title: Comparison of dual-antiplatelet therapy durations after endovascular revascularization of infrainguinal arteries.
abstract: BACKGROUND
  The optimal dual-antiplatelet therapy (DAPT) duration after endovascular revascularization of infrainguinal arteries is uncertain.
  
  
  METHODS
  This study examines DAPT prescription trends and 12-month major adverse limb events (MALEs; a composite of repeat endovascular or surgical revascularization, acute vessel thrombosis, or amputation of the target limb), major adverse cardiovascular events (MACEs; all-cause mortality, nonfatal myocardial infarction [MI], stroke, or coronary revascularization), fatal bleeding events, and those requiring interruption or discontinuation of DAPT (hemorrhagic complications) for patients enrolled into the Excellence in Peripheral Artery Disease (XLPAD) registry.
  
  
  RESULTS
  Data on 368 patients prescribed antiplatelet therapy were analyzed; 8.2% were prescribed antiplatelet monotherapy, 48.6% DAPT for ≤3 months, and 43.2% for >3 months. Patients in the >3 DAPT prescribed group were older, had preexisting coronary artery disease (CAD), and prior MI (all P < 0.001). Overall MALE in the ≤3 and >3-month DAPT prescribed groups were 22.3% and 23.9%, respectively (P = 0.541). Survival analysis showed significantly higher rates of MACE in patients prescribed >3-month DAPT (17.6% vs. 9.5%; P = 0.019). An "as-treated" analysis excluded 10 patients who were prescribed DAPT for >3 months and revealed similar rates of MALE (24.9% vs. 20.8%; P = 0.386) and MACE (12.2% vs. 14.8%; P = 0.443) in patients receiving ≤3 and >3 DAPT. Hemorrhagic complications were similar across all prescribed and "as-treated" DAPT groups.
  
  
  CONCLUSIONS
  After infrainguinal endovascular procedures, patients with underlying CAD were prescribed longer (>3 months) duration of DAPT and experienced more cardiovascular events compared with those prescribed ≤3 months of DAPT. Adverse limb events were similar in both groups.
authors.affiliation: Veteran Affairs North Texas Health Care System, Dallas, TX; University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Karan
authors.initials: K
authors.lastname: Sarode
authors.affiliation: Veteran Affairs North Texas Health Care System, Dallas, TX; University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Atif
authors.initials: A
authors.lastname: Mohammad
authors.affiliation: Veteran Affairs North Texas Health Care System, Dallas, TX.
authors.forename: Swagata
authors.initials: S
authors.lastname: Das
authors.affiliation: University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Ariel
authors.initials: A
authors.lastname: Vinas
authors.affiliation: Veteran Affairs North Texas Health Care System, Dallas, TX.
authors.forename: Avantika
authors.initials: A
authors.lastname: Banerjee
authors.affiliation: Veteran Affairs North Texas Health Care System, Dallas, TX; University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Shirling
authors.initials: S
authors.lastname: Tsai
authors.affiliation: Veteran Affairs Eastern Colorado Healthcare System, Denver, CO.
authors.forename: Ehrin J
authors.initials: EJ
authors.lastname: Armstrong
authors.affiliation: Midwest Cardiovascular Research Foundation, Davenport, IA.
authors.forename: Nicolas W
authors.initials: NW
authors.lastname: Shammas
authors.affiliation: St. Louis University Medical Center, St. Louis, MO.
authors.forename: Andrew
authors.initials: A
authors.lastname: Klein
authors.affiliation: Veteran Affairs North Texas Health Care System, Dallas, TX; University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Emmanouil S
authors.initials: ES
authors.lastname: Brilakis
authors.affiliation: Veteran Affairs North Texas Health Care System, Dallas, TX; University of Texas Southwestern Medical Center, Dallas, TX. Electronic address: subhash.banerjee@utsouthwestern.edu.
authors.forename: Subhash
authors.initials: S
authors.lastname: Banerjee
mesh_terms: D000367:Age Factors; D000368:Aged; D000671:Amputation, Surgical; D015897:Comorbidity; D018572:Disease-Free Survival; D004334:Drug Administration Schedule; D011307:Drug Prescriptions; D004359:Drug Therapy, Combination; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D010818:Practice Patterns, Physicians' / Q000639:trends*; D016016:Proportional Hazards Models; D012008:Recurrence; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D010975:Platelet Aggregation Inhibitors