Antithrombotic therapy in patients with lower limb chronic ischemia: is therapy with aspirin alone sufficient?
Peripheral artery diseases have increasingly been gaining in medical and social importance due to not only growing morbidity but also therapeutic outcomes not fully satisfying both clinicians and patients, especially those with manifestations of critical limb ischemia. Revascularizing interventions combined with optimal medicamentous treatment are the “gold standard” in treatment of symptomatic lesions of peripheral arteries. Along with it, risks for the development of thrombotic complications both in the zone of the reconstruction and in other vascular basins, negatively influence overall rates of patients’ mortality and disability. Antiplatelet agents have so far remained in fact the only substantiated from the point of view of evidence-based medicine therapeutic factor decreasing the risks for the development of thrombotic complications in this patient cohort. A series of other drugs influencing blood coagulation system, as well as a combination thereof, by the findings of hitherto performed trials failed to demonstrate sufficient efficacy and/or safety. Oral anticoagulants opened new possibilities for antithrombotic prevention and treatment and have widely been used in various cardiovascular diseases. The results of a series of trials the most significant of which may be considered VOYAGER PAD showed possibilities and feasibility of introducing anticoagulants into therapeutic regimens for patients with PAD. Safety and efficacy of treatment regimens envisaging a combination of antiplatelet drugs with rivaroxaban at a dose of 2.5 mg twice daily were demonstrated both for patients undergoing conservative treatment and those after endured endovascular revascularizing interventions.
Keywords:peripheral artery disease; atherosclerosis obliterans; COMPASS; VOYAGER PAD; rivaroxaban; aspirin; revascularization; critical ischemia
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