Effectiveness and safety of anticoagulant versus antiplatelet therapy in patients after endovascular revascularisation of the lower limb

Abstract

Background. Patients with peripheral arterial disease (PAD) are routinely prescribed antiplatelet treatment (APT) after revascularisation. An exception are patients who receive anticoagulant treatment (ACT) due to comorbidity. We set out to determine possible differences in the effectiveness and safety between ACT and APT in patients who underwent endovascular revascularisation of the lower limb arteries.
 
 Methods. In a single-centre retrospective study, we analysed the data of 1,587 consecutive patients with PAD who underwent successful endovascular revascularisation of the lower limb arteries due to disabling intermittent claudication or chronic critical limb ischemia in a 5-year period. Patients were divided in the ACT and APT group based on their prescribed treatment. After balancing both groups' baseline characteristics and cardiovascular risk factors with propensity score matching (PSM), we compared the effectiveness and safety of both treatment regimens in the first year afterrevascularisation.
 
 Results. Compared to patients with APT, patients with ACT were older, more often reported arterial hypertension, diabetes, chronic kidney disease, congestive heart failure, ischaemic heart disease, and a history of stroke or transient ischaemic attack. After PSM, the odds ratio (OR) for an effective outcome with ACT versus APT was 0.78 (95% CI 0.39–1.59; p=0.502), while the OR for a safe outcome with ACT versus APT was 4.12 (95% CI 0.82–20.73; p=0.085).
 
 Conclusions. Patients who required ACT were older, had more cardiovascular risk factors, and more advanced PAD than patients with APT. After matching, we found no statistically significant difference in the effectiveness and safety of both treatment regimens.