Treatment
16
Summary of Recommendations
Recommendation
Grade/
LOE
4. Medical management
4.1 Evaluate cardiovascular risk factors in all patients with suspected CLTI. 1-B
4.2 Manage all modifiable risk factors to recommended levels in all patients
with suspected CLTI.
1-B
4.3 Treat all patients with CLTI with an antiplatelet agent. 1-A
4.4 Consider clopidogrel as the single antiplatelet agent of choice in patients
with CLTI.
2-B
4.5 Consider low-dose aspirin and rivaroxaban, 2.5 mg twice daily, to reduce
adverse cardiovascular events and lower extremity ischemic events in
patients with CLTI.
2-B
4.6 Do NOT use systemic vitamin K antagonists for the treatment of lower
extremity atherosclerosis in patients with CLTI.
1-B
4.7 Use moderate- or high-intensity statin therapy to reduce all-cause and
cardiovascular mortality in patients with CLTI.
1-A
4.8 Control hypertension to target levels of <140 mm Hg systolic and <90
mm Hg diastolic in patients with CLTI.
1-B
4.9 Consider control of type 2 DM in CLTI patients to achieve a
hemoglobin A1c of <7% (53 mmol/mol [International Federation of
Clinical Chemistry]).
2-B
4.10 Use metformin as the primary hypoglycemic agent in patients with type
2 DM and CLTI.
1-A
4.11 Consider withholding metformin immediately before and for 24–48
hours aer the administration of an iodinated contrast agent for
diabetic patients, especially those with an estimated glomerular
filtration rate <30 mL/min/1.73 m
2
.
2-C
4.12 Offer smoking cessation interventions (pharmacotherapy, counseling,
or behavior modification therapy) to all patients with CLTI who smoke
or use tobacco products.
1-A
4.13 Ask all CLTI patients who are smokers or former smokers about status
of tobacco use at every visit.
1-A
4.14 Prescribe analgesics of appropriate strength for CLTI patients who have
ischemic rest pain of the lower extremity and foot until pain resolves
aer revascularization.
GPS
4.15 In CLTI patients with chronic severe pain, use paracetamol
(acetaminophen) in combination with opioids for pain control.
GPS
