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
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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. / Savarese, Gianluigi; Reiner, Martin F; Uijl, Alicia; D'Amario, Domenico; Agewall, Stefan; Atar, Dan; Baumgartner, Iris; Borghi, Claudio; De Carlo, Marco; Drexel, Heinz; Kaski, Juan Carlos; Kjeldsen, Keld P; Kucher, Nils; Lund, Lars H; Niessner, Alexander; Semb, Anne Grete; Schmidt, Thomas A; Sulzgruber, Patrick; Tamargo, Juan; Vitale, Cristiana; Wassmann, Sven; Aboyans, Victor; Lewis, Basil S.
I: European Heart Journal - Cardiovascular Pharmacotherapy, Bind 6, Nr. 2, 2020, s. 86-93.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Antithrombotic therapy and major adverse limb events in patients with chronic lower extremity arterial disease
T2 - 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
AU - Savarese, Gianluigi
AU - Reiner, Martin F
AU - Uijl, Alicia
AU - D'Amario, Domenico
AU - Agewall, Stefan
AU - Atar, Dan
AU - Baumgartner, Iris
AU - Borghi, Claudio
AU - De Carlo, Marco
AU - Drexel, Heinz
AU - Kaski, Juan Carlos
AU - Kjeldsen, Keld P
AU - Kucher, Nils
AU - Lund, Lars H
AU - Niessner, Alexander
AU - Semb, Anne Grete
AU - Schmidt, Thomas A
AU - Sulzgruber, Patrick
AU - Tamargo, Juan
AU - Vitale, Cristiana
AU - Wassmann, Sven
AU - Aboyans, Victor
AU - Lewis, Basil S
PY - 2020
Y1 - 2020
N2 - 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.
AB - 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.
U2 - 10.1093/ehjcvp/pvz036
DO - 10.1093/ehjcvp/pvz036
M3 - Journal article
C2 - 31392312
VL - 6
SP - 86
EP - 93
JO - European Heart Journal - Cardiovascular Pharmacotherapy
JF - European Heart Journal - Cardiovascular Pharmacotherapy
SN - 2055-6837
IS - 2
ER -
ID: 237702438