Antithrombotic agents after peripheral transluminal angioplasty: a review of the studies, methods and evidence for their use

Abstract

Objective: to review published studies and assess the strength of the evidence for the use of antithrombotic agents for the prevention of re-occlusion after peripheral angioplasty.

Methods: a literature search was performed. All randomised comparative studies with patency assessments or clinical endpoints were included. The methods and results of the studies were compared and evaluated.

Results: eleven randomised trials were identified, six of them were double blind. The majority of patients included were those with femoropopliteal lesions. A significant benefit of aspirin in one placebo-controlled study is balanced by no apparent benefit in another study. No dose-dependent effect of aspirin in the range 50-1000 mg/day has been shown in any of the four studies investigating such an effect. None of the three studies comparing platelet inhibitors and oral anticoagulants have shown any differences in outcome and no other well-designed studies of anticoagulants have been reported.

Conclusions: evidence for a reduction in the likelihood of re-occlusion or restenosis after peripheral transluminal angioplasty with platelet inhibitors remains equivocal. Evidence for the efficacy of any other agent in this indication is also lacking.