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Antithrombotic Therapy and Major Adverse Limb Events in Patients With Chronic Lower Extremity Arterial Disease: Systematic Review and Meta-analysis from the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy in Collaboration with the European Society of Cardiology Working Group on Aorta & Peripheral Vascular Diseases.

Savarese, G; Reiner, MF; Uijl, A; D Amario, D; Agewall, S; Atar, D; Baumgartner, I; Borghi, C; De Carlo, M; Drexel, H; et al. Savarese, G; Reiner, MF; Uijl, A; D Amario, D; Agewall, S; Atar, D; Baumgartner, I; Borghi, C; De Carlo, M; Drexel, H; Kaski, JC; Kjeldsen, KP; Kucher, N; Lund, LH; Niessner, A; Semb, AG; Schmidt, TA; Sulzgruber, P; Tamargo, J; Vitale, C; Wassmann, S; Aboyans, V; Lewis, BS (2020) Antithrombotic Therapy and Major Adverse Limb Events in Patients With Chronic Lower Extremity Arterial Disease: Systematic Review and Meta-analysis from the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy in Collaboration with the European Society of Cardiology Working Group on Aorta & Peripheral Vascular Diseases. Eur Heart J Cardiovasc Pharmacother, 6 (2). pp. 86-93. ISSN 2055-6845 https://doi.org/10.1093/ehjcvp/pvz036
SGUL Authors: Kaski, Juan Carlos

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Abstract

INTRODUCTION: The role and selection of antithrombotic therapy to improve limb outcomes in chronic lower extremity artery disease (LEAD) is still debated. We conducted a meta-analysis to examine the efficacy and safety of anti-thrombotic and more intense antithrombotic therapy on limb outcomes and limb salvage in patients with chronic LEAD. METHODS: Study inclusion criteria were: enrollment of patients with LEAD, randomized allocation to more vs. less intense antithrombotic therapy [more vs. less intense single antiplatelet therapy (SAPT); dual antiplatelet therapy (DAPT) vs. SAPT; dual antithrombotic therapy vs. SAPT or oral anticoagulant]; enrolment of ≥ 200 patients; reporting of at least one of following outcomes: limb amputation or revascularization. Seven randomized studies enrolling 30'447 patients were included. RESULTS: Over a median follow-up of 24 months, more vs. less intense antithrombotic therapy or placebo significantly reduced the risk of limb revascularization (relative risk [RR]: 0.89; 95% confidence interval [CI]: 0.83 - 0.94) and limb amputation (RR: 0.63, 95% confidence interval [CI]: 0.46-0.86), as well as stroke (RR: 0.82, 95% CI: 0.70-0.97). There was no statistically significant effect on the risk of myocardial infarction (RR: 0.98, 95% CI: 0.87-1.11), all-cause (RR: 0.93, 95% CI: 0.86-1.01) and cardiovascular death (RR: 0.97, 95% CI: 0.86-1.08). Risk of major bleeding increased (RR: 1.23, 95% CI: 1.04-1.44). CONCLUSION: In patients with LEAD, more intense antithrombotic therapy reduces risk of limb amputation and revascularization as well as stroke, with an increase in the risk of bleeding events.

Item Type: Article
Additional Information: This is a pre-copyedited, author-produced version of an article accepted for publication in European Heart Journal - Cardiovascular Pharmacotherapy following peer review. The version of record Gianluigi Savarese, Martin F Reiner, Alicia Uijl, Domenico D´Amario, Stefan Agewall, Dan Atar, Iris Baumgartner, Claudio Borghi, Marco De Carlo, Heinz Drexel, Juan Carlos Kaski, Keld P Kjeldsen, Nils Kucher, Lars H Lund, Alexander Niessner, Anne Grete Semb, Thomas A Schmidt, Patrick Sulzgruber, Juan Tamargo, Cristiana Vitale, Sven Wassmann, Victor Aboyans, Basil S Lewis, Antithrombotic Therapy and Major Adverse Limb Events in Patients With Chronic Lower Extremity Arterial Disease: Systematic Review and Meta-analysis from the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy in Collaboration with the European Society of Cardiology Working Group on Aorta & Peripheral Vascular Diseases, European Heart Journal - Cardiovascular Pharmacotherapy, Volume 6, Issue 2, April 2020, Pages 86–93 is available online at: https://doi.org/10.1093/ehjcvp/pvz036
Keywords: anti-thrombotic therapy, anticoagulation, antiplatelet therapy, bleeding, cardiovascular disease, lower extremity artery disease, meta-analysis, peripheral artery disease
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Journal or Publication Title: Eur Heart J Cardiovasc Pharmacother
ISSN: 2055-6845
Language: eng
Dates:
DateEvent
April 2020Published
8 August 2019Published Online
2 August 2019Accepted
Publisher License: Publisher's own licence
PubMed ID: 31392312
Go to PubMed abstract
URI: http://openaccess.sgul.ac.uk/id/eprint/111119
Publisher's version: https://doi.org/10.1093/ehjcvp/pvz036

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