Antithrombotic Therapy and Major Adverse Limb Events in Patients With Chronic Lower Extremity Arterial Disease: Systematic Review and Meta-analysis from the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy in Collaboration with the European Society of Cardiology Working Group on Aorta & Peripheral Vascular Diseases.

Savarese, Gianluigi; Reiner, Martin F; Uijl, Alicia; D Amario, Domenico; Agewall, Stefan; Atar, Dan; Baumgartner, Iris; Borghi, Claudio; De Carlo, Marco; Drexel, Heinz; Kaski, Juan Carlos; Kjeldsen, Keld P; Kucher, Nils; Lund, Lars H; Niessner, Alexander; Semb, Anne Grete; Schmidt, Thomas A; Sulzgruber, Patrick; Tamargo, Juan; Vitale, Cristiana; ... (2020). Antithrombotic Therapy and Major Adverse Limb Events in Patients With Chronic Lower Extremity Arterial Disease: Systematic Review and Meta-analysis from the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy in Collaboration with the European Society of Cardiology Working Group on Aorta & Peripheral Vascular Diseases. European heart journal - cardiovascular pharmacotherapy, 6(2), pp. 86-93. Oxford University Press 10.1093/ehjcvp/pvz036

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INTRODUCTION The role and selection of antithrombotic therapy to improve limb outcomes in chronic lower extremity artery disease (LEAD) is still debated. We conducted a meta-analysis to examine the efficacy and safety of anti-thrombotic and more intense antithrombotic therapy on limb outcomes and limb salvage in patients with chronic LEAD. METHODS Study inclusion criteria were: enrollment of patients with LEAD, randomized allocation to more vs. less intense antithrombotic therapy [more vs. less intense single antiplatelet therapy (SAPT); dual antiplatelet therapy (DAPT) vs. SAPT; dual antithrombotic therapy vs. SAPT or oral anticoagulant]; enrolment of ≥ 200 patients; reporting of at least one of following outcomes: limb amputation or revascularization. Seven randomized studies enrolling 30'447 patients were included. RESULTS Over a median follow-up of 24 months, more vs. less intense antithrombotic therapy or placebo significantly reduced the risk of limb revascularization (relative risk [RR]: 0.89; 95% confidence interval [CI]: 0.83 - 0.94) and limb amputation (RR: 0.63, 95% confidence interval [CI]: 0.46-0.86), as well as stroke (RR: 0.82, 95% CI: 0.70-0.97). There was no statistically significant effect on the risk of myocardial infarction (RR: 0.98, 95% CI: 0.87-1.11), all-cause (RR: 0.93, 95% CI: 0.86-1.01) and cardiovascular death (RR: 0.97, 95% CI: 0.86-1.08). Risk of major bleeding increased (RR: 1.23, 95% CI: 1.04-1.44). CONCLUSION In patients with LEAD, more intense antithrombotic therapy reduces risk of limb amputation and revascularization as well as stroke, with an increase in the risk of bleeding events.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Angiology

UniBE Contributor:

Baumgartner, Iris and Drexel, Heinz

Subjects:

600 Technology > 610 Medicine & health

ISSN:

2055-6837

Publisher:

Oxford University Press

Language:

English

Submitter:

Catherine Gut

Date Deposited:

28 Aug 2019 09:39

Last Modified:

17 Mar 2020 01:31

Publisher DOI:

10.1093/ehjcvp/pvz036

PubMed ID:

31392312

Uncontrolled Keywords:

anti-thrombotic therapy anticoagulation antiplatelet therapy bleeding cardiovascular disease lower extremity artery disease meta-analysis peripheral artery disease

URI:

https://boris.unibe.ch/id/eprint/132662

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