Study Supports ≥ 6 Months of DAPT After Endovascular Revascularization for Lower Extremity PAD

 

November 13, 2019—Sungsoo Choo, MD, et al published findings from an investigation to determine the optimal strategy for antiplatelet therapy in patients who have undergone endovascular revascularization for lower extremity peripheral artery disease (PAD). The study is available online in Journal of the American College of Cardiology (JACC): Cardiovascular Interventions.

The investigators concluded that dual antiplatelet therapy (DAPT) for ≥ 6 months after endovascular revascularization for lower extremity PAD was associated with decreased 5-year major adverse cardiovascular events (MACEs) and major adverse limb events (MALEs).

The study involved an analysis of 693 patients with lower extremity PAD who were treated with different antiplatelet therapies from March 2008 to February 2013. The treatments included monoantiplatelet therapy (MAPT) and DAPT of various durations after endovascular revascularization and were classified into two groups (DAPT < 6 months; MAPT vs DAPT ≥ 6 months).

The primary outcomes were MACE and MALE rates, and the safety outcome was major bleeding.

As summarized in JACC: Cardiovascular Interventions, the investigators found the following results at 5-year follow-up:

  • MACEs occurred less frequently in the DAPT for ≥ 6 months group than in the DAPT for < 6 months or MAPT group (17.3% vs 31.3%; hazard ratio, 0.44; 95% confidence interval, 0.3–0.65; P < .001).
  • MALEs also occurred less frequently in the DAPT for ≥ 6 months group than the DAPT for < 6 months group or MAPT group (21.5% vs 43.7%; hazard ratio, 0.42; 95% CI, 0.3–0.58; P < .001).
  • Major bleeding events were infrequent, with no signal toward harm with DAPT for ≥ 6 months.

Results were consistent after inverse probability-weighted adjustment and propensity score matching, reported the investigators in JACC: Cardiovascular Interventions.

 

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