PMID- 34023428 OWN - NLM STAT- MEDLINE DCOM- 20211221 LR - 20221207 IS - 1097-6809 (Electronic) IS - 0741-5214 (Linking) VI - 74 IP - 4 DP - 2021 Oct TI - Impact of dual antiplatelet therapy after lower extremity revascularization for chronic limb-threatening ischemia. PG - 1327-1334 LID - S0741-5214(21)00752-7 [pii] LID - 10.1016/j.jvs.2021.04.067 [doi] AB - OBJECTIVE: The optimal antiplatelet regimen after lower extremity revascularization in patients with chronic limb-threatening ischemia (CLTI) is unknown because current recommendations are based on extrapolation of data from trials in coronary artery disease and stroke. METHODS: We identified all patients undergoing an elective lower extremity revascularization for CLTI in the Vascular Quality Initiative registry discharged on a mono antiplatelet agent (MAPT) or dual antiplatelet therapy (DAPT). RESULTS: From 2003 to 2018, 50,890 patients underwent revascularization procedures for CLTI, and were discharged on MAPT or DAPT. Of these, 33,781 patients underwent endovascular therapy (EVT), and 17,109 patients underwent open surgery (OS) procedures. The rate of major amputation at 30 days in the target limb in the EVT group was 0.3% and 0.4% in the OS group (P = .22). On Kaplan-Meier analyses, patients on MAPT at discharge had a higher risk of 1-year major amputation compared with DAPT after EVT but not after OS procedures. Patients on MAPT had lower overall survival and amputation-free survival at 30 days and 1 year compared with DAPT after both EVT and OS. At 1 year, the MAPT group was at higher risk for target lesion reintervention after EVT compared with the DAPT group (15.9% vs 13%; P = .0012). There was no significant difference in thrombosis at 1 year between the MAPT and DAPT groups either after EVT (3.9% vs 3.7%; P = .3048) or OS (3.1% vs 3.2%; P = .2893). On Cox regression analysis, DAPT was associated with improved survival but not major amputation after both EVT and OS. CONCLUSIONS: In patients with CLTI, DAPT at the time of discharge has a positive impact on amputation-free survival and overall survival after both EVT and OS as well as target lesion reintervention after EVT. DAPT was not associated with a positive impact on major amputation after either EVT or OS. CI - Published by Elsevier Inc. FAU - Ramanan, Bala AU - Ramanan B AD - Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Tex. Electronic address: bala.ramanan@utsouthwestern.edu. FAU - Jeon-Slaughter, Haekyung AU - Jeon-Slaughter H AD - Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Tex. FAU - Chen, Xiaofei AU - Chen X AD - Department of Statistical Science, Southern Methodist University, Dallas, Tex. FAU - Kashyap, Vikram S AU - Kashyap VS AD - Vascular Center, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio. FAU - Kirkwood, Melissa L AU - Kirkwood ML AD - Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Tex. FAU - Timaran, Carlos H AU - Timaran CH AD - Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Tex. FAU - Modrall, J Gregory AU - Modrall JG AD - Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Tex. FAU - Tsai, Shirling AU - Tsai S AD - Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Tex. LA - eng PT - Comparative Study PT - Journal Article DEP - 20210520 PL - United States TA - J Vasc Surg JT - Journal of vascular surgery JID - 8407742 RN - 0 (Platelet Aggregation Inhibitors) SB - IM MH - Aged MH - Aged, 80 and over MH - Amputation, Surgical MH - Chronic Disease MH - *Dual Anti-Platelet Therapy/adverse effects MH - *Endovascular Procedures/adverse effects/mortality MH - Female MH - Humans MH - Ischemia/diagnosis/mortality/*surgery MH - Limb Salvage MH - Lower Extremity/*blood supply MH - Male MH - Middle Aged MH - Patient Discharge MH - Peripheral Arterial Disease/diagnosis/mortality/*surgery MH - Platelet Aggregation Inhibitors/*administration & dosage/adverse effects MH - Progression-Free Survival MH - Registries MH - Retrospective Studies MH - Risk Assessment MH - Risk Factors MH - Time Factors MH - *Vascular Surgical Procedures/adverse effects/mortality OTO - NOTNLM OT - Chronic limb threatening ischemia OT - Dual antiplatelet therapy OT - Vascular Quality Initiative EDAT- 2021/05/24 06:00 MHDA- 2021/12/22 06:00 CRDT- 2021/05/23 20:39 PHST- 2020/10/23 00:00 [received] PHST- 2021/04/23 00:00 [accepted] PHST- 2021/05/24 06:00 [pubmed] PHST- 2021/12/22 06:00 [medline] PHST- 2021/05/23 20:39 [entrez] AID - S0741-5214(21)00752-7 [pii] AID - 10.1016/j.jvs.2021.04.067 [doi] PST - ppublish SO - J Vasc Surg. 2021 Oct;74(4):1327-1334. doi: 10.1016/j.jvs.2021.04.067. Epub 2021 May 20.