Article

New treatments for peripheral artery disease

John Bartholomew, MD and G. Jay Bishop, MD
Cleveland Clinic Journal of Medicine May 2020, 87 (5 suppl 1) 21-25; DOI: https://doi.org/10.3949/ccjm.87.s1.03

Article Figures & Data

Figures

  • Figure 1
    Figure 1

    Therapeutic approach for patients with peripheral artery disease.

    BID = 2 times per day; MI = myocardial infarction

    Reprinted from Hussain MA, et al. Antithrombotic therapy for peripheral artery disease: recent advances. J Am Coll Cardiol 2018; 71(21):2450–2467. Copyright 2018, with permission from The American College of Cardiology Foundation.

Tables

  • TABLE 1

    Natural history of peripheral artery disease

    Symptoms at diagnosis in patients with PADPatients (%)5-Year outcomes
    Asymptomatic20–50Major adverse limb events
    Atypical leg discomfort40–50 Stable claudication: 70%–80%
    Claudication10–30 Lower extremity revascularization: 10%–20%
     Critical limb ischemia: 1%–2%
    Major adverse cardiovascular events
     Myocardial infarction/stroke: 20%
     Death: 15%–30%
    1-year outcomes
    Critical limb ischemia1–2Amputation: 25%

    • Source: Data from reference 6.

  • TABLE 2

    Clinical trials of antithrombotic therapy for peripheral artery disease (PAD)

    TherapyTrial, date (agent)
    Symptomatic PADSingle agentCAPRIE 1996 (clopidogrel vs placebo)9
    CLIPS 2007 (ASA vs placebo)10
    EUCLID 2016 (ticagrelor vs clopidogrel)11
    Dual antiplateletCHARISMA 2009 (clopidogrel + ASA vs ASA)12
    PLATO 2015 (ticagrelor + ASA vs clopidogrel + ASA)13
    PEGASUS-TIMI 54 2016 (ticagrelor + ASA vs ASA)14
    PRODIGY 2016 (clopidogrel + ASA for 24M vs 6M)15
    DAPT 2017 (P2Y12 inhibitor + ASA for 30M vs 12M)16
    PAR-1 antagonistTRA2 P-TIMI 50 2013 (vorapaxar vs placebo)17
    TRACER 2014 (vorapaxar vs placebo)18
    AnticoagulationWAVE 2007 (warfarin + antiplatelet vs antiplatelet)19
    COMPASS 2017 (rivaroxaban + ASA vs ASA)20
    Asymptomatic PADPOPADAD 2008 (ASA vs placebo)21
    AAA 2010 (ASA vs placebo)22
    Revascularization for PADSurgicalDutch BOA 2000 (anticoagulation vs ASA)23
    CASPAR 2010 (clopidogrel + ASA vs ASA)24
    EndovascularMIRROR 2012 (clopidogrel + ASA vs placebo)25

    • AAA = Aspirin for Asymptomatic Atherosclerosis; ASA = acetylsalicylic acid; BOA = Bypass Oral anticoagulants or Aspirin; CAPRIE = Clopidogrel Versus Aspirin in Patients at Risk of Ischaemic Events; CASPAR = Clopidogrel and Acetylsalicylic Acid in Bypass Surgery for Peripheral Arterial Disease; CHARISMA = Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management, and Avoidance; CLIPS = Critical Leg Ischaemia Prevention Study; COMPASS = Cardiovascular Outcomes for People Using Anticoagulation Strategies; DAPT = dual antiplatelet therapy; EUCLID = Examining Use of Ticagrelor in Peripheral Artery Disease; M = months; MIRROR = Management of Peripheral Arterial Interventions With Mono or Dual Antiplatelet Therapy; PAR = protease-activated receptor; PEGASUS-TIMI 54 = Prevention of Cardiovascular Events in Patients With Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin–Thrombolysis In Myocardial Infarction 54; PLATO = Study of Platelet Inhibition and Patient Outcomes; POPADAD = Prevention of Progression of Arterial Disease and Diabetes; PRODIGY = Prolonging Dual Antiplatelet Treatment After Grading Stent-Induced Intimal Hyperplasia Study; TRA2 P-TIMI 50 = Thrombin Receptor Antagonist in Secondary Prevention of Atherothrombotic Ischemic Events–Thrombolysis In Myocardial Infarction 50; TRACER = Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome; WAVE = Warfarin Antiplatelet Vascular Evaluation

    • Source: Data from reference 8.

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