Peripheral arterial disease antiplatelet agents

Thrombolytic agents and antiplatelet therapy, including GPIIb/llla inhibitors, are an important modality in the treatment of peripheral arterial disease. The following section presents the latest published data supporting the use of these relatively new drugs during PPI. 

The efficacy of clopidogrel as an antiplatelet agent in atherothrombotic disorders was demonstrated in the CAPRIE trial. In this study of more than 19,000 patients with a history of either myocardial infarction (MI), stroke, or peripheral arterial disease (PAD), clopidogrel 75 mg/day was compared with aspirin 325 mg/day for its ability to decrease MI, stroke, or cardiovascular death. In the final analysis, clopidogrel was slightly (8% relative risk reduction [RRR]) more effective than aspirin (p =. 043) and had a similar incidence of adverse effects. It is not associated with the blood dyscrasias (neutropenia) common with its congener, ticlopidine, and is used widely in patients with atherosclerosis. 

Antiplatelets are the mainstay of treatment for acute coronary syndrome (ACS), a spectrum of ischemic events that include myocardial infarction and unstable angina, with well-established benefit in preventing atherothrombosis. Results of a meta-analysis of 145 clinical studies reported a 25% reduction of atherothrombotic events in high-risk patients treated with antiplatelet therapy [12]. Another meta-analysis of 109 clinical trials has concluded that antiplatelet medications were able to reduce transient ischemic attacks and strokes by 22%, reduce coronary artery disease by 29%, and reduce peripheral artery disease by 23% [13]. Table 19.1 summarizes the major commercially available antiplatelet agents. 

---