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World J Cardiol. Jul 26, 2017; 9(7): 583-593
Published online Jul 26, 2017. doi: 10.4330/wjc.v9.i7.583
Peripheral interventions and antiplatelet therapy: Role in current practice
Pahul Singh, Yenal Harper, Carrie S Oliphant, Mohamed Morsy, Michelle Skelton, Raza Askari, Rami N Khouzam
Pahul Singh, Yenal Harper, Mohamed Morsy, Raza Askari, Rami N Khouzam, Department of Medicine, Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN 38163, United States
Carrie S Oliphant, Methodist University Hospital, Memphis, TN 38104, United States
Carrie S Oliphant, Department of Clinical Pharmacy, University of Tennessee College of Pharmacy, Memphis, TN 38163, United States
Michelle Skelton, Department of Biology, Emory University, Atlanta, GA 30322, United States
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: There is no conflict of interest associated with the senior author or any of the other coauthors. All authors contributed their efforts in this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Rami N Khouzam, MD, FACP, FACC, FASNC, FASE, FSCAI, Associate Professor, Department of Medicine, Division of Cardiovascular Diseases, University of Tennessee Health Science Center, 956 Court Avenue, Ste. A318D, Memphis, TN 38163, United States. khouzamrami@yahoo.com
Telephone: +1-901-4170809 Fax: +1-901-7475805
Received: January 31, 2017
Peer-review started: February 10, 2017
First decision: March 6, 2017
Revised: April 6, 2017
Accepted: April 23, 2017
Article in press: April 24, 2017
Published online: July 26, 2017
Processing time: 176 Days and 6.9 Hours
Abstract

Peripheral arterial disease (PAD) is a common disorder associated with a high risk of cardiovascular mortality and continues to be under-recognized. The major risk factors for PAD are similar to those for coronary and cerebrovascular disease. Management includes exercise program, pharmacologic therapy and revascularization including endovascular and surgical approach. The optimal revascularization strategy, endovascular or surgical intervention, is often debated due to the paucity of head to head randomized controlled studies. Despite significant advances in endovascular interventions resulting in increased utilization over surgical bypass, significant challenges still remain. Platelet activation and aggregation after percutaneous transluminal angioplasty of atherosclerotic arteries are important risk factors for re-occlusion/restenosis and life-threatening thrombosis following endovascular procedures. Antiplatelet agents are commonly prescribed to reduce the risk of myocardial infarction, stroke and death from cardiovascular causes in patients with PAD. Despite an abundance of data demonstrating efficacy of antiplatelet therapy in coronary artery disease and cerebrovascular disease, there is a paucity of clinical information, clinical guidelines and randomized controlled studies in the PAD population. Hence, data on antiplatelet therapy in coronary interventions is frequently extrapolated to peripheral interventions. The aim of this review article is to elucidate the current data on revascularization and the role and duration of antiplatelet and anticoagulant therapy in re-vascularized lower limb PAD patients.

Keywords: Peripheral arterial disease; Peripheral vascular disease; Antiplatelet therapy; Revascularization

Core tip: Peripheral arterial disease (PAD) is nearly a pandemic disorder which carries a high morbidity and mortality. Treatment includes risk factor modification, revascularization whenever feasible and medical management including antiplatelet therapy being a crucial element. Despite improvements in endovascular techniques and equipment for revascularization in PAD patients, current data regarding antiplatelet therapy in this population is limited. Our objective is to consolidate the current data on role and duration of antiplatelet and anticoagulant therapy in re-vascularized lower limb PAD patients.