Current Evidence for Antithrombotic Therapy after Peripheral Vascular Interventions
Sibu P. Saha, Thomas F. Whayne, Jr. and Debabrata Mukherjee
Affiliation: Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, 326 Wethington Building, 900 South Limestone Street, Lexington, KY 40536-0200, USA.
Keywords: Anticoagulation, platelet inhibitors, thrombin inhibitors, aspirin, peripheral arterial disease.
There is occurring a progressive increase in peripheral arterial disease (PAD) in the United States and around
the World. This is undoubtedly associated with deterioration in health status and an increase in cardiovascular risk factors.
There are multiple old and new antithrombotic and anticoagulation medications that have been used for the treatment of
PAD. Several are considered in this review. The purpose of antithrombotics in surgery is the prevention of thrombosis of
surgical bypass grafts in order to help maintain their patency. Multiple different medication approaches can be made in association
with surgery. Just as in the case of peripheral vascular surgery, thrombosis also plagues the long-term maintenance
of patency following peripheral vascular interventions (PVIs). Platelets play a key role in the initiation and propagation
of thrombus formation following these PVIs and the use of antithrombotic medication helps reduce the likelihood of
intravascular thrombus formation and adverse ischemic events during and after the procedure. Currently used antithrombotic
agents after percutaneous peripheral revascularization include aspirin, clopidogrel, cilostazol and warfarin. Available
medications remain in a state of flux and new oral direct thrombin and Factor Xa inhibitors may also find a place as clinical
evidence-based medicine accumulates.
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