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Journal article
Antithrombotic therapy and major adverse limb events in patients with chronic lower extremity arterial disease: systematic review and meta-analysis from the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy in Collaboration with the European Society of Cardiology Working Group on Aorta and Peripheral Vascular Diseases
European heart journal. Cardiovascular pharmacotherapy, v 6(2), pp 86-93
01 Apr 2020
PMID: 31392312
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Aims : The role and selection of antithrombotic therapy to improve limb outcomes in chronic lower extremity artery disease (LEAD) is still debated. We conducted a meta-analysis to examine the efficacy and safety of antithrombotic and more intense antithrombotic therapy on limb outcomes and limb salvage in patients with chronic LEAD
Methods and results : Study inclusion criteria were: enrolment of patients with LEAD, randomized allocation to more vs. less intense antithrombotic therapy [more vs. less intense single-antiplatelet therapy (SAPT); dual-antiplatelet therapy vs. SAPT; dual antithrombotic therapy vs. SAPT or oral anticoagulant]; enrolment of >= 200 patients; reporting of at least one of following outcomes: limb amputation or revascularization. Seven randomized studies enrolling 30 447 patients were included. Over a median follow-up of 24 months, more vs. less intense antithrombotic therapy or placebo significantly reduced the risk of limb revascularization [relative risk (RR) 0.89, 95% confidence interval (CI) 0.83-0.94] and limb amputation (RR 0.63, 95% CI 0.46-0.86), as well as stroke (RR 0.82, 95% CI 0.70-0.97). There was no statistically significant effect on the risk of myocardial infarction (RR 0.98, 95% CI 0.87-1.11), all-cause (RR 0.93, 95% CI 0.86-1.01), and cardiovascular death (RR 0.97, 95% CI 0.86-1.08). Risk of major bleeding increased (RR 1.23, 95% CI 1.04-1.44)
Conclusion : In patients with LEAD, more intense antithrombotic therapy reduces the risk of limb amputation and revascularization as well as stroke with an increase in the risk of bleeding events.
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Details
- Title
- Antithrombotic therapy and major adverse limb events in patients with chronic lower extremity arterial disease: systematic review and meta-analysis from the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy in Collaboration with the European Society of Cardiology Working Group on Aorta and Peripheral Vascular Diseases
- Creators
- Gianluigi Savarese - Karolinska InstitutetMartin F. Reiner - Univ Hosp Zurich, Dept Med, Ramistr 100, Zurich 8091, SwitzerlandAlicia Uijl - Karolinska Inst, Dept Med, Div Cardiol, S1 02, Stockholm 17176, SwedenDomenico D'Amario - Istituti di Ricovero e Cura a Carattere ScientificoStefan Agewall - Oslo University HospitalDan Atar - Univ Oslo, ulleval, Oslo Univ Hosp, Dept Cardiol, Oslo, NorwayIris Baumgartner - University Hospital of BernClaudio Borghi - University of BolognaMarco De Carlo - Azienda Osped Univ Pisana, Cardiothorac & Vasc Dept, Via Paradisa 2, Pisa 56100, ItalyHeinz Drexel - Drexel UniversityJuan Carlos Kaski - St George's, University of LondonKeld P. Kjeldsen - Aalborg UniversityNils Kucher - Univ Hosp Zurich, Clin Angiol, Zurich, SwitzerlandLars H. Lund - Karolinska University HospitalAlexander Niessner - Medical University of ViennaAnne Grete Semb - Diakonhjemmet HospitalThomas A. Schmidt - Zealand University HospitalSven Wassmann - Lungenheilkunde München-PasingPatrick Sulzgruber - Med Univ Vienna, Dept Internal Med 2, Div Cardiol, Waehringer Guertel 18-20, A-1090 Vienna, AustriaVictor Aboyans - Dupuytren Univ Hosp, Dept Cardiol, 2 Martin Luther King Ave, Limoges 87000, FranceJuan Tamargo - Universidad Complutense de MadridBasil S. Lewis - Carmel Medical CenterCristiana Vitale - IRCCS San Raffaele, Dept Med Sci, Rome, Italy
- Publication Details
- European heart journal. Cardiovascular pharmacotherapy, v 6(2), pp 86-93
- Publisher
- Oxford Univ Press
- Number of pages
- 8
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- College of Medicine
- Web of Science ID
- WOS:000531890000004
- Scopus ID
- 2-s2.0-85082147691
- Other Identifier
- 991021897363104721
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- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Cardiac & Cardiovascular Systems
- Pharmacology & Pharmacy