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Treatment
5.1.1. Antiplatelet and Antithrombotic Therapy for PAD
COR LOE
Recommendations
1 A
1. In patients with symptomatic PAD, single antiplatelet therapy
is recommended to reduce the risk of MACE.
1 B-R
2. In patients with symptomatic PAD, single antiplatelet therapy
with clopidogrel alone (75 mg daily) is recommended to
reduce the risk of MACE.
1 C-LD
3. In patients with symptomatic PAD, single antiplatelet therapy
with aspirin alone (range, 75–325 mg daily) is recommended
to reduce the risk of MACE.
1 A
4. In patients with symptomatic PAD, low-dose rivaroxaban
(2.5 mg twice daily) combined with low-dose aspirin is
effective to reduce the risk of MACE and MALE.
1 B-R
5. After endovascular or surgical revascularization for PAD,
antiplatelet therapy is recommended.
1 A
6. After endovascular or surgical revascularization for PAD,
low-dose rivaroxaban (2.5 mg twice daily) combined with
low-dose aspirin is recommended to reduce the risk of
MACE and MALE.
2a C-LD
7. After endovascular revascularization for PAD, dual
antiplatelet therapy with a P2Y12 antagonist and low-dose
aspirin is reasonable for at least 1 to 6 months.
2a C-LD
8. After endovascular or surgical revascularization in patients
with PAD who require full-intensity anticoagulation for
another indication and are not at high risk of bleeding,
adding single antiplatelet therapy is reasonable.
2a C-EO
9. In patients with asymptomatic PAD single antiplatelet
therapy is reasonable to reduce the risk of MACE.
2b B-R
10. In patients with symptomatic PAD without recent
revascularization, the benefit of dual antiplatelet therapy is
uncertain.
2b B-R
11. In patients with symptomatic PAD, the benefit of vorapaxar
added to existing antiplatelet therapy is uncertain.
2b B-R
12. After surgical revascularization for PAD with a prosthetic
graft, dual antiplatelet therapy with a P2Y12 antagonist and
low-dose aspirin may be reasonable for at least 1 month.
3: Harm A
13. In patients with PAD without another indication (eg, atrial
fibrillation), full-intensity oral anticoagulation should not be
used to reduce the risk of MACE and MALE.
