PMID- 31630320
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20240519
IS  - 2193-8261 (Print)
IS  - 2193-6544 (Electronic)
IS  - 2193-6544 (Linking)
VI  - 8
IP  - 2
DP  - 2019 Dec
TI  - A Review of Antithrombotic Treatment in Critical Limb Ischemia After Endovascular 
      Intervention.
PG  - 193-209
LID - 10.1007/s40119-019-00153-7 [doi]
AB  - Endovascular intervention is often used to treat critical limb ischemia (CLI). 
      Post-intervention treatment with antiplatelet and/or anticoagulant therapy has 
      reduced morbidity and mortality due to cardiovascular complications. The purpose 
      of this review is to shed light on the various pharmacologic treatment protocols 
      for treating CLI following endovascular procedures. We reviewed the literature 
      comparing outcomes after antithrombotic treatment for patients with CLI. We 
      characterized antithrombotic therapies into three categories: (1) 
      mono-antiplatelet therapy (MAPT) vs. dual antiplatelet therapy (DAPT), (2) MAPT 
      vs. antiplatelet (AP) + anticoagulant (AC) therapy, and (3) AC vs. AP + AC 
      therapy. Relevant results and statistics were extracted to determine differences 
      in the rates of the following outcomes: (1) re-stenosis, (2) occlusion, (3) 
      target limb revascularization (TLR), (4) major amputation, (5) major adverse 
      cardiac events, (6) all-cause death, and (7) bleeding. Studies suggest that DAPT 
      reduces post-surgical restenosis, TLR, and amputation for diabetic patients, 
      without increasing major bleeding incidences, compared to MAPT. Also, AP + AC 
      therapy provides overall superior efficacy, with no difference in bleeding 
      incidences, compared to antiplatelet alone. Additionally, the effects were 
      significant for restenosis, limb salvage, survival rates, and cumulative rate of 
      above ankle amputation or death. These results suggest that treatment with DAPT 
      and AP + AC might provide better outcomes than MAPT following the endovascular 
      intervention for CLI, and that the ideal treatment may be related to the 
      condition of the individual patient. However, the studies were few and 
      heterogenous with small patient populations. Therefore, further large controlled 
      studies are warranted to confirm these outcomes.
FAU - Gupta, Amol
AU  - Gupta A
AUID- ORCID: 0000-0001-8307-4192
AD  - Heart, Vascular & Leg Center, Bakersfield, CA, USA. amol@vippllc.com.
FAU - Lee, Michael S
AU  - Lee MS
AD  - Division of Cardiology, UCLA Medical Center, Los Angeles, CA, USA.
FAU - Gupta, Kush
AU  - Gupta K
AD  - Kasturba Medical College, Mangalore, India.
FAU - Kumar, Vinod
AU  - Kumar V
AD  - Heart, Vascular & Leg Center, Bakersfield, CA, USA.
FAU - Reddy, Sarath
AU  - Reddy S
AD  - Division of Cardiology, The Brooklyn Hospital Center, Brooklyn, NY, USA.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20191019
PL  - England
TA  - Cardiol Ther
JT  - Cardiology and therapy
JID - 101634495
PMC - PMC6828854
OTO - NOTNLM
OT  - Anticoagulant
OT  - Antiplatelet
OT  - Critical limb ischemia
OT  - Endovascular procedures
OT  - Peripheral artery disease
COIS- Amol Gupta, Michael Lee, Kush Gupta, Vinod Kumar, and Sarath Reddy have nothing 
      to disclose.
EDAT- 2019/10/21 06:00
MHDA- 2019/10/21 06:01
PMCR- 2019/10/19
CRDT- 2019/10/21 06:00
PHST- 2019/08/28 00:00 [received]
PHST- 2019/10/21 06:00 [pubmed]
PHST- 2019/10/21 06:01 [medline]
PHST- 2019/10/21 06:00 [entrez]
PHST- 2019/10/19 00:00 [pmc-release]
AID - 10.1007/s40119-019-00153-7 [pii]
AID - 153 [pii]
AID - 10.1007/s40119-019-00153-7 [doi]
PST - ppublish
SO  - Cardiol Ther. 2019 Dec;8(2):193-209. doi: 10.1007/s40119-019-00153-7. Epub 2019 
      Oct 19.