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Single versus dual antiplatelet therapy following peripheral arterial endovascular intervention for chronic limb threatening ischaemia:retrospective cohort study
- Source :
- Chinai, N, Ambler, G K, Wardle, B G, Locker, D, Bosanquet, D C, Goyal, N, Chick, C, Hinchliffe, R J & Twine, C P 2020, ' Single versus dual antiplatelet therapy following peripheral arterial endovascular intervention for chronic limb threatening ischaemia : retrospective cohort study ', PLoS ONE, vol. 15, no. 6 . https://doi.org/10.1371/journal.pone.0234271, PLoS ONE, PLoS ONE, Vol 15, Iss 6, p e0234271 (2020)
- Publication Year :
- 2020
-
Abstract
- ObjectivesAntiplatelet therapy following peripheral arterial endovascular intervention lacks high quality evidence to guide practice. The aim of this study was to assess the effect of three months of dual antiplatelet therapy on amputation-free survival following peripheral arterial endovascular intervention in patients with chronic limb threatening ischemia.MethodsA retrospective review of symptomatic patients undergoing primary peripheral arterial endovascular intervention over a seven-year period was performed. The primary outcome measure was amputation-free survival. A sample size calculation based on previous cohort studies suggested that 629 limbs would be required to show a difference between single and dual therapy. Kaplan-Meier estimates and multivariate logistic regression analysis of recorded baseline characteristics was performed to determine predictors of amputation-free survival. Dual antiplatelet therapy was routinely given for 3 months.Results754 limbs were treated with primary angioplasty and/or stenting over a 7-year period, 508 of these for chronic limb threatening ischemia. There was no difference in unadjusted amputation-free survival between patients with chronic limb threatening ischaemia taking single vs. dual antiplatelet therapy (69% vs. 74% respectively Log rank Chi2 = 0.1, p = .72). After adjusting for confounders, at 1 year there was also no significant difference in amputation-free survival between patients taking single vs. dual antiplatelet therapy [OR 0.8, 95% CI 0.5–1.2, p = .3]. There was no difference in rates of major bleeding between single and dual antiplatelet therapy.ConclusionsThere was no clear evidence of reduced amputation-free survival in patients with chronic limb threatening ischemia undergoing peripheral arterial endovascular intervention being treated with dual antiplatelet therapy for 3 months. This is at odds with other retrospective case series and highlights the limitations in basing clinical practice on such data. There is a need for an adequately powered, independent randomised trial to definitively answer the question.
- Subjects :
- Male
Physiology
Kaplan-Meier Estimate
030204 cardiovascular system & hematology
Logistic regression
Antiplatelet Therapy
Pathology and Laboratory Medicine
Vascular Medicine
Cohort Studies
0302 clinical medicine
Endocrinology
Ischemia
Animal Cells
Medicine and Health Sciences
Coronary Heart Disease
030212 general & internal medicine
Musculoskeletal System
Multidisciplinary
Pharmaceutics
Confounding
Endovascular Procedures
Peripheral
Body Fluids
Blood
Lower Extremity
Medicine
Female
Anatomy
Cellular Types
Cohort study
Research Article
Platelets
medicine.medical_specialty
Endocrine Disorders
Science
Cardiology
Hemorrhage
Surgical and Invasive Medical Procedures
03 medical and health sciences
Signs and Symptoms
Drug Therapy
Diagnostic Medicine
Internal medicine
medicine
Diabetes Mellitus
Humans
cardiovascular diseases
Survival analysis
Aged
Retrospective Studies
Blood Cells
business.industry
Biology and Life Sciences
Retrospective cohort study
Cell Biology
medicine.disease
Survival Analysis
Log-rank test
Body Limbs
Metabolic Disorders
Stent Implantation
business
Platelet Aggregation Inhibitors
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Journal :
- Chinai, N, Ambler, G K, Wardle, B G, Locker, D, Bosanquet, D C, Goyal, N, Chick, C, Hinchliffe, R J & Twine, C P 2020, ' Single versus dual antiplatelet therapy following peripheral arterial endovascular intervention for chronic limb threatening ischaemia : retrospective cohort study ', PLoS ONE, vol. 15, no. 6 . https://doi.org/10.1371/journal.pone.0234271, PLoS ONE, PLoS ONE, Vol 15, Iss 6, p e0234271 (2020)
- Accession number :
- edsair.doi.dedup.....87a9c4eff17ac14ef617203e7e011fa4