Key Points
ÎThe leading causes of morbidity and mortality in patients with peripheral arterial disease (PAD) are myocardial infarction (MI) and stroke. Therefore, as in patients with coronary artery disease (CAD), the primary benefit of antithrombotic therapy in this patient population is prevention of vascular events and mortality. The patient-important outcomes (ie, total mortality, nonfatal MI, nonfatal stroke, major nonfatal extracranial bleed) are the same outcomes considered for recommendations for CAD and stroke.
ÎHigh-quality evidence supports an effect of aspirin on vascular mortality.
ÎIn addition, a recent meta-analysis provided moderate-quality evidence that long-term use of aspirin reduces mortality from specific cancer types.
ÎMost asymptomatic patients with PAD will be identified through ankle- brachial index (ABI) screening.
• The ABI is calculated separately for each leg. The ABI denominator for both legs is the higher of the right and left arm pressures. The numerator for the right ABI is the higher of two right ankle pressure measurements, and the numerator for the left ABI is the higher of two left ankle pressure measurements. The ABI for the patient is the lower of the right and left ABIs.
ÎAspirin slightly reduces total mortality regardless of cardiovascular risk profile if taken over 10 years.
• In people at moderate to high risk of cardiovascular events, the reduction in MI is closely balanced with an increase in major bleeds.
• Whatever their risk status, people who are averse to taking medication over a prolonged time period for very small benefits will be disinclined to use aspirin for primary prophylaxis.
• Individuals who value preventing an MI substantially higher than avoiding a gastrointestinal bleed, if they are in the moderate or high cardiovascular risk group, will be more likely to choose aspirin.
