Butera Elena, Klok Frederikus Albertus, Goedegebuur Jamilla, Porfidia Angelo, Bikdeli Behnood, Ageno Walter, Pola Roberto
Percorso Trombosi, Dipartimento di Scienza dell'Invecchiamento, Ortopediche e Reumatologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy.
Department of Medicine-Thrombosis and Hemostasis, Leiden University Medical Center, 2333 Leiden, The Netherlands.
J Clin Med. 2025 Jul 21;14(14):5157. doi: 10.3390/jcm14145157.
Venous thromboembolism (VTE) is conventionally treated with anticoagulant therapy. In contrast, the core treatment for peripheral artery disease (PAD) is antiplatelet therapy. VTE and PAD share common risk factors and may occur in the same patient. Nonetheless, there is little evidence of the best antithrombotic regimen to use when the two conditions coexist, especially in terms of the extended prevention of major adverse cardiovascular events (MACE), major adverse limb events (MALE), and VTE recurrences. We conducted an online survey of members of the Italian Society of Angiology and Vascular Medicine (SIAPAV) to explore current prescribing habits for extended antithrombotic therapy in patients with PAD and unprovoked VTE. The survey included four clinical scenarios with variations in age, gender, bleeding risk, index VTE event, and severity of PAD. In all cases, patients had received anticoagulation for 6 months, and the key question was how to continue treatment beyond 6 months from the index VTE event. A total of 174 clinicians participated to the survey. The most common choice was combining antiplatelet therapy with a direct oral anticoagulant (DOAC) at a low dose. Full-dose DOAC alone or antiplatelet therapy alone were less frequently chosen. Older age and high bleeding risk increased the preference for antiplatelet therapy alone. This survey highlights the marked variability in antithrombotic prescribing patterns among specialists in vascular medicine for patients with unprovoked VTE and concomitant PAD, reflecting the lack of evidence on optimal management in this specific setting. More research is needed to define the safest and most effective treatment strategies for patients with concurrent PAD and VTE.
静脉血栓栓塞症（VTE）传统上采用抗凝治疗。相比之下，外周动脉疾病（PAD）的核心治疗方法是抗血小板治疗。VTE和PAD有共同的危险因素，且可能发生在同一患者身上。然而，几乎没有证据表明这两种情况并存时使用哪种最佳抗血栓治疗方案，特别是在预防主要不良心血管事件（MACE）、主要不良肢体事件（MALE）和VTE复发方面。我们对意大利血管病学和血管医学学会（SIAPAV）的成员进行了一项在线调查，以探索PAD和不明原因VTE患者延长抗血栓治疗的当前处方习惯。该调查包括四种临床场景，在年龄、性别、出血风险、首发VTE事件和PAD严重程度方面存在差异。在所有情况下，患者都接受了6个月的抗凝治疗，关键问题是在首发VTE事件发生6个月后如何继续治疗。共有174名临床医生参与了该调查。最常见的选择是将抗血小板治疗与低剂量直接口服抗凝剂（DOAC）联合使用。单独使用全剂量DOAC或单独使用抗血小板治疗的选择较少。年龄较大和出血风险较高增加了单独使用抗血小板治疗的偏好。这项调查突出了血管医学专家针对不明原因VTE和合并PAD患者的抗血栓处方模式存在显著差异，反映出在这种特定情况下缺乏关于最佳管理的证据。需要更多的研究来确定PAD和VTE并发患者最安全、最有效的治疗策略。
