Antithrombotic strategies for patients with coronary and lower extremity peripheral artery diseases: a narrative review

ABSTRACT

Introduction

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.

Areas covered

This paper reviews current data on antithrombotic therapies tested in CAD patients with concomitant lower extremity PAD.

Expert opinion

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.

KEYWORDS:

• Antiplatelet therapy
• aspirin
• clopidogrel
• ticagrelor
• dual antiplatelet therapy
• warfarin
• rivaroxaban
• anticoagulation therapy
• peripheral artery disease
• coronary artery disease

Article highlights

• PAD is a marker of increased risk for adverse events in patients with CAD.

• The ischemic risk can be mitigated using antithrombotic agents at the price of increased bleeding events.

• It seems that the antithrombotic response in PAD patients varies based on the atherosclerotic burden.

• For patients with isolated PAD, a P2Y12 inhibitor seems sufficient.

• Patients at high risk, such as those with combined PAD and CAD, benefit from a more intense and prolonged antithrombotic treatment.

• Dual antiplatelet therapy and novel antithrombotic regimens

• decrease the high event rate of patients with concomitant PAD and CAD.

Declaration of interest

L De Luca has received honoraria for advisory boards or as speaker/chairman at scientific congresses from Amgen, Aspen, AstraZeneca, Bayer, Boehringer Ingelheim, Chiesi, Daiichi Sankyo, Eli Lilly, Menarini, Pfizer/BMS, Sanofi, Servier; M.P.B. has received grant support to Brigham and Women’s Hospital from Amgen, AstraZeneca and Merck. Grant support to CPC Clinical research from Amgen, AstraZeneca, Bayer, Janssen, Merck; The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose. 

Additional information

Funding

This paper was not funded.