Place of non-vitamin K antagonist oral anticoagulants in anticoagulant-antiplatelet combinations in peripheral artery disease.
Non-vitamin K antagonist oral anticoagulants are becoming increasingly important in the prophylaxis and treatment of thrombosis in atrial fibrillation and venous thromboembolism. Antiplatelets are widely prescribed in the primary and secondary prevention of cardiac and vascular diseases. There are potentially numerous situations where anticoagulants and antiplatelets may be combined; these combinations have been explored in coronary artery disease, and some have been included in updated recommendations. Is it legitimate to transpose these recommendations to the management of peripheral artery disease? The specific characteristics of the treated vessels, the stents used, the respective frequencies of stent thrombosis and its effect on the target organ are probably different, and explain why opinions differ. However, because of a lack of evidence, empirical behaviours are being established without scientific validation. This review of the literature details the situations in which combinations of an anticoagulant and an antiplatelet have been explored in peripheral artery disease. We discuss the issue of antithrombotic combinations in stable peripheral artery disease and for vascular or endovascular surgery.
Services des maladies vasculaires, de l'hypertension et de pharmacologie clinique, CHRU de Strasbourg, BP 426, 67091 Strasbourg, France. Electronic address: Dominique.stephan@chru-strasbourg.fr.
Dominique
D
Stephan
Services des maladies vasculaires, de l'hypertension et de pharmacologie clinique, CHRU de Strasbourg, BP 426, 67091 Strasbourg, France.
Elena-Mihaela
EM
Cordeanu
Services des maladies vasculaires, de l'hypertension et de pharmacologie clinique, CHRU de Strasbourg, BP 426, 67091 Strasbourg, France.
Corina
C
Mirea
Services des maladies vasculaires, de l'hypertension et de pharmacologie clinique, CHRU de Strasbourg, BP 426, 67091 Strasbourg, France.
Alix
A
Faller
Service de chirurgie vasculaire et de transplantation rénale, CHRU de Strasbourg, 67091 Strasbourg, France.
Anne
A
Lejay
Services des maladies vasculaires, de l'hypertension et de pharmacologie clinique, CHRU de Strasbourg, BP 426, 67091 Strasbourg, France.
Sébastien
S
Gaertner
D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D006801:Humans; D058729:Peripheral Arterial Disease / Q000517:prevention & control*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D055502:Secondary Prevention / Q000379:methods*; D014812:Vitamin K / Q000037:antagonists & inhibitors*
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D014812:Vitamin K
Anticoagulants oraux directs; Antiplaquettaires; Antiplatelets; Artériopathie oblitérante des membres inférieurs; Aspirin; Aspirine; Clopidogrel; Non-vitamin K antagonist oral anticoagulants; Peripheral artery disease