title: The role of antiplatelet therapy in patients with peripheral artery disease and lower extremity peripheral artery revascularization.
abstract: OBJECTIVE
  Although antiplatelet agents are frequently prescribed to patients with lower extremity peripheral artery disease (PAD), there is an overall lack of consensus among published evidence and guidelines with respect to this practice.
  
  
  RESULTS
  Antiplatelet agents are prescribed to patients with PAD to reduce both cardiovascular and limb-based events during the follow-up period. A large evidence base supports the use of antiplatelet monotherapy with aspirin or clopidogrel in patients with symptomatic PAD or a history of peripheral artery revascularization. However, antiplatelet monotherapy has not proven beneficial in patients with asymptomatic PAD. Dual antiplatelet therapy has not demonstrated a clear benefit in reducing the risk of cardiovascular events in patients with symptomatic PAD. Its role in reducing the risk of adverse limb events following endovascular or surgical revascularization also remains unclear. Recently, the use of vorapaxar in addition to aspirin and/or clopidogrel has been associated with a significant reduction in the need for repeat revascularization procedures and hospitalization for limb ischemia in patients with established PAD.
  
  
  CONCLUSIONS
  Eligible patients with symptomatic PAD or with a history of peripheral artery revascularization should be prescribed antiplatelet monotherapy for secondary prevention of both cardiovascular and limb events, using aspirin, clopidogrel, and/or vorapaxar. Given the significant overlap of PAD and coronary artery disease, the evidence presented in this article may have important implications for management of patients with coronary artery disease.
authors.affiliation: aVeteran Affairs North Texas Healthcare System bUniversity of Texas, Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Subhash
authors.initials: S
authors.lastname: Banerjee
authors.forename: Karan
authors.initials: K
authors.lastname: Sarode
authors.forename: Ariel
authors.initials: A
authors.lastname: Vinas
authors.forename: Avantika
authors.initials: A
authors.lastname: Banerjee
authors.forename: Atif
authors.initials: A
authors.lastname: Mohammad
authors.forename: Emmanouil S
authors.initials: ES
authors.lastname: Brilakis
mesh_terms: D019468:Disease Management; D057510:Endovascular Procedures / Q000379:methods; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply; D058729:Peripheral Arterial Disease / Q000150:complications / Q000628:therapy; D010975:Platelet Aggregation Inhibitors / Q000145:classification / Q000494:pharmacology; D018570:Risk Assessment; D055502:Secondary Prevention / Q000379:methods; D013927:Thrombosis / Q000209:etiology / Q000517:prevention & control
chemical_list: D010975:Platelet Aggregation Inhibitors