Int J Angiol. 2012 Dec;21(4):187-94. doi: 10.1055/s-0032-1330232.
A review of the role of anticoagulation in the treatment of peripheral arterial disease.
The International journal of angiology : official publication of the International College of Angiology, Inc
Thomas F Whayne
Affiliations
Affiliations
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, Kentucky.
PMID: 24293975
PMCID: PMC3578611 DOI: 10.1055/s-0032-1330232
Abstract
Peripheral arterial disease (PAD) is a major medical/surgical problem associated with high risk for coronary heart disease (CHD). Anticoagulation plays a significant role in the management of the PAD patient. However, evidence-based medicine supports only select anticoagulants, mainly antiplatelet agents. The available anticoagulant classes, their individual medications, and the mechanisms of action are described. Dextran 40, platelet glycoprotein (GP) IIb/IIIa receptor antagonists, direct thrombin (factor IIa, FIIa) inhibitors, and factor Xa (FXa) inhibitors do not, at this juncture, appear to have a significant role to play in the PAD patient. Aspirin has been used in PAD patients for a few decades, as has warfarin, but the role of warfarin is very limited. An attempt has been made to place each medication and its function in context all the way to the present with oral direct thrombin (FIIa) and FXa inhibitors described. These inhibitors may ultimately play an, as yet, undefined role in PAD. Specific use of anticoagulants in PAD patients is described and aspirin still stands out as a fundamental therapy. The thienopyridines, especially clopidogrel, have their established place and there is some evidence for benefit from the use of clopidogrel in dual therapy with aspirin. Dipyridamole, especially with aspirin as dual therapy, and cilostazol also have their evidence-based niches. The main role played by warfarin is for the patient with a vein graft in the arterial circulation. Heparin retains significant procedural importance. For now, Class I, Level of Evidence A center around aspirin for the PAD patient with clopidogrel, an alternative agent.
Keywords: anticoagulation; aspirin; cardiovascular disease; coronary artery; peripheral arterial disease; risk factors; thienopyridines
References
- Br J Surg. 2005 Feb;92(2):159-65 - PubMed
- J Clin Invest. 1975 Sep;56(3):624-32 - PubMed
- Cardiology. 2005;103(3):158-60 - PubMed
- Lancet. 1985 Feb 23;1(8426):415-9 - PubMed
- Lancet. 1992 Jul 18;340(8812):143-5 - PubMed
- Chest. 2008 Jun;133(6 Suppl):199S-233S - PubMed
- J Vasc Surg. 1998 Jul;28(1):23-6; discussion 26-7 - PubMed
- Cardiol Rev. 2011 Mar-Apr;19(2):95-100 - PubMed
- J Clin Invest. 1983 Nov;72(5):1521-5 - PubMed
- N Engl J Med. 2011 Sep 8;365(10):883-91 - PubMed
- N Engl J Med. 2009 Sep 17;361(12):1139-51 - PubMed
- Chest. 2005 Feb;127(2 Suppl):53S-59S - PubMed
- J Vasc Surg. 2004 May;39(5):977-84 - PubMed
- N Engl J Med. 2006 Apr 20;354(16):1706-17 - PubMed
- Chest. 1992 Oct;102(4 Suppl):337S-351S - PubMed
- J Vasc Surg. 1998 Sep;28(3):446-57 - PubMed
- Curr Pharm Des. 2003;9(28):2289-302 - PubMed
- J Clin Invest. 1968 Sep;47(9):2169-80 - PubMed
- Int J Cardiol. 2011 Aug 4;150(3):325-31 - PubMed
- Chest. 2012 Feb;141(2 Suppl):e669S-e690S - PubMed
- J Vasc Surg. 2010 Oct;52(4):825-33, 833.e1-2 - PubMed
- J Neurol Sci. 1996 Nov;143(1-2):1-13 - PubMed
- J Vasc Surg. 1998 Feb;27(2):267-74; discussion 274-5 - PubMed
- Catheter Cardiovasc Interv. 2012 Mar 1;79(4):501-31 - PubMed
- N Engl J Med. 2009 Sep 3;361(10):940-2 - PubMed
- Circulation. 2005 Feb 8;111(5):633-42 - PubMed
- Lancet. 2000 Jan 29;355(9201):346-51 - PubMed
- Blood Coagul Fibrinolysis. 2011 Oct;22(7):565-70 - PubMed
- Med Sci Monit. 2009 Dec;15(12):MS24-30 - PubMed
- J Am Coll Cardiol. 2011 Mar 15;57(11):1251-63 - PubMed
- J Vasc Surg. 2005 Aug;42(2):252-8 - PubMed
- Cochrane Database Syst Rev. 2011 Nov 09;(11):CD001272 - PubMed
- Cochrane Database Syst Rev. 2005 Jan 25;(1):CD002071 - PubMed
- Eur J Vasc Endovasc Surg. 1996 Jul;12(1):86-90 - PubMed
- Am Heart J. 1990 Dec;120(6 Pt 1):1414-8 - PubMed
- Clin Appl Thromb Hemost. 2004 Jan;10(1):9-18 - PubMed
- J Vasc Interv Radiol. 2005 Feb;16(2 Pt 1):165-71 - PubMed
- Br J Pharmacol. 2006 Jan;147 Suppl 1:S241-51 - PubMed
- Catheter Cardiovasc Interv. 2009 Jul 1;74 Suppl 1:S7-S11 - PubMed
- N Engl J Med. 2011 Sep 15;365(11):981-92 - PubMed
- J Vasc Surg. 1997 Sep;26(3):517-38 - PubMed
- Br J Haematol. 2008 Jun;141(6):757-63 - PubMed
- N Engl J Med. 2007 Nov 15;357(20):2001-15 - PubMed
- Platelets. 2004 Jun;15(4):215-22 - PubMed
- Drug Metab Dispos. 2010 Jan;38(1):92-9 - PubMed
- Circulation. 2009 Dec 22;120(25):2577-85 - PubMed
- Blood Transfus. 2009 Jan;7(1):18-23 - PubMed
- Am J Surg. 1990 Jun;159(6):556-60 - PubMed
- BMJ. 1994 Jan 15;308(6922):159-68 - PubMed
- Circulation. 2010 Jun 15;121(23):2584-91 - PubMed
- Thromb Res. 1988 Dec 1;52(5):353-9 - PubMed
- J Am Coll Cardiol. 2011 Feb 8;57(6):672-84 - PubMed
- JAMA. 2001 Sep 19;286(11):1317-24 - PubMed
- Cochrane Database Syst Rev. 2011 Jun 15;(6):CD000536 - PubMed
- J Vasc Surg. 2002 Mar;35(3):413-21 - PubMed
- Lancet Neurol. 2010 Oct;9(10):959-68 - PubMed
- Nature. 2001 Jan 11;409(6817):202-7 - PubMed
Publication Types