Peripheral Vascular Disease Management

Antiplatelet Therapy

• The American College of Cardiology recommends single antiplatelet therapy for most patients with symptomatic peripheral arterial disease (PAD) to reduce the risk of major adverse cardiovascular events, with options including aspirin (75-325 mg daily) or clopidogrel (75 mg daily) 1, 2, 3
• Clopidogrel (75 mg daily) may be preferred over aspirin in patients with PAD due to its superior efficacy in reducing cardiovascular events in the CAPRIE trial 3, 4
• For asymptomatic PAD patients, antiplatelet therapy is reasonable but the evidence is less robust 1, 5, 2
• Low-dose rivaroxaban (2.5 mg twice daily) combined with low-dose aspirin is effective for reducing both major adverse cardiovascular events and major adverse limb events in symptomatic PAD patients, particularly those at high risk 5, 2
• Dual antiplatelet therapy (aspirin plus clopidogrel) is reasonable for 1-6 months after endovascular revascularization but is not well-established for long-term use in patients without recent revascularization 1, 2

Lipid-Lowering and Antihypertensive Therapy

• The American College of Cardiology recommends statin therapy for all patients with PAD to reduce cardiovascular risk 1
• Antihypertensive therapy should be administered to patients with hypertension and PAD to reduce the risk of MI, stroke, heart failure, and cardiovascular death, with options including angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) 1, 3
• Beta-blockers are effective antihypertensive agents and are not contraindicated in patients with PAD 3

Diabetes Management and Smoking Cessation

• The American College of Cardiology recommends optimizing glycemic control in patients with PAD and diabetes, with a target hemoglobin A1C of less than 7% 3, 6
• Smoking cessation is vital for patients with PAD who continue to smoke, with options including nicotine replacement therapy, bupropion, and varenicline 1, 3

Post-Revascularization Medication Regimens

• After endovascular or surgical revascularization, antiplatelet therapy is recommended, with options including low-dose rivaroxaban (2.5 mg twice daily) combined with low-dose aspirin 2
• Dual antiplatelet therapy with a P2Y12 antagonist (e.g., clopidogrel) and low-dose aspirin is reasonable for at least 1-6 months after endovascular revascularization 2