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A Review of Antithrombotic Treatment in Critical Limb Ischemia After Endovascular Intervention

Authors :
Amol Gupta
Michael S. Lee
Kush Gupta
Vinod Kumar
Sarath Reddy
Source :
Cardiology and Therapy, Vol 8, Iss 2, Pp 193-209 (2019)
Publication Year :
2019
Publisher :
Adis, Springer Healthcare, 2019.

Abstract

Abstract Endovascular intervention is often used to treat critical limb ischemia (CLI). Post-intervention treatment with antiplatelet and/or anticoagulant therapy has reduced morbidity and mortality due to cardiovascular complications. The purpose of this review is to shed light on the various pharmacologic treatment protocols for treating CLI following endovascular procedures. We reviewed the literature comparing outcomes after antithrombotic treatment for patients with CLI. We characterized antithrombotic therapies into three categories: (1) mono-antiplatelet therapy (MAPT) vs. dual antiplatelet therapy (DAPT), (2) MAPT vs. antiplatelet (AP) + anticoagulant (AC) therapy, and (3) AC vs. AP + AC therapy. Relevant results and statistics were extracted to determine differences in the rates of the following outcomes: (1) re-stenosis, (2) occlusion, (3) target limb revascularization (TLR), (4) major amputation, (5) major adverse cardiac events, (6) all-cause death, and (7) bleeding. Studies suggest that DAPT reduces post-surgical restenosis, TLR, and amputation for diabetic patients, without increasing major bleeding incidences, compared to MAPT. Also, AP + AC therapy provides overall superior efficacy, with no difference in bleeding incidences, compared to antiplatelet alone. Additionally, the effects were significant for restenosis, limb salvage, survival rates, and cumulative rate of above ankle amputation or death. These results suggest that treatment with DAPT and AP + AC might provide better outcomes than MAPT following the endovascular intervention for CLI, and that the ideal treatment may be related to the condition of the individual patient. However, the studies were few and heterogenous with small patient populations. Therefore, further large controlled studies are warranted to confirm these outcomes.

Details

Language :
English
ISSN :
21938261 and 21936544
Volume :
8
Issue :
2
Database :
Directory of Open Access Journals
Journal :
Cardiology and Therapy
Publication Type :
Academic Journal
Accession number :
edsdoj.6390ba406d6d4336870b66d3baa6cad1
Document Type :
article
Full Text :
https://doi.org/10.1007/s40119-019-00153-7