Apolinario Michael, Firth Christine, Matti Lana, Girardo Marlene, Rayfield Corbin, Fatunde Olubadewa, Liedl David, Wennberg Paul, Shamoun Fadi Elias
Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ, USA.
Department of Biomedical Statistics and Informatics, Division of Health Sciences Research, Mayo Clinic, Scottsdale, AZ, USA.
Vasa. 2025 Jul;54(4):273-279. doi: 10.1024/0301-1526/a001193. Epub 2025 May 28.
Peripheral arterial disease (PAD) increases cardiovascular (CV) morbidity and mortality, but remains underdiagnosed and undertreated. Several trials support low-dose direct oral anticoagulant (DOAC) use in PAD treatment, although this has yet to be widely adopted in clinical practice. We conducted a retrospective study of patients who underwent ankle-brachial index testing (ABI) from 1996 - 2020 at Mayo Clinic. We included patients with PAD defined by abnormal ABI (<1.0 or >/=1.4). Primary outcomes evaluated were myocardial infarcts (MI), ischemic strokes (IS), critical limb ischemia (CLI)/amputation, bleeding events and all-cause mortality. DOAC and warfarin use were each compared to no anticoagulant use for the outcomes using univariate analysis and multivariate analysis. 22,162 patients had abnormal ABI readings; 1,266 were on warfarin and 269 were on DOAC for any indication. Both the DOAC and warfarin groups showed significant a decrease in all-cause mortality. The DOAC group showed superior mortality outcomes with HR 0.50 [95% CI 0.40-0.63], p-value <0.001 compared to warfarin with HR 0.88 [95% CI 0.81-0.96], p-value <0.004. There appeared to be a similar trend for MI and CLI/amputation however this was not statistically significant. IS was similar with only warfarin being statistically significant. The DOAC group had improved bleeding outcomes compared to the warfarin group, HR 0.53 (95% CI 0.24-0.85), p-value 0.007. Notably, the addition of ASA for both AC groups resulted in significant HR >1. Our study shows that anticoagulation use, particularly DOACs, is associated with decreased all-cause mortality in patients with PAD. There appears to be a favorable trend for DOACs in MI, IS and CLI/amputation. Lastly, DOACs were found to have superior outcomes with bleeding events.
外周动脉疾病（PAD）会增加心血管（CV）疾病的发病率和死亡率，但目前仍存在诊断不足和治疗不足的情况。多项试验支持在PAD治疗中使用低剂量直接口服抗凝剂（DOAC），尽管这在临床实践中尚未得到广泛应用。我们对1996年至2020年在梅奥诊所接受踝臂指数测试（ABI）的患者进行了一项回顾性研究。我们纳入了ABI异常（<1.0或≥1.4）定义的PAD患者。评估的主要结局包括心肌梗死（MI）、缺血性中风（IS）、严重肢体缺血（CLI）/截肢、出血事件和全因死亡率。使用单因素分析和多因素分析将DOAC和华法林的使用与未使用抗凝剂的结局进行比较。22162例患者ABI读数异常；1266例使用华法林，269例因任何适应症使用DOAC。DOAC组和华法林组的全因死亡率均显著降低。与华法林组相比，DOAC组的死亡率结局更佳，HR为0.50 [95% CI 0.40 - 0.63]，p值<0.001，而华法林组HR为0.88 [95% CI 0.81 - 0.96]，p值<0.004。MI和CLI/截肢似乎也有类似趋势，但无统计学意义。IS情况相似，仅华法林组具有统计学意义。与华法林组相比，DOAC组的出血结局有所改善，HR为0.53（95% CI 0.24 - 0.85），p值为0.
