A Review of Antithrombotic Treatment in Critical Limb Ischemia After Endovascular Intervention
Abstract Endovascular intervention is often used to treat critical limb ischemia (CLI). Post-intervention treatment with antiplatelet and/or anticoagulant therapy has reduced morbidity and mortality due to cardiovascular complications. The purpose of this review is to shed light on the various pharm...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Adis, Springer Healthcare
2019-10-01
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| Series: | Cardiology and Therapy |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1007/s40119-019-00153-7 |
| _version_ | 1818348424925282304 |
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| author | Amol Gupta Michael S. Lee Kush Gupta Vinod Kumar Sarath Reddy |
| author_facet | Amol Gupta Michael S. Lee Kush Gupta Vinod Kumar Sarath Reddy |
| author_sort | Amol Gupta |
| collection | DOAJ |
| description | Abstract Endovascular intervention is often used to treat critical limb ischemia (CLI). Post-intervention treatment with antiplatelet and/or anticoagulant therapy has reduced morbidity and mortality due to cardiovascular complications. The purpose of this review is to shed light on the various pharmacologic treatment protocols for treating CLI following endovascular procedures. We reviewed the literature comparing outcomes after antithrombotic treatment for patients with CLI. We characterized antithrombotic therapies into three categories: (1) mono-antiplatelet therapy (MAPT) vs. dual antiplatelet therapy (DAPT), (2) MAPT vs. antiplatelet (AP) + anticoagulant (AC) therapy, and (3) AC vs. AP + AC therapy. Relevant results and statistics were extracted to determine differences in the rates of the following outcomes: (1) re-stenosis, (2) occlusion, (3) target limb revascularization (TLR), (4) major amputation, (5) major adverse cardiac events, (6) all-cause death, and (7) bleeding. Studies suggest that DAPT reduces post-surgical restenosis, TLR, and amputation for diabetic patients, without increasing major bleeding incidences, compared to MAPT. Also, AP + AC therapy provides overall superior efficacy, with no difference in bleeding incidences, compared to antiplatelet alone. Additionally, the effects were significant for restenosis, limb salvage, survival rates, and cumulative rate of above ankle amputation or death. These results suggest that treatment with DAPT and AP + AC might provide better outcomes than MAPT following the endovascular intervention for CLI, and that the ideal treatment may be related to the condition of the individual patient. However, the studies were few and heterogenous with small patient populations. Therefore, further large controlled studies are warranted to confirm these outcomes. |
| first_indexed | 2024-12-13T17:49:51Z |
| format | Article |
| id | doaj.art-6390ba406d6d4336870b66d3baa6cad1 |
| institution | Directory Open Access Journal |
| issn | 2193-8261 2193-6544 |
| language | English |
| last_indexed | 2024-12-13T17:49:51Z |
| publishDate | 2019-10-01 |
| publisher | Adis, Springer Healthcare |
| record_format | Article |
| series | Cardiology and Therapy |
| spelling | doaj.art-6390ba406d6d4336870b66d3baa6cad12022-12-21T23:36:31ZengAdis, Springer HealthcareCardiology and Therapy2193-82612193-65442019-10-018219320910.1007/s40119-019-00153-7A Review of Antithrombotic Treatment in Critical Limb Ischemia After Endovascular InterventionAmol Gupta0Michael S. Lee1Kush Gupta2Vinod Kumar3Sarath Reddy4Heart, Vascular & Leg CenterDivision of Cardiology, UCLA Medical CenterKasturba Medical CollegeHeart, Vascular & Leg CenterDivision of Cardiology, The Brooklyn Hospital CenterAbstract Endovascular intervention is often used to treat critical limb ischemia (CLI). Post-intervention treatment with antiplatelet and/or anticoagulant therapy has reduced morbidity and mortality due to cardiovascular complications. The purpose of this review is to shed light on the various pharmacologic treatment protocols for treating CLI following endovascular procedures. We reviewed the literature comparing outcomes after antithrombotic treatment for patients with CLI. We characterized antithrombotic therapies into three categories: (1) mono-antiplatelet therapy (MAPT) vs. dual antiplatelet therapy (DAPT), (2) MAPT vs. antiplatelet (AP) + anticoagulant (AC) therapy, and (3) AC vs. AP + AC therapy. Relevant results and statistics were extracted to determine differences in the rates of the following outcomes: (1) re-stenosis, (2) occlusion, (3) target limb revascularization (TLR), (4) major amputation, (5) major adverse cardiac events, (6) all-cause death, and (7) bleeding. Studies suggest that DAPT reduces post-surgical restenosis, TLR, and amputation for diabetic patients, without increasing major bleeding incidences, compared to MAPT. Also, AP + AC therapy provides overall superior efficacy, with no difference in bleeding incidences, compared to antiplatelet alone. Additionally, the effects were significant for restenosis, limb salvage, survival rates, and cumulative rate of above ankle amputation or death. These results suggest that treatment with DAPT and AP + AC might provide better outcomes than MAPT following the endovascular intervention for CLI, and that the ideal treatment may be related to the condition of the individual patient. However, the studies were few and heterogenous with small patient populations. Therefore, further large controlled studies are warranted to confirm these outcomes.http://link.springer.com/article/10.1007/s40119-019-00153-7AnticoagulantAntiplateletCritical limb ischemiaEndovascular proceduresPeripheral artery disease |
| spellingShingle | Amol Gupta Michael S. Lee Kush Gupta Vinod Kumar Sarath Reddy A Review of Antithrombotic Treatment in Critical Limb Ischemia After Endovascular Intervention Cardiology and Therapy Anticoagulant Antiplatelet Critical limb ischemia Endovascular procedures Peripheral artery disease |
| title | A Review of Antithrombotic Treatment in Critical Limb Ischemia After Endovascular Intervention |
| title_full | A Review of Antithrombotic Treatment in Critical Limb Ischemia After Endovascular Intervention |
| title_fullStr | A Review of Antithrombotic Treatment in Critical Limb Ischemia After Endovascular Intervention |
| title_full_unstemmed | A Review of Antithrombotic Treatment in Critical Limb Ischemia After Endovascular Intervention |
| title_short | A Review of Antithrombotic Treatment in Critical Limb Ischemia After Endovascular Intervention |
| title_sort | review of antithrombotic treatment in critical limb ischemia after endovascular intervention |
| topic | Anticoagulant Antiplatelet Critical limb ischemia Endovascular procedures Peripheral artery disease |
| url | http://link.springer.com/article/10.1007/s40119-019-00153-7 |
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