Optimal Strategy for Antiplatelet Therapy in Patients With Lower Extremity Artery Disease

Background: The duration of antiplatelet therapy in patients with lower extremity artery disease (LEAD) has not been well established. This study aimed to evaluate the clinical outcome according to the duration of dual-antiplatelet therapy (DAPT).

Methods: From April 2009 through June 2019, 376 patients with LEAD underwent successful endovascular revascularization. After the procedure, the received single-antiplatelet therapy (SAPT) or DAPT of various durations were classified into 2 groups (SAPT or DAPT < 6 months vs DAPT >= 6 months). The primary outcomes were major adverse cardiovascular events (MACE) and major adverse limb events (MALE). The safety outcome was moderate-to-severe bleeding according to the Global Use of Strategies to Open Occluded Arteries (GUSTO) criteria.

Results: Over the 40-month follow-up period, MACE occurred less frequently in the DAPT >= 6-month group than in the SAPT or DAPT < 6-month group (12.4% vs 23.8%; hazard ratio [HR], 0.56; 95% confidence interval [CI], 0.35 to 0.89; P = 0.014) after inverse probability-weighted adjustment and propensity-score matching analysis (HR, 0.55, 95% CI, 0.30 to 0.99, P = 0.048). MALE showed no significant differences between the 2 groups (DAPT >= 6-month group: 17.1% vs SAPT or DAPT < 6-month group: 13.1%; HR, 1.05; 95% CI, 0.62 to 1.78; P = 0.846). A significant difference between the DAPT >= 6-month group and the SAPT or DAPT < 6-month group was not observed regarding the incidence of moderate-to-severe GUSTO bleeding.

Conclusions: In patients with LEAD, DAPT for >= 6 months after endovascular revascularization was associated with a lower incidence of MACE.