patients With Chronic Lower Extremity Arterial Disease: Systematic Review and Meta-analysis from the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy in Collaboration with the European Society of Cardiology Working Group on Aorta & Peripheral Vascular Diseases


Savarese, Gianluigi; Reiner, Martin F; Uijl, Alicia; D Amario, Domenico; Agewall, Stefan; Atar, Dan; Baumgartner, Iris; Borghi, Claudio; De Carlo, Marco; Drexel, Heinz; Kaski, Juan Carlos; Kjeldsen, Keld P; Kucher, Nils; Lund, Lars H; Niessner, Alexander; Semb, Anne Grete; Schmidt, Thomas A; Sulzgruber, Patrick; Tamargo, Juan; Vitale, Cristiana; Wassmann, Sven; Aboyans, Victor; Lewis, Basil S (2019). Antithrombotic Therapy and Major Adverse Limb Events in Patients With Chronic Lower Extremity Arterial Disease: Systematic Review and Meta-analysis from the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy in Collaboration with the European Society of Cardiology Working Group on Aorta & Peripheral Vascular Diseases. European Heart Journal - Cardiovascular Pharmacotherapy:Epub ahead of print.

Abstract

INTRODUCTION

The role and selection of antithrombotic therapy to improve limb outcomes in chronic lower extremity artery disease (LEAD) is still debated. We conducted a meta-analysis to examine the efficacy and safety of anti-thrombotic and more intense antithrombotic therapy on limb outcomes and limb salvage in patients with chronic LEAD.

METHODS

Study inclusion criteria were: enrollment of patients with LEAD, randomized allocation to more vs. less intense antithrombotic therapy [more vs. less intense single antiplatelet therapy (SAPT); dual antiplatelet therapy (DAPT) vs. SAPT; dual antithrombotic therapy vs. SAPT or oral anticoagulant]; enrolment of ≥ 200 patients; reporting of at least one of following outcomes: limb amputation or revascularization. Seven randomized studies enrolling 30'447 patients were included.

RESULTS

Over a median follow-up of 24 months, more vs. less intense antithrombotic therapy or placebo significantly reduced the risk of limb revascularization (relative risk [RR]: 0.89; 95% confidence interval [CI]: 0.83 - 0.94) and limb amputation (RR: 0.63, 95% confidence interval [CI]: 0.46-0.86), as well as stroke (RR: 0.82, 95% CI: 0.70-0.97). There was no statistically significant effect on the risk of myocardial infarction (RR: 0.98, 95% CI: 0.87-1.11), all-cause (RR: 0.93, 95% CI: 0.86-1.01) and cardiovascular death (RR: 0.97, 95% CI: 0.86-1.08). Risk of major bleeding increased (RR: 1.23, 95% CI: 1.04-1.44).

CONCLUSION

In patients with LEAD, more intense antithrombotic therapy reduces risk of limb amputation and revascularization as well as stroke, with an increase in the risk of bleeding events.

Abstract

INTRODUCTION

The role and selection of antithrombotic therapy to improve limb outcomes in chronic lower extremity artery disease (LEAD) is still debated. We conducted a meta-analysis to examine the efficacy and safety of anti-thrombotic and more intense antithrombotic therapy on limb outcomes and limb salvage in patients with chronic LEAD.

METHODS

Study inclusion criteria were: enrollment of patients with LEAD, randomized allocation to more vs. less intense antithrombotic therapy [more vs. less intense single antiplatelet therapy (SAPT); dual antiplatelet therapy (DAPT) vs. SAPT; dual antithrombotic therapy vs. SAPT or oral anticoagulant]; enrolment of ≥ 200 patients; reporting of at least one of following outcomes: limb amputation or revascularization. Seven randomized studies enrolling 30'447 patients were included.

RESULTS

Over a median follow-up of 24 months, more vs. less intense antithrombotic therapy or placebo significantly reduced the risk of limb revascularization (relative risk [RR]: 0.89; 95% confidence interval [CI]: 0.83 - 0.94) and limb amputation (RR: 0.63, 95% confidence interval [CI]: 0.46-0.86), as well as stroke (RR: 0.82, 95% CI: 0.70-0.97). There was no statistically significant effect on the risk of myocardial infarction (RR: 0.98, 95% CI: 0.87-1.11), all-cause (RR: 0.93, 95% CI: 0.86-1.01) and cardiovascular death (RR: 0.97, 95% CI: 0.86-1.08). Risk of major bleeding increased (RR: 1.23, 95% CI: 1.04-1.44).

CONCLUSION

In patients with LEAD, more intense antithrombotic therapy reduces risk of limb amputation and revascularization as well as stroke, with an increase in the risk of bleeding events.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Angiology
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:8 August 2019
Deposited On:21 Aug 2019 09:50
Last Modified:25 Sep 2019 00:42
Publisher:Oxford University Press
ISSN:2055-6837
OA Status:Green
Publisher DOI:https://doi.org/10.1093/ehjcvp/pvz036
PubMed ID:31392312

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