A comprehensive review on antithrombotic therapy for peripheral artery disease

Peripheral artery disease (PAD) is a morbid and costly disease that can result in loss of limb and life if not managed appropriately with risk factor modification, antithrombotic therapy, and revascularization when necessary. Antithrombotic therapy includes antiplatelet and anticoagulant drugs. Antiplatelet agents used in PAD can include aspirin, reversible and irreversible P2Y12 inhibitors, and PAR-1 antagonists. These drugs are prescribed as both monotherapy or dual-antiplatelet therapy and are critical components of pre- and post-revascularization maintenance. Anticoagulants, such as vitamin K antagonists and heparin products, have long been used in cardiac disease; in patients with PAD, these drugs have been largely supplanted by new direct factor Xa antagonists, which offer superior safety profiles and reduced adverse events after revascularization. Anticoagulants are often used alongside antiplatelet medications after PAD revascularization; however, there is a lack of guideline consensus about therapy selection and large regional disparity in regard to antithrombotic prescribing patterns. In this review, we analyze the existing literature and guidelines regarding the use of antithrombotic therapy in patients with PAD and offer a framework to aid clinicians' decision making regarding therapy selection and duration based on current existing evidence.