Document Detail


Antithrombotic therapy in peripheral artery disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.
MedLine Citation:
PMID:  22315275     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: This guideline focuses on antithrombotic drug therapies for primary and secondary prevention of cardiovascular disease as well as for the relief of lower-extremity symptoms and critical ischemia in persons with peripheral arterial disease (PAD).
METHODS: The methods of this guideline follow those described in Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines in this supplement.
RESULTS: The most important of our 20 recommendations are as follows. In patients aged ≥ 50 years with asymptomatic PAD or asymptomatic carotid stenosis, we suggest aspirin (75-100 mg/d) over no therapy (Grade 2B) for the primary prevention of cardiovascular events. For secondary prevention of cardiovascular disease in patients with symptomatic PAD (including patients before and after peripheral arterial bypass surgery or percutaneous transluminal angioplasty), we recommend long-term aspirin (75-100 mg/d) or clopidogrel (75 mg/d) (Grade 1A). We recommend against the use of warfarin plus aspirin in patients with symptomatic PAD (Grade 1B). For patients undergoing peripheral artery percutaneous transluminal angioplasty with stenting, we suggest single rather than dual antiplatelet therapy (Grade 2C). For patients with refractory claudication despite exercise therapy and smoking cessation, we suggest addition of cilostazol (100 mg bid) to aspirin (75-100 mg/d) or clopidogrel (75 mg/d) (Grade 2C). In patients with critical limb ischemia and rest pain unable to undergo revascularization, we suggest the use of prostanoids (Grade 2C). In patients with acute limb ischemia due to acute thrombosis or embolism, we recommend surgery over peripheral arterial thrombolysis (Grade 1B).
CONCLUSIONS: Recommendations continue to favor single antiplatelet therapy for primary and secondary prevention of cardiovascular events in most patients with asymptomatic PAD, symptomatic PAD, and asymptomatic carotid stenosis. Additional therapies for relief of limb symptoms should be considered only after exercise therapy, smoking cessation, and evaluation for peripheral artery revascularization.
Authors:
Pablo Alonso-Coello; Sergi Bellmunt; Catherine McGorrian; Sonia S Anand; Randolph Guzman; Michael H Criqui; Elie A Akl; Per Olav Vandvik; Maarten G Lansberg; Gordon H Guyatt; Frederick A Spencer;
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Publication Detail:
Type:  Journal Article; Practice Guideline    
Journal Detail:
Title:  Chest     Volume:  141     ISSN:  1931-3543     ISO Abbreviation:  Chest     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-02-08     Completed Date:  2012-04-13     Revised Date:  2013-06-26    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  United States    
Other Details:
Languages:  eng     Pagination:  e669S-90S     Citation Subset:  AIM; IM    
Affiliation:
Iberoamerican Cochrane Centre, CIBERESP-IIB Sant Pau, Barcelona, Spain.
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MeSH Terms
Descriptor/Qualifier:
Aged
Angioplasty
Arterial Occlusive Diseases / blood,  drug therapy*,  prevention & control*
Carotid Stenosis / blood,  drug therapy,  prevention & control
Combined Modality Therapy
Drug Therapy, Combination
Evidence-Based Medicine*
Fibrinolytic Agents / adverse effects,  therapeutic use*
Humans
Ischemia / blood,  drug therapy,  prevention & control
Leg / blood supply
Middle Aged
Platelet Aggregation Inhibitors / adverse effects,  therapeutic use
Recurrence / prevention & control
Societies, Medical*
Thrombolytic Therapy
Vascular Surgical Procedures
Chemical
Reg. No./Substance:
0/Fibrinolytic Agents; 0/Platelet Aggregation Inhibitors
Comments/Corrections

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