Comparison of dual-antiplatelet therapy durations after endovascular revascularization of infrainguinal arteries

Karan Sarode, Atif Mohammad, Swagata Das, Ariel Vinas, Avantika Banerjee, Shirling Tsai, Ehrin J. Armstrong, Nicolas W. Shammas, Andrew Klein, Emmanouil S. Brilakis, Subhash Banerjee

Research output: Contribution to journalArticle

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Abstract

Background The optimal dual-antiplatelet therapy (DAPT) duration after endovascular revascularization of infrainguinal arteries is uncertain. Methods This study examines DAPT prescription trends and 12-month major adverse limb events (MALEs; a composite of repeat endovascular or surgical revascularization, acute vessel thrombosis, or amputation of the target limb), major adverse cardiovascular events (MACEs; all-cause mortality, nonfatal myocardial infarction [MI], stroke, or coronary revascularization), fatal bleeding events, and those requiring interruption or discontinuation of DAPT (hemorrhagic complications) for patients enrolled into the Excellence in Peripheral Artery Disease (XLPAD) registry. Results Data on 368 patients prescribed antiplatelet therapy were analyzed; 8.2% were prescribed antiplatelet monotherapy, 48.6% DAPT for ≤3 months, and 43.2% for >3 months. Patients in the >3 DAPT prescribed group were older, had preexisting coronary artery disease (CAD), and prior MI (all P < 0.001). Overall MALE in the ≤3 and >3-month DAPT prescribed groups were 22.3% and 23.9%, respectively (P = 0.541). Survival analysis showed significantly higher rates of MACE in patients prescribed >3-month DAPT (17.6% vs. 9.5%; P = 0.019). An "as-treated" analysis excluded 10 patients who were prescribed DAPT for >3 months and revealed similar rates of MALE (24.9% vs. 20.8%; P = 0.386) and MACE (12.2% vs. 14.8%; P = 0.443) in patients receiving ≤3 and >3 DAPT. Hemorrhagic complications were similar across all prescribed and "as-treated" DAPT groups. Conclusions After infrainguinal endovascular procedures, patients with underlying CAD were prescribed longer (>3 months) duration of DAPT and experienced more cardiovascular events compared with those prescribed ≤3 months of DAPT. Adverse limb events were similar in both groups.

Original languageEnglish (US)
Pages (from-to)1235-1244
Number of pages10
JournalAnnals of Vascular Surgery
Volume29
Issue number6
DOIs
StatePublished - Aug 1 2015
Externally publishedYes

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Arteries
Group Psychotherapy
Therapeutics
Extremities
Coronary Artery Disease
Myocardial Infarction
Endovascular Procedures
Peripheral Arterial Disease
Survival Analysis
Amputation
Prescriptions
Registries
Thrombosis
Stroke
Hemorrhage
Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Comparison of dual-antiplatelet therapy durations after endovascular revascularization of infrainguinal arteries. / Sarode, Karan; Mohammad, Atif; Das, Swagata; Vinas, Ariel; Banerjee, Avantika; Tsai, Shirling; Armstrong, Ehrin J.; Shammas, Nicolas W.; Klein, Andrew; Brilakis, Emmanouil S.; Banerjee, Subhash.

In: Annals of Vascular Surgery, Vol. 29, No. 6, 01.08.2015, p. 1235-1244.

Research output: Contribution to journalArticle

Sarode, K, Mohammad, A, Das, S, Vinas, A, Banerjee, A, Tsai, S, Armstrong, EJ, Shammas, NW, Klein, A, Brilakis, ES & Banerjee, S 2015, 'Comparison of dual-antiplatelet therapy durations after endovascular revascularization of infrainguinal arteries', Annals of Vascular Surgery, vol. 29, no. 6, pp. 1235-1244. https://doi.org/10.1016/j.avsg.2015.03.040
Sarode, Karan ; Mohammad, Atif ; Das, Swagata ; Vinas, Ariel ; Banerjee, Avantika ; Tsai, Shirling ; Armstrong, Ehrin J. ; Shammas, Nicolas W. ; Klein, Andrew ; Brilakis, Emmanouil S. ; Banerjee, Subhash. / Comparison of dual-antiplatelet therapy durations after endovascular revascularization of infrainguinal arteries. In: Annals of Vascular Surgery. 2015 ; Vol. 29, No. 6. pp. 1235-1244.
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abstract = "Background The optimal dual-antiplatelet therapy (DAPT) duration after endovascular revascularization of infrainguinal arteries is uncertain. Methods This study examines DAPT prescription trends and 12-month major adverse limb events (MALEs; a composite of repeat endovascular or surgical revascularization, acute vessel thrombosis, or amputation of the target limb), major adverse cardiovascular events (MACEs; all-cause mortality, nonfatal myocardial infarction [MI], stroke, or coronary revascularization), fatal bleeding events, and those requiring interruption or discontinuation of DAPT (hemorrhagic complications) for patients enrolled into the Excellence in Peripheral Artery Disease (XLPAD) registry. Results Data on 368 patients prescribed antiplatelet therapy were analyzed; 8.2{\%} were prescribed antiplatelet monotherapy, 48.6{\%} DAPT for ≤3 months, and 43.2{\%} for >3 months. Patients in the >3 DAPT prescribed group were older, had preexisting coronary artery disease (CAD), and prior MI (all P < 0.001). Overall MALE in the ≤3 and >3-month DAPT prescribed groups were 22.3{\%} and 23.9{\%}, respectively (P = 0.541). Survival analysis showed significantly higher rates of MACE in patients prescribed >3-month DAPT (17.6{\%} vs. 9.5{\%}; P = 0.019). An {"}as-treated{"} analysis excluded 10 patients who were prescribed DAPT for >3 months and revealed similar rates of MALE (24.9{\%} vs. 20.8{\%}; P = 0.386) and MACE (12.2{\%} vs. 14.8{\%}; P = 0.443) in patients receiving ≤3 and >3 DAPT. Hemorrhagic complications were similar across all prescribed and {"}as-treated{"} DAPT groups. Conclusions After infrainguinal endovascular procedures, patients with underlying CAD were prescribed longer (>3 months) duration of DAPT and experienced more cardiovascular events compared with those prescribed ≤3 months of DAPT. Adverse limb events were similar in both groups.",
author = "Karan Sarode and Atif Mohammad and Swagata Das and Ariel Vinas and Avantika Banerjee and Shirling Tsai and Armstrong, {Ehrin J.} and Shammas, {Nicolas W.} and Andrew Klein and Brilakis, {Emmanouil S.} and Subhash Banerjee",
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T1 - Comparison of dual-antiplatelet therapy durations after endovascular revascularization of infrainguinal arteries

AU - Sarode, Karan

AU - Mohammad, Atif

AU - Das, Swagata

AU - Vinas, Ariel

AU - Banerjee, Avantika

AU - Tsai, Shirling

AU - Armstrong, Ehrin J.

AU - Shammas, Nicolas W.

AU - Klein, Andrew

AU - Brilakis, Emmanouil S.

AU - Banerjee, Subhash

PY - 2015/8/1

Y1 - 2015/8/1

N2 - Background The optimal dual-antiplatelet therapy (DAPT) duration after endovascular revascularization of infrainguinal arteries is uncertain. Methods This study examines DAPT prescription trends and 12-month major adverse limb events (MALEs; a composite of repeat endovascular or surgical revascularization, acute vessel thrombosis, or amputation of the target limb), major adverse cardiovascular events (MACEs; all-cause mortality, nonfatal myocardial infarction [MI], stroke, or coronary revascularization), fatal bleeding events, and those requiring interruption or discontinuation of DAPT (hemorrhagic complications) for patients enrolled into the Excellence in Peripheral Artery Disease (XLPAD) registry. Results Data on 368 patients prescribed antiplatelet therapy were analyzed; 8.2% were prescribed antiplatelet monotherapy, 48.6% DAPT for ≤3 months, and 43.2% for >3 months. Patients in the >3 DAPT prescribed group were older, had preexisting coronary artery disease (CAD), and prior MI (all P < 0.001). Overall MALE in the ≤3 and >3-month DAPT prescribed groups were 22.3% and 23.9%, respectively (P = 0.541). Survival analysis showed significantly higher rates of MACE in patients prescribed >3-month DAPT (17.6% vs. 9.5%; P = 0.019). An "as-treated" analysis excluded 10 patients who were prescribed DAPT for >3 months and revealed similar rates of MALE (24.9% vs. 20.8%; P = 0.386) and MACE (12.2% vs. 14.8%; P = 0.443) in patients receiving ≤3 and >3 DAPT. Hemorrhagic complications were similar across all prescribed and "as-treated" DAPT groups. Conclusions After infrainguinal endovascular procedures, patients with underlying CAD were prescribed longer (>3 months) duration of DAPT and experienced more cardiovascular events compared with those prescribed ≤3 months of DAPT. Adverse limb events were similar in both groups.

AB - Background The optimal dual-antiplatelet therapy (DAPT) duration after endovascular revascularization of infrainguinal arteries is uncertain. Methods This study examines DAPT prescription trends and 12-month major adverse limb events (MALEs; a composite of repeat endovascular or surgical revascularization, acute vessel thrombosis, or amputation of the target limb), major adverse cardiovascular events (MACEs; all-cause mortality, nonfatal myocardial infarction [MI], stroke, or coronary revascularization), fatal bleeding events, and those requiring interruption or discontinuation of DAPT (hemorrhagic complications) for patients enrolled into the Excellence in Peripheral Artery Disease (XLPAD) registry. Results Data on 368 patients prescribed antiplatelet therapy were analyzed; 8.2% were prescribed antiplatelet monotherapy, 48.6% DAPT for ≤3 months, and 43.2% for >3 months. Patients in the >3 DAPT prescribed group were older, had preexisting coronary artery disease (CAD), and prior MI (all P < 0.001). Overall MALE in the ≤3 and >3-month DAPT prescribed groups were 22.3% and 23.9%, respectively (P = 0.541). Survival analysis showed significantly higher rates of MACE in patients prescribed >3-month DAPT (17.6% vs. 9.5%; P = 0.019). An "as-treated" analysis excluded 10 patients who were prescribed DAPT for >3 months and revealed similar rates of MALE (24.9% vs. 20.8%; P = 0.386) and MACE (12.2% vs. 14.8%; P = 0.443) in patients receiving ≤3 and >3 DAPT. Hemorrhagic complications were similar across all prescribed and "as-treated" DAPT groups. Conclusions After infrainguinal endovascular procedures, patients with underlying CAD were prescribed longer (>3 months) duration of DAPT and experienced more cardiovascular events compared with those prescribed ≤3 months of DAPT. Adverse limb events were similar in both groups.

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