Antithrombotic Therapy in Peripheral Arterial Occlusive Disease: Recommendations
7. Antithrombotic therapy should not be used to maintain patency of vascular reconstructions involving high-flow, low-resistance arteries greater than 6 mm indiameter. This is a grade Cl recommendation. However, for the same rationale provided in recommendation 3, life-long aspirin therapy should be considered in these patients to reduce long-term cardiovascular morbidity and mortality.
8. Aspirin, 81 to 325 mg^d (with or witiiout dipyridamole, 75 mg three times daily) may be useful in patients having prosthetic, femoral-popliteal bypass operations, and antiplatelet therapy should be begun preopera-tively. This is a grade B1 recommendation. In addition, life-long aspirin should be continued for the same rationale provided in recommendation 3.
9. In patients undergoing saphenous vein femoral-popliteal or distal bypass, aspirin therapy, 81 to 325 mg/d, is recommended to reduce the incidence of MI and stroke. This is a grade A1 recommendation. In patients unable to take aspirin, ticlopidine should be considered. This is a grade B2 recommendation. Asthma medications inhalers further As per recommendation 4, clopidogrel should also be considered for such patients who are unable to take aspirin. Life-long aspirin therapy should be considered based on reasons provided in recommendation 3.
10. It is recommended that long-term oral anticoagulation with warfarin with or witiiout aspirin not be used routinely in patients after infrainguinal bypass and other vascular reconstructions. This is a grade A1 recommendation. For patients undergoing infrainguinal bypass who are at high risk of graft thrombosis, the combination of warfarin and aspirin should be considered. This is a grade B2 recommendation.
11. It is recommended that aspirin, 81 rag’d to 650 mg twice daily, be given preoperatively and continued indefinitely in patients undergoing carotid endarterectomy to prevent subsequent TIAs and stroke. This is a grade A1 recommendation.
12. Aspirin should be used before and after angioplasty of the aortoiliac arteries to reduce the incidence of periprocedural thromboembolic events. This is a grade Cl recommendation. Anticoagulation during angioplasty is probably not necessary for large or high-flow arteries. Aspirin combined with ticlopidine should be considered for patients undergoing angioplasty of femoral and more peripheral arteries. This is a grade B2 recommendation. For the reasons stated in recommendation 3, all patients undergoing peripheral angioplasty should be treated with life-long aspirin therapy, in the absence of contraindications, to reduce long-term cardiovascular morbidity and mortality.