Antiplatelet Agents in Peripheral Arterial Disease: A Review

Peripheral arterial disease (PAD) is a prevalent condition linked to high cardiovascular morbidity and mortality in addition to significant limb-related complications including intermittent claudication, ischemic ulcers, and amputation. The role of dual antiplatelet therapy (DAPT), particularly in patients who have not undergone revascularization, remains uncertain. The Clopidogrel vs Aspirin in Patients at Risk of Ischemic Events trial established clopidogrel as more effective than aspirin in reducing ischemic events, while the Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management, and Avoidance trial further explored DAPT but found no significant improvement over aspirin alone. Based on the results of the COMPASS (Net Clinical Benefit of Low-Dose Rivaroxaban Plus Aspirin as compared with aspirin in patients with chronic vascular disease) and VOYAGER (Vascular outcomes study of ASA with rivaroxaban in endovascular or surgical limb revascularization for peripheral artery disease) trials the American College of Cardiology and American Heart Association published new guidelines recommending the use of low-dose rivaroxaban combined with aspirin for certain patient populations. In this review, we will discuss new evidence as compared to old for the use of DAPT versus dual inhibition therapy in patients diagnosed with PAD.