PMID- 18574279
OWN - NLM
STAT- MEDLINE
DCOM- 20080826
LR  - 20170602
IS  - 0012-3692 (Print)
IS  - 0012-3692 (Linking)
VI  - 133
IP  - 6 Suppl
DP  - 2008 Jun
TI  - Antithrombotic therapy for peripheral artery occlusive disease: American College 
      of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition).
PG  - 815S-843S
LID - S0012-3692(08)60131-2 [pii]
LID - 10.1378/chest.08-0686 [doi]
AB  - This chapter is devoted to antithrombotic therapy for peripheral artery occlusive 
      disease as part of the American College of Chest Physicians Evidence-Based 
      Clinical Practice Guidelines (8th Edition). Grade 1 recommendations are strong 
      and indicate that the benefits do, or do not, outweigh risks, burden, and costs. 
      Grade 2 suggests that individual patients' values may lead to different choices 
      (for a full understanding of the grading see the "Grades of Recommendation" 
      chapter by Guyatt et al, CHEST 2008; 133:123S-131S). Among the key 
      recommendations in this chapter are the following: We recommend lifelong 
      antiplatelet therapy in comparison to no antiplatelet therapy in pulmonary artery 
      disease (PAD) patients with clinically manifest coronary or cerebrovascular 
      disease (Grade 1A), and also in those without clinically manifest coronary or 
      cerebrovascular disease (Grade 1B). In patients with PAD and intermittent 
      claudication, we recommend against the use of anticoagulants (Grade 1A). For 
      patients with moderate to severe disabling intermittent claudication who do not 
      respond to exercise therapy, and who are not candidates for surgical or 
      catheter-based intervention, we recommend cilostazol (Grade 1A). We suggest that 
      clinicians not use cilostazol in those with less-disabling claudication (Grade 
      2A). In patients with short-term (< 14 days) arterial thrombosis or embolism, we 
      suggest intraarterial thrombolytic therapy (Grade 2B), provided they are at low 
      risk of myonecrosis and ischemic nerve damage developing during the time to 
      achieve revascularization. For patients undergoing major vascular reconstructive 
      procedures, we recommend IV unfractionated heparin (UFH) prior to the application 
      of vascular cross clamps (Grade 1A). For all patients undergoing infrainguinal 
      arterial reconstruction, we recommend aspirin (75-100 mg, begun preoperatively) 
      [Grade 1A]. For routine autogenous vein infrainguinal bypass, we recommend 
      aspirin (75-100 mg, begun preoperatively) [Grade 1A]. For routine prosthetic 
      infrainguinal bypass, we recommend aspirin (75-100 mg, begun preoperatively) 
      [Grade 1A]. In patients undergoing carotid endarterectomy, we recommend that 
      aspirin, 75-100 mg, be administered preoperatively and continued indefinitely 
      (75-100 mg/d) [Grade 1A]. In nonoperative patients with asymptomatic carotid 
      stenosis (primary or recurrent), we suggest that dual antiplatelet therapy with 
      aspirin and clopidogrel be avoided (Grade 1B). For all patients undergoing 
      lower-extremity balloon angioplasty (with or without stenting), we recommend 
      long-term aspirin, 75-100 mg/d (Grade 1C).
FAU - Sobel, Michael
AU  - Sobel M
AD  - VA Puget Sound Health Care System and University of Washington School of 
      Medicine, Seattle, WA. Electronic address: michael.sobel@va.gov.
FAU - Verhaeghe, Raymond
AU  - Verhaeghe R
AD  - Katholieke Universiteit Leuven, Leuven, Belgium.
LA  - eng
PT  - Journal Article
PT  - Practice Guideline
PL  - United States
TA  - Chest
JT  - Chest
JID - 0231335
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 9005-49-6 (Heparin)
RN  - R16CO5Y76E (Aspirin)
SB  - IM
MH  - Arterial Occlusive Diseases/*drug therapy
MH  - Aspirin/administration & dosage/therapeutic use
MH  - *Evidence-Based Medicine
MH  - Fibrinolytic Agents/*therapeutic use
MH  - Heparin/administration & dosage/therapeutic use
MH  - Humans
MH  - Platelet Aggregation Inhibitors/administration & dosage/*therapeutic use
MH  - Risk Assessment
MH  - Risk Factors
MH  - *Thrombolytic Therapy
EDAT- 2008/07/24 09:00
MHDA- 2008/08/30 09:00
CRDT- 2008/07/24 09:00
PHST- 2008/07/24 09:00 [pubmed]
PHST- 2008/08/30 09:00 [medline]
PHST- 2008/07/24 09:00 [entrez]
AID - S0012-3692(08)60131-2 [pii]
AID - 10.1378/chest.08-0686 [doi]
PST - ppublish
SO  - Chest. 2008 Jun;133(6 Suppl):815S-843S. doi: 10.1378/chest.08-0686.