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 and Peripheral Vascular Diseases.
Administration, Oral
Aged
Amputation, Surgical
Anticoagulants
/ administration & dosage
Chronic Disease
Dual Anti-Platelet Therapy
Female
Fibrinolytic Agents
/ administration & dosage
Hemorrhage
/ chemically induced
Humans
Limb Salvage
Lower Extremity
/ blood supply
Male
Middle Aged
Peripheral Arterial Disease
/ diagnosis
Platelet Aggregation Inhibitors
/ administration & dosage
Randomized Controlled Trials as Topic
Risk Assessment
Risk Factors
Stroke
/ mortality
Time Factors
Treatment Outcome
Anticoagulation
Antiplatelet therapy
Antithrombotic therapy
Bleeding
Cardiovascular disease
Lower extremity artery disease
Meta-analysis
Peripheral artery disease
Journal
European heart journal. Cardiovascular pharmacotherapy
ISSN: 2055-6845
Titre abrégé: Eur Heart J Cardiovasc Pharmacother
Pays: England
ID NLM: 101669491
Informations de publication
Date de publication:
01 04 2020
01 04 2020
Historique:
received:
31
05
2019
revised:
28
06
2019
accepted:
05
08
2019
pubmed:
9
8
2019
medline:
21
10
2020
entrez:
9
8
2019
Statut:
ppublish
Résumé
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 antithrombotic and more intense antithrombotic therapy on limb outcomes and limb salvage in patients with chronic LEAD. Study inclusion criteria were: enrolment of patients with LEAD, randomized allocation to more vs. less intense antithrombotic therapy [more vs. less intense single-antiplatelet therapy (SAPT); dual-antiplatelet therapy 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. 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% 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). In patients with LEAD, more intense antithrombotic therapy reduces the risk of limb amputation and revascularization as well as stroke with an increase in the risk of bleeding events.
Identifiants
pubmed: 31392312
pii: 5544981
doi: 10.1093/ehjcvp/pvz036
doi:
Substances chimiques
Anticoagulants
0
Fibrinolytic Agents
0
Platelet Aggregation Inhibitors
0
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
86-93Commentaires et corrections
Type : CommentIn
Informations de copyright
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.