CHEST Guidelines-Antithrombotic-Therapy-in-Peripheral-Artery-Diseas

Antithrombotic-Therapy-in-Peripheral-Artery-Diseas

Pdf Summary

The "Antithrombotic Therapy and Prevention of Thrombosis, 9th Edition: ACCP Guidelines" published in February 2012, provides comprehensive recommendations on antithrombotic drug therapies for the prevention of cardiovascular events, especially in managing peripheral arterial disease (PAD). Key recommendations include:

1. <strong>Primary Prevention</strong>: For individuals over 50 with asymptomatic PAD or carotid stenosis, aspirin (75-100 mg daily) is recommended for primary prevention of cardiovascular events (Grade 2B).

2. <strong>Secondary Prevention</strong>: Patients with symptomatic PAD (before and after arterial procedures) should continue long-term use of aspirin (75-100 mg) or clopidogrel (75 mg) (Grade 1A). Combining warfarin with aspirin is discouraged due to increased risk of bleeding (Grade 1B).

3. <strong>Post-Angioplasty/Stenting</strong>: Single antiplatelet therapy is preferred over dual therapy for those undergoing peripheral artery stenting (Grade 2C).

4. <strong>Refractory Claudication</strong>: Cilostazol may be considered in addition to aspirin or clopidogrel for patients not responding to lifestyle management (Grade 2C).

5. <strong>Critical Limb Ischemia</strong>: Prostanoids can be added for patients with rest pain unable to undergo revascularization (Grade 2C).

6. <strong>Acute Limb Ischemia</strong>: Immediate systemic anticoagulation with heparin and surgery over thrombolytic therapy are recommended (Grade 1B).

In-depth methods and analyses support these guidelines, focusing on balancing benefits like prevention of myocardial infarction against risks such as major bleeds. The guidelines underscore the use of specific therapies based on levels of risk and clinical intervention outcomes. They promote single antiplatelet therapies for most cases, reserving additional treatments for refractory symptoms when other lifestyle interventions have failed.

Overall, these guidelines serve as a detailed roadmap for clinicians managing antithrombotic therapy across various conditions linked to PAD and associated cardiovascular risks, ensuring interventions are both strategic and patient-specific.

Keywords

antithrombotic therapy

ACCP guidelines

cardiovascular prevention

peripheral arterial disease

aspirin

clopidogrel

warfarin

angioplasty

cilostazol

anticoagulation