This is not the most recent version of the article. View current version (15 AUG 2012)
Antiplatelet and anticoagulant drugs for prevention of restenosis/reocclusion following peripheral endovascular treatment
Editorial Group: Cochrane Peripheral Vascular Diseases Group
Published Online: 21 JAN 2009
Assessed as up-to-date: 20 OCT 2004
Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Dörffler-Melly J, Koopman MM, Prins MH, Büller HR. Antiplatelet and anticoagulant drugs for prevention of restenosis/reocclusion following peripheral endovascular treatment. Cochrane Database of Systematic Reviews 2005, Issue 1. Art. No.: CD002071. DOI: 10.1002/14651858.CD002071.pub2.
- Publication Status: Edited (no change to conclusions)
- Published Online: 21 JAN 2009
This is not the most recent version of the article.View current version (15 Aug 2012)
Peripheral arterial disease (PAD) is frequently treated by balloon angioplasty. Restenosis/reocclusion of the dilated segments occurs often depending on length of occlusion, lower leg outflow, stage of disease and presence of cardiovascular risk factors. To prevent reocclusion, patients are treated with antithrombotic agents.
To determine whether any antithrombotic drug is more effective in preventing reocclusion after peripheral endovascular treatment, compared to another antithrombotic drug, no treatment, placebo, or other vasoactive drugs.
We searched the Cochrane Peripheral Vascular Diseases Group's trials register (last searched June 29 2004), the Cochrane Central Register of Controlled trials (CENTRAL Issue 2, 2004), MEDLINE and EMBASE (last searched June 2004).
Randomised trials were categorized as A (double or single blinded) or B (not blinded). Participants included patients with symptomatic PAD treated by endovascular revascularization of the pelvic or femoropopliteal arteries. Interventions were anticoagulant, antiplatelet or other vasoactive drug therapy compared with no treatment, placebo, or any other vasoactive drug. Clinical endpoints were re-obstruction, amputation, death, myocardial infarction, stroke and major bleeding.
Data collection and analysis
Details of the number of randomized patients, treatment, study design, study category, allocation concealment and patient characteristics were extracted. Analysis was based on intention-to-treat data. To examine the effects of binary outcomes such as amputation and major bleeding, odds ratios were computed using a fixed effect model. The 95% confidence intervals of the effect sizes were calculated.
A 60% reduction of recurrent obstruction was found with aspirin (ASA) 330 mg combined with dipyridamol (DIP) as compared to placebo at 12 months follow-up. At six months following endovascular treatment, a positive effect on patency was found with 50 to 100 mg ASA combined with DIP (n = 356). However, this was not significant. ASA/DIP tended towards showing a superior effect on patency after femoropopliteal angioplasty compared with vitamin K antagonists (VKA) at three, six, and twelve months. Periinterventional treatment with low molecular weight heparin (LMWH) in femoropopliteal obstructions resulted in significantly lower restenosis/reocclusion rates than with unfractionated heparin.
Aspirin 50 to 300 mg started prior to femoropopliteal endovascular treatment appears to be the most effective and is safe. Clopidogrel might be an alternative, but data are lacking. Abciximab might be a useful adjunctive for high risk patients with long segmental femoropopliteal interventions. Low molecular weight heparin seems to be more effective in preventing reocclusion or restenosis than unfractionated heparin.
Plain language summary
Drugs to prevent the re-occurrence of narrowing of blood vessels in peripheral arterial disease after the damaged blood vessels have been widened surgically
Peripheral arterial disease of leg arteries can progressively cause leg pain on walking, pain at rest, ulcers and gangrene because of reduced blood flow. An inflatable balloon catheter inserted into the artery is used to widen and unblock the affected artery (termed angioplasty) yet reoccurrence of narrowing (restenosis/reocclusion) frequently occurs because of platelet clumping (aggregation) and activated blood clotting in the damaged blood vessel. This review of 14 randomized clinical trials set out to determine if any drug was more effective than another in preventing renarrowing of the artery. Aspirin (50 to 330 mg), with or without dipyridamol, reduced the incidence of reocclusion at six to 12 months when compared with no therapy or vitamin K antagonists. Three trials showed that higher doses of aspirin had no advantage on early occlusions (within one month) and were more likely to cause gastrointestinal side effects and peptic ulcer. In one study, low molecular weight heparin was more effective than heparin over six months, without causing increased bleeding. Few studies were available for potent new antiplatelet drugs (ticlopidine, abciximab). In one study in high risk patients abciximab given into the vein tended to improve early patency. Results of large randomized studies are required.