Department of Cardiosciences, A.O. San Camillo-Forlanini , Roma, Italy.
School of Medicine and CPC Clinical Research, University of Colorado , Aurora, CO, USA.
Expert Rev Cardiovasc Ther. 2020 Dec;18(12):881-889. doi: 10.1080/14779072.2020.1833719. Epub 2020 Oct 14.
Patients with coexisting coronary artery disease (CAD) and peripheral artery disease (PAD) present a very high rate of cardiovascular (CV) morbidity and mortality. Several studies have demonstrated that different regimens of antithrombotic therapies may reduce adverse CV events in patients with CAD or PAD. However, data on optimal antithrombotic combination to use in these very high-risk patients are scarce and conflicting.
This paper reviews current data on antithrombotic therapies tested in CAD patients with concomitant lower extremity PAD.
The antithrombotic response in lower extremity PAD patients varies based on the atherosclerotic burden. For patients with isolated stable PAD may be sufficient a less potent P2Y12 inhibitor as clopidogrel, whereas patients with lower extremity PAD and documented CAD benefit from a more intense and prolonged antithrombotic treatment.
患有并存的冠状动脉疾病 (CAD) 和外周动脉疾病 (PAD) 的患者具有极高的心血管 (CV) 发病率和死亡率。多项研究表明,不同的抗血栓治疗方案可能会降低 CAD 或 PAD 患者的不良 CV 事件。然而,关于在这些极高危患者中使用最佳抗血栓联合治疗的数据仍然有限且存在争议。
本文综述了目前在伴有下肢 PAD 的 CAD 患者中进行的抗血栓治疗研究的数据。
下肢 PAD 患者的抗血栓反应取决于动脉粥样硬化负担。对于单纯稳定型 PAD 的患者,较弱的 P2Y12 抑制剂如氯吡格雷可能就足够了,而有下肢 PAD 和已确诊 CAD 的患者则受益于更强化和延长的抗血栓治疗。