Rationale for the use of antiplatelet drugs in patients with peripheral vascular disease.

Peripheral vascular disease (PVD) is complicated by progression of atherosclerotic disease of lower limbs and by cardiovascular events occurring in cardiac and cerebral area. Antiplatelet treatment seems to be able to retard the atherosclerotic progression of peripheral vessel. This was demonstrated by angiographic studies and by a clinical trial showing that aspirin reduced the need of surgical intervention in PVD patients. Three large clinical trials have been planned to assess the effect of antiplatelet treatment on cardiovascular complications. By intention-to-treat analysis, no study showed a beneficial effect for this treatment. Conversely, by on-treatment analysis, antiplatelet treatment showed a significant reduction of global cardiovascular events. Until now, no study has had the power to assess the effect of antiplatelet treatment on major cardiovascular events. The evaluation of patients at high risk of major events by antiplatelet treatment should be an important issue of future clinical trials.