Significant variation in P2Y12 inhibitor use after peripheral vascular intervention in Medicare beneficiaries.
There is no consensus regarding whether to use antithrombotic medications in patients with peripheral artery disease after lower-extremity peripheral vascular intervention.



The main hypothesis is that significant variation exists regarding use of antithrombotic medications after lower-extremity peripheral vascular intervention. We sought to examine the patterns of postprocedural antithrombotic medication use and associated factors in Medicare patients.



We measured rates of P2Y12 inhibitor use after peripheral vascular intervention in a 100% national sample of Medicare beneficiaries with Part D prescription drug coverage. We used logistic regression modeling to examine associations between patient and clinical factors and P2Y12 inhibitor use.



Between 2010 and 2012, a total of 85,830 patients underwent peripheral vascular intervention and had prescription drug claims. Overall, 18.3% of patients were treated with an oral anticoagulant, 19.1% received no P2Y12 inhibitor, 30.8% received a P2Y12 inhibitor before and after the procedure, 6.2% received a P2Y12 inhibitor for up to 30 days after the procedure, and 25.6% received a P2Y12 inhibitor for more than 30 days after the procedure. After adjustment, factors associated with P2Y12 inhibitor use included male sex; black race; history of renal disease, dementia, or heart failure; physician specialty; and clinical setting of the procedure. We observed a strong interaction effect between clinical setting and physician specialty (P < .001).



One-fifth of patients who underwent lower-extremity peripheral vascular intervention did not fill a prescription for a P2Y12 inhibitor. Patients whose operators were surgeons or radiologists had lower odds of P2Y12 inhibitor use. More research to determine the optimal use and duration of antithrombotic medications after the procedure is warranted.
Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute and Department of Medicine, Duke University School of Medicine, Durham, NC. Electronic address: schuyler.jones@duke.edu.
W Schuyler
WS
Jones
Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC.
Xiaojuan
X
Mi
Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC.
Laura G
LG
Qualls
Duke Clinical Research Institute and Department of Surgery, Duke University School of Medicine, Durham, NC.
Ryan S
RS
Turley
Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute and Department of Medicine, Duke University School of Medicine, Durham, NC.
Sreekanth
S
Vemulapalli
Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute and Department of Medicine, Duke University School of Medicine, Durham, NC.
Eric D
ED
Peterson
Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute and Department of Medicine, Duke University School of Medicine, Durham, NC.
Manesh R
MR
Patel
Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute and Department of Medicine, Duke University School of Medicine, Durham, NC.
Lesley H
LH
Curtis
D001741:Black or African American / Q000706:statistics & numerical data; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty; D017073:Atherectomy; D000072096:Cardiologists; D003704:Dementia / Q000453:epidemiology; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000453:epidemiology; D006801:Humans; D007674:Kidney Diseases / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D006278:Medicare; D016491:Peripheral Vascular Diseases / Q000628:therapy*; D010820:Physicians / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D058921:Purinergic P2Y Receptor Antagonists / Q000627:therapeutic use*; D000072177:Radiologists; D015642:Radiology, Interventional; D012737:Sex Factors; D015607:Stents; D066231:Surgeons; D014481:United States / Q000453:epidemiology; D014656:Vascular Surgical Procedures
D058921:Purinergic P2Y Receptor Antagonists