title: Clopidogrel and 1-year freedom from amputation after endovascular lower extremity revascularization in the Medicare population.
abstract: OBJECTIVE
  To evaluate freedom from amputation in patients identified utilizing clopidogrel following their lower extremity endovascular revascularization (LER).
  
  
  METHODS
  Patients, 65 years of age and older, undergoing LER were identified from Medicare Provider Analysis and Review and Carrier files utilizing International Classification of Diseases diagnosis and Current Procedural Terminology codes. Postprocedural use of clopidogrel was identified using the National Drug Code directory. Outcomes were evaluated.
  
  
  RESULTS
  A total of 14 353 patients were identified: 5697 (39.7%) with claudication, 1467 (10.2%) with rest pain, and 7189 (50.1%) with ulceration/tissue loss. In all, 5416 (37.7%) patients were identified using clopidogrel after LER. Overall, patients initiated on clopidogrel had lower amputation rates at 30 days (10.34% vs 14.09%; P < .0001), 90 days (14.05% vs 18.71%; P < .0001), and 1 year (19.68% vs 24.06%; P < .0001).
  
  
  CONCLUSIONS
  Utilization of clopidogrel after LER was associated with lower rates of amputation, yet only 38% of the Medicare population was identified as using clopidogrel. Patients with ulceration and tissue loss benefited the most with significantly greater freedom from amputation and overall survival.
authors.affiliation: Division of Vascular Surgery, University of Missouri, School of Medicine, Columbia, MO, USA.
authors.forename: Mark L
authors.initials: ML
authors.lastname: Janzen
authors.affiliation: Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
authors.forename: Viktor Y
authors.initials: VY
authors.lastname: Dombrovskiy
authors.affiliation: Division of Vascular Surgery, University of Missouri, School of Medicine, Columbia, MO, USA.
authors.forename: Edgar Luis
authors.initials: EL
authors.lastname: Galiñanes
authors.affiliation: Division of Vascular Surgery, University of Missouri, School of Medicine, Columbia, MO, USA trvogel1@gmail.com.
authors.forename: Todd R
authors.initials: TR
authors.lastname: Vogel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000009:adverse effects / Q000401:mortality; D000077144:Clopidogrel; D018572:Disease-Free Survival; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D006278:Medicare; D058729:Peripheral Arterial Disease / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine
keywords: Clopidogrel; amputation; endovascular