Antithrombotic Therapy In Peripheral Artery Disease
Publication Date: February 1, 2012
Last Updated: March 14, 2022
Recommendations
Diagnosis Of DVT
For persons with asymptomatic PAD, we suggest aspirin 75 to 100 mg daily over no aspirin therapy. (2, B)
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Secondary Prevention of Cardiovascular Events in Patients With Symptomatic PAD
For secondary prevention in patients with symptomatic PAD, we recommend one of the two following antithrombotic regimens to be continued long term over no antithrombotic treatment: aspirin 75 to 100 mg daily or clopidogrel 75 mg daily. (1, A)
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We suggest not to use dual antiplatelet therapy with aspirin plus clopidogrel. (2, B)
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We recommend not to use an antiplatelet agent with moderate intensity warfarin. (1, B)
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Antithrombotic Therapy for the Management of Patients With Claudication
For patients with intermittent claudication refractory to exercise therapy and smoking cessation, we suggest the use of cilostazol in addition to previously recommended antithrombotic therapies (aspirin 75-100 mg daily or clopidogrel 75 mg daily); (2, C)
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we suggest against the use of pentoxifylline, heparinoids, or prostanoids. (2, C)
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Critical Limb Ischemia
For patients with symptomatic PAD and critical leg ischemia/rest pain who are not candidates for vascular intervention, we suggest the use of prostanoids in addition to previously recommended antithrombotic therapies (aspirin 75-100 mg daily or clopidogrel 75 mg daily). (2, C)
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Acute Limb Ischemia
In patients with acute limb ischemia due to arterial emboli or thrombosis, we suggest immediate systemic anticoagulation with unfractionated heparin over no anticoagulation; (2, C)
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we suggest reperfusion therapy (surgery or intraarterial thrombolysis) over no reperfusion therapy; (2, C)
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and we recommend surgery over intraarterial thrombolysis. (1, B)
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In patients undergoing intraarterial thrombolysis, we suggest rt-PA or urokinase over streptokinase. (2, C)
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Endovascular Revascularization in Patients With Symptomatic PAD
For patients undergoing peripheral artery PTA with or without stenting, we recommend long-term aspirin (75-100 mg/d) or clopidogrel (75 mg/d). (1, A)
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For patients undergoing peripheral artery PTA with stenting, we suggest single rather than dual antiplatelet therapy. (2, C)
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Antithrombotic Therapy Following] Peripheral Artery Bypass Graft Surgery
We recommend one of the following antithrombotic regimens to be continued long term in most patients following peripheral artery bypass graft surgery over no antithrombotic treatment: aspirin 75 to 100 mg daily or clopidogrel 75 mg daily. (1, A)
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We recommend single antiplatelet therapy over antiplatelet therapy and warfarin. (1, B)
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In patients undergoing below-knee bypass graft surgery with prosthetic grafts, we suggest clopidogrel 75 mg/d plus aspirin (75-100 mg/d) over aspirin alone for 1 year. (2, C)
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For all other patients, we suggest single over dual antiplatelet therapy. (2, B)
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Carotid Artery Stenosis
For persons with asymptomatic carotid stenosis, we suggest aspirin 75 to 100 mg daily over no aspirin therapy. (2, B)
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In patients with symptomatic carotid stenosis (including recent carotid endarterectomy), we recommend long-term antiplatelet therapy (clopidogrel [75 mg once daily] or aspirinextended- release dipyridamole [25 mg/200 mg bid] or aspirin [75-100 mg once daily]) over no antiplatelet therapy. (1, A)
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We suggest either clopidogrel (75 mg once daily) or aspirinextended- release dipyridamole (25 mg/200 mg bid) over aspirin (75-100 mg/day). (2, B)
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Recommendation Grading
Disclaimer
Overview
Title
Antithrombotic Therapy In Peripheral Artery Disease
Authoring Organization
American College of Chest Physicians
Publication Month/Year
February 1, 2012
Last Updated Month/Year
May 15, 2023
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Document Objectives
This guideline focuses on antithrombotic drug therapies for primary and secondary prevention of cardiovascular disease as well as for the relief of lower-extremity symptoms and critical ischemia in persons with peripheral arterial disease (PAD).
Target Patient Population
Patients with peripheral arterial disease
Inclusion Criteria
Female, Male, Adolescent, Adult, Older adult
Health Care Settings
Ambulatory, Home health, Hospice, Hospital, Long term care, Outpatient
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Prevention, Management, Treatment
Diseases/Conditions (MeSH)
D000925 - Anticoagulants, D002318 - Cardiovascular Diseases, D058729 - Peripheral Arterial Disease
Keywords
anticoagulation, peripheral artery disease (P.A.D.), Antithrombotic Agents, Peripheral artery disease, Anticoagulation