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Extended clopidogrel therapy after lower extremity revascularization improves survival and reduces major adverse events in peripheral arterial disease patients without increasing bleeding risk.
A large retrospective study reveals that patients with peripheral arterial disease (PAD) who received clopidogrel for more than 12 months following lower extremity revascularization (LER) had significantly better survival and cardiovascular outcomes—without a rise in bleeding complications—compared to those on shorter therapy.
The study analyzed electronic medical records of 1,954 PAD patients who underwent either open surgical or endovascular LER. In total, 17 unique perioperative and 101 long-term antithrombotic regimens were identified, underscoring the wide variability in real-world clinical practice. Clopidogrel emerged as the most frequently prescribed antiplatelet, used in nearly 70% of cases.
Among clopidogrel users, 947 patients (69.5%) received extended therapy (>12 months). This group was more likely to have undergone a prior endovascular intervention and be treated for claudication. In contrast, those on shorter-duration therapy (≤12 months) were older and exhibited higher rates of comorbidities such as congestive heart failure and chronic renal insufficiency.
Kaplan-Meier survival analysis revealed markedly better overall survival, major adverse limb event (MALE)-free survival, and major adverse cardiac event (MACE)-free survival in the extended therapy group. Importantly, multivariate Cox regression confirmed that limited clopidogrel use was independently linked with increased risk of mortality (hazard ratio [HR] 1.93), combined mortality or MALE (HR 1.32), and combined mortality or MACE (HR 1.39).
Notably, the duration of clopidogrel was not linked to increased bleeding complications. The findings emphasize the requisition for standardization in antithrombotic regimens post-LER and highlight the challenges of observational research owing to substantial prescription variability. The authors call for prospective randomized trials to determine optimal antithrombotic strategies tailored to individual PAD patient profiles.
Journal of Vascular Surgery
Variations in antithrombotic prescriptions and evaluation of extended clopidogrel therapy after lower extremity revascularization for peripheral artery disease
Nicholas Wells et al.
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