Combination antiplatelet therapy in patients with peripheral arterial disease: is the best therapy aspirin, clopidogrel, or both?

Patients with peripheral arterial disease (PAD) are at increased risk of atherothrombotic events. Antiplatelet therapy and risk-factor modification represent the basis of treatment to prevent the ischemic events associated with PAD. The efficacy of aspirin in the secondary prevention of myocardial infarction and stroke has been demonstrated in a large number of trials. More recently, however, the clinical benefit of clopidogrel compared with aspirin in patients with PAD was confirmed. Many clinical trials have evaluated the efficacy of combination antiplatelet therapy in the prevention of recurrent ischemic events in patients with atherosclerotic vascular diseases. Although the results of these studies appear promising, the benefits resulting from dual antiplatelet therapy are counterbalanced by a significant increase in bleeding. Further studies are needed to establish the optimal antiplatelet therapy in the management and prevention of PAD.