Brigham and Women's Hospital Heart & Vascular Center, Boston, Massachusetts; Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Vascular Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.
Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Vascular Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Surgery, King Saud University, Riyadh, Kingdom of Saudi Arabia.
J Am Coll Cardiol. 2018 May 29;71(21):2450-2467. doi: 10.1016/j.jacc.2018.03.483.
Peripheral artery disease (PAD) affects over 200 million people globally and is a cause of significant morbidity, mortality, and disability due to limb loss. Although secondary prevention with antithrombotic therapy is a mainstay of treatment to prevent adverse cardiovascular events, PAD patients are often undertreated with antithrombotic agents. Furthermore, there is a paucity of high-quality data from randomized controlled trials of PAD patients, leading to wide variations in clinical practice and guideline recommendations. Recently, there have been important advances that have further increased the number of antiplatelet and anticoagulant choices potentially available for patients with PAD. In this context, this paper aims to summarize the current available evidence for the safety and efficacy of various antithrombotic agents in PAD, and discuss how to integrate this emerging evidence into actual clinical practice. An evidenced-based approach to PAD patients is essential to achieve optimal outcomes, weighing cardiovascular and limb benefits against bleeding risks.
外周动脉疾病(PAD)影响着全球超过 2 亿人,由于肢体丧失,它是导致发病率、死亡率和残疾的重要原因。尽管抗血栓治疗的二级预防是预防不良心血管事件的主要治疗方法,但 PAD 患者经常接受抗血栓药物治疗不足。此外,由于缺乏来自 PAD 患者的随机对照试验的高质量数据,导致临床实践和指南建议存在很大差异。最近,在抗血小板和抗凝药物的选择方面有了重要的进展,这使得潜在的抗血小板和抗凝药物的选择数量进一步增加。在这种情况下,本文旨在总结目前关于各种抗血栓药物在 PAD 中的安全性和疗效的现有证据,并讨论如何将这一新出现的证据纳入实际的临床实践中。对外周动脉疾病患者采用循证方法至关重要,需要权衡心血管和肢体获益与出血风险,以达到最佳结果。