OSU Antithrombotic PAD Management Post Revascularization

According to Bonaca et al. (2020), limb symptoms frequently develop in patients with peripheral artery disease, to include those that are post revascularization. Such symptoms range from severe claudication, which limits function, to critical limb-threatening ischemia. Patients who undergo peripheral revascularization are at high risk for subsequent vascular complications with a risk approximately 4 times as high as that among persons who have never undergone revascularization. Several observations, to include use of inhibiting thrombin-mediated activation of platelets with vorapaxar reduced the risk of acute limb ischemia in patients with stable peripheral artery disease, indicate that the risk of this complication is modifiable. Additionally, the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) trial showed that rivaroxaban (a selective direct factor Xa inhibitor) at a dose of 2.5 mg twice daily added to aspirin reduced ischemic risk. Additional factors, such as bleeding risk, also plays a role in the judicial use of anticoagulants. Medication treatment plans in the presence of bleeding risk factors will require additional scrutiny as the clinician and patient weigh the risks. 

The decision tree used in this app was developed by the Anticoagulation Forum (Barnes, Parikh & Wirth, 2021) as an ACE Rapid Resource, called the Antithrombotic Management Following Peripheral Arterial Disease (PAD) Revascularization. The following disclaimer is posted by the AC Forum, "ACE Rapid Resources are not clinical practice guidelines; they are Anticoagulation Forum, Inc.’s best recommendations based on current knowledge, and no warranty or guaranty is expressed or implied. The content provided is for informational purposes for medical professionals only and is not intended to be used or relied upon by them as specific medical advice, diagnosis, or treatment, the determination of which remains the responsibility of the medical professionals for their patients."