Treatment Asymptomatic PAD
ÎFor persons with asymptomatic PAD, the American College of Chest Physicians (ACCP) suggests aspirin over no aspirin therapy (2-B).
Symptomatic PAD
ÎFor secondary prevention in patients with symptomatic PAD, the ACCP recommends long-term continuation of either aspirin or clopidogrel over no antithrombotic treatment (both 1-A).
ÎThe ACCP suggests NOT to use dual antiplatelet therapy with aspirin plus clopidogrel (2-B). The ACCP recommends NOT to use an antiplatelet agent with moderate-intensity warfarin (1-B).
ÎFor patients with intermittent claudication refractory to exercise therapy (and smoking cessation), the ACCP suggests the use of cilostazol in addition to previously recommended antithrombotic therapies (aspirin or clopidogrel) (2-C).
ÎThe ACCP suggests AGAINST the use of pentoxifylline, heparinoids, or prostanoids (2-C).
Acute Limb Ischemia
ÎFor patients with symptomatic PAD and critical leg ischemia/rest pain who are not candidates for vascular intervention, the ACCP suggests the use of prostanoids in addition to previously recommended antithrombotic therapies (aspirin or clopidogrel) (2-C).
Values and preferences: Patients who do not value uncertain relief of rest pain and ulcer healing greater than avoidance of a high likelihood of drug-related side effects will be disinclined to take prostanoids.
ÎIn patients with acute limb ischemia due to arterial emboli or thrombosis, the ACCP suggests immediate systemic anticoagulation with unfractionated heparin over no anticoagulation (2-C). The ACCP suggests reperfusion therapy (surgery or intraarterial thrombolysis) over no reperfusion therapy (2-C). The ACCP recommends surgery over intraarterial thrombolysis (1-B). In patients undergoing intraarterial thrombolysis, the ACCP suggests recombinant tissue-type plasminogen activator (rt-PA) or urokinase over streptokinase (2-C).
