Antithrombotic Strategies for Patients With Peripheral Artery Disease: JACC Scientific Statement

Affiliations

¹ CPC Clinical Research, Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA. Electronic address: marc.bonaca@cpcmed.org.
² Frankel Cardiovascular Center, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
³ Cardioangiology Center Bethanien, Frankfurt, Germany, and the Center for Vascular Research, Munich, Germany.
⁴ University of Connecticut School of Pharmacy, Storrs, Connecticut, USA.
⁵ Vascular Surgery and Center for Limb Preservation, University of California-San Francisco, San Francisco, California, USA.
⁶ Division of Vascular and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA.
⁷ CPC Clinical Research, Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA.
⁸ Cardiovascular Division, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA.
⁹ Vascular Medicine Outcomes (VAMOS) Program, Department of Internal Medicine, Section of Cardiology, Yale University, New Haven, Connecticut, USA.
¹⁰ McMaster University and the Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario, Canada.
¹¹ Vascular Medicine, UT Southwestern Medical Center, Dallas, Texas, USA.

PMID: 39197984
DOI: 10.1016/j.jacc.2024.06.027

Free article

Review

Antithrombotic Strategies for Patients With Peripheral Artery Disease: JACC Scientific Statement

Marc P Bonaca et al. J Am Coll Cardiol. 2024.

Free article

. 2024 Sep 3;84(10):936-952.

doi: 10.1016/j.jacc.2024.06.027.

Authors

Affiliations

¹ CPC Clinical Research, Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA. Electronic address: marc.bonaca@cpcmed.org.
² Frankel Cardiovascular Center, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
³ Cardioangiology Center Bethanien, Frankfurt, Germany, and the Center for Vascular Research, Munich, Germany.
⁴ University of Connecticut School of Pharmacy, Storrs, Connecticut, USA.
⁵ Vascular Surgery and Center for Limb Preservation, University of California-San Francisco, San Francisco, California, USA.
⁶ Division of Vascular and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA.
⁷ CPC Clinical Research, Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA.
⁸ Cardiovascular Division, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA.
⁹ Vascular Medicine Outcomes (VAMOS) Program, Department of Internal Medicine, Section of Cardiology, Yale University, New Haven, Connecticut, USA.
¹⁰ McMaster University and the Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario, Canada.
¹¹ Vascular Medicine, UT Southwestern Medical Center, Dallas, Texas, USA.

PMID: 39197984
DOI: 10.1016/j.jacc.2024.06.027

Abstract

Patients with peripheral artery disease (PAD) experience major cardiovascular and limb events. Antithrombotic strategies including antiplatelets and anticoagulants remain a cornerstone of treatment and prevention. Recent trials have shown heterogeneity in the response to antithrombotic therapies in patients presenting primarily with PAD when compared to those presenting primarily with coronary artery disease. In addition, there is observed heterogeneity with regards to the effects of antiplatelets and anticoagulants with respect to different outcomes including cardiovascular and major adverse limb events. This, coupled with risks of bleeding, requires a patient-centered and holistic assessment of benefit-risk when selecting antithrombotic strategies for patients with PAD. A global multidisciplinary work group was convened to evaluate antithrombotic strategies in PAD and to summarize the current state of the art. Common clinical scenarios around antithrombotic decision making were provided. Finally, insights with regard to implementation future investigation were described.

Keywords: antithrombotic therapy; major adverse limb event; peripheral artery disease.

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Conflict of interest statement

Funding Support and Author Disclosures Drs Bonaca and Hess work with CPC, a nonprofit academic research organization affiliated with the University of Colorado that has received research grant/consulting funding from Abbott Laboratories, Agios Pharmaceuticals Inc, Alexion Pharma, Alnylam Pharmaceuticals Inc, Amgen Inc, Angionetics Inc, Anthos Therapeutics, ARCA Biopharma Inc, Array BioPharma Inc, AstraZeneca and Affiliates, Atentiv LLC, Audentes Therapeutics Inc, Bayer and Affiliates, Beth Israel Deaconess Medical Center, Better Therapeutics Inc, Boston Clinical Research Institute, Bristol Myers Squibb Company, Cambrian Biopharma Inc, Cardiol Therapeutics Inc, CellResearch Corp, Cleerly Inc, Cook Regentec LLC, CSL Behring LLC, Eidos Therapeutics, Inc, EP Trading Co Ltd, EPG Communication Holdings Ltd, Epizon Pharma Inc, Esperion Therapeutics Inc, Everly Well Inc, Exicon Consulting Pvt Ltd, Faraday Pharmaceuticals Inc, Foresee Pharmaceuticals Co Ltd, Fortress Biotech Inc, HDL Therapeutics Inc, HeartFlow Inc, Hummingbird Bioscience, Insmed Inc, Ionis Pharmaceuticals, IQVIA Inc, Janssen and Affiliates, Kowa Research Institute Inc, Kyushu University, Lexicon Pharmaceuticals Inc, Medimmune Ltd, Medpace, Merck & Affiliates, Nectero Medical Inc, Novartis Pharmaceuticals Corp, Novo Nordisk Inc, Osiris Therapeutics Inc, Pfizer Inc, PhaseBio Pharmaceuticals Inc, PPD Development, LP, Prairie Education and Research Cooperative, Prothena Biosciences Limited, Regeneron Pharmaceuticals Inc, Regio Biosciences Inc, Saint Luke’s Hospital of Kansas City, Sanifit Therapeutics SA, Sanofi Groupe, Silence Therapeutics PLC, Smith & Nephew plc, Stanford Center for Clinical Research, Stealth BioTherapeutics Inc, State of Colorado CCPD Grant, The Brigham & Women's Hospital Inc, The Feinstein Institutes for Medical Research, Thrombosis Research Institute, University of Colorado, University of Pittsburgh, VarmX, Virta Health Corporation, Worldwide Clinical Trials Inc, WraSer LLC, and Yale Cardiovascular Research Group. Dr Bonaca has received support from the AHA SFRN under award numbers 18SFRN3390085 (BWH-DH SFRN Center) and 18SFRN33960262 (BWH-DH Clinical Project). Dr Barnes has received grants from Boston Scientific; has received consulting fees from Pfizer, and Bristol Myers Squibb, Janssen, Bayer, AstraZeneca, Sanofi, Anthos, Abbott Vascular, Boston Scientific; has been part of the Data and Safety Monitoring Board (DSMB) for Translational Sciences (Clinical Events Adjudication Committee); and has been a member of the Board of Directors - Anticoagulation Forum. Dr Bauersachs has received personal fees from Bayer, Bristol Myers Squibb, LEO-Pharma, Pfizer, VIATRIS; and has received research support from the Bavarian State Ministry of Health and FADOI (Federazione delle Associazioni dei Dirigenti Ospedalieri Internisti). Dr Conte has received grants from BioGenCell and Profusa; and has been a member of the DSMB for Abbott Vascular. Dr Mena-Hurtado has received consulting fees from Abbott, Cook, and Penumbra; and has received grants from the National Institutes of Health, Philip, Shockwave, and Abbott. Dr Weitz has received consulting fees from Alnylam, Anthos, Bayer, Bristol Myers Squibb, Daiichi-Sankyo, Ionis, JnJ, Merck, and Regeneron. Dr Beckman has received grants from Bristol Myers Squibb; and has received consulting fees from JanOne, Janssen, Novartis, MingSight, and Merck. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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Antithrombotic Strategies for Patients With Peripheral Artery Disease: JACC Scientific Statement

Affiliations

Antithrombotic Strategies for Patients With Peripheral Artery Disease: JACC Scientific Statement

Authors

Affiliations

Abstract

Conflict of interest statement

Publication types

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Medical