Zdravniški Vestnik (Oct 2022)
Effectiveness and safety of anticoagulant versus antiplatelet therapy in patients after endovascular revascularisation of the lower limb
Abstract
Background: After revascularisation, patients with peripheral arterial disease (PAD) are routinely prescribed antiplatelet treatment (APT). Patients who receive anticoagulant treatment (ACT) due to comorbidity are an exception. We set out to determine possible differences in the effectiveness and safety between ACT and APT in patients after endovascular revascularisation of the lower limb arteries. Methods: In a single-centre retrospective cohort study, we analysed the data of 1,587 PAD patients who underwent successful endovascular revascularisation of the lower limb arteries due to disabling intermittent claudication or chronic critical limb ischemia over a 5-year period. Patients were divided into the ACT and APT groups based on their prescribed treatment. After balancing both groups’ baseline characteristics with propensity score matching, we compared the effectiveness and safety of both treatment regimens in the first year after revascularisation. Results: Compared to patients with APT, patients with ACT were older, and more often reported arterial hypertension, diabetes, chronic kidney disease, congestive heart failure, ischaemic heart disease, and prior stroke or transient ischaemic attack. After matching, 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 elderly, had more cardiovascular risk factors and had more advanced PAD than patients with APT. After matching, we found no statistically significant difference in the effectiveness and safety of both treatment regimens; however the wide OR confidence intervals warrant further research.
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