Resident University of Texas Southwestern Dallas, Texas
Background: The optimal antiplatelet therapy regimen after endovascular revascularization of infrainguinal arteries remains uncertain.
Methods: Using the ongoing multicenter Excellence in Peripheral Artery Disease (XLPAD) registry (NCT01904851), we analyzed antiplatelet prescription trends and outcomes of 2412 patients undergoing endovascular revascularization to compare patients who were prescribed antiplatelet monotherapy to those who were prescribed dual-antiplatelet therapy (DAPT). The primary outcomes assessed over a 12-month period were major adverse limb events (MALEs; a composite of death, repeat endovascular revascularization, surgical revascularization, and target limb amputation) and major adverse cardiovascular events (MACEs; a composite of death, myocardial infarction (MI), and stroke).
Results: Out of 2412 patients in the study, 47.7% (n=1151) were treated with DAPT (1078 received aspirin and clopidogrel, 35 received aspirin and ticagrelor, and 38 received aspirin and prasugrel). Patients who were prescribed DAPT had a significantly (p<0.05) higher incidence of preexisting coronary artery disease (CAD)(64.1% vs. 44.7%) and prior MI (26.0% vs. 16.5%). Kaplan-Meier analysis showed no significant difference at 12 months between the DAPT group and antiplatelet monotherapy group in freedom from MALE (87.2% vs. 85.3%, p=0.10) or MACE (96.4% vs. 95.9%, p=0.47). After adjusting for age, sex, race, and cardiovascular risk factors (diabetes, hypertension, dyslipidemia, smoking) in the DAPT group compared with the antiplatelet monotherapy group, the hazard ratios for MALE and MACE at 12 months were 0.86 (95% CI 0.68-1.11, p=0.24) and 0.88 (95% CI 0.55-1.40, p=0.58), respectively.
Conclusions: After infrainguinal endovascular revascularization, patients with underlying CAD were more likely to be prescribed DAPT as opposed to antiplatelet monotherapy. Adverse limb and cardiovascular events were similar in patients treated with DAPT and antiplatelet monotherapy.