Division of Vascular and Endovascular Surgery, Duke University School of Medicine, Durham, North Carolina, USA.
Department of Cardiology, Dupuytren University Hospital, and INSERM 1094, Limoges University, Limoges, France.
JACC Cardiovasc Interv. 2021 Apr 12;14(7):796-802. doi: 10.1016/j.jcin.2021.01.035.
Evidence for antithrombotic treatment following lower extremity revascularization (LER) for peripheral artery disease (PAD) is limited, leading to weak and conflicting guideline recommendations and heterogeneous practice patterns. This variability in post-LER antithrombotic treatment raises quality-of-care issues that have long been under-studied. This Viewpoint reviews the most updated guidelines, currently-available evidence, and contemporary data about practice patterns and practitioner opinions in this area. Particular attention is paid to distinctions between antiplatelet therapy, anticoagulant therapy, and combination therapy in light of the recent VOYAGER-PAD (Vascular Outcomes Study of ASA [acetylsalicylic acid] Along with Rivaroxaban in Endovascular or Surgical Limb Revascularization for PAD) trial. The implications of VOYAGER-PAD pertaining to various subgroups of patients undergoing LER are explored. Overall, this Viewpoint argues for consideration of post-LER therapy targeted at both platelet function and the coagulation cascade, though further LER-specific analyses, including expected VOYAGER-PAD sub-analyses, are needed.
下肢血运重建 (LER) 后抗血栓治疗的证据有限，导致指南推荐意见薄弱且相互矛盾，以及实践模式存在差异。这种LER 后抗血栓治疗的变异性提出了长期以来研究不足的医疗质量问题。本观点回顾了最新的指南、当前可用的证据，以及该领域实践模式和从业者意见的最新数据。特别关注抗血小板治疗、抗凝治疗和联合治疗之间的区别，鉴于最近的 VOYAGER-PAD（ASA [乙酰水杨酸] 与利伐沙班在下肢动脉疾病的血管内或手术血运重建中的血管结局研究）试验。还探讨了 VOYAGER-PAD 对接受 LER 的各种亚组患者的影响。总体而言，本观点认为需要考虑针对血小板功能和凝血级联的 LER 后治疗，尽管还需要进一步的 LER 特异性分析，包括预期的 VOYAGER-PAD 亚分析。
