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Category: Antithrombotic Therapy

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, […]

Antithrombotic Therapy in Peripheral Arterial Occlusive Disease: Conclusion

Two randomized clinical trials have evaluated low-dose and high-dose aspirin for antiplatelet therapy administered in conjunction with peripheral PTA.’ Both studies showed equivalent 1- and 2-year patency rates with either a low dose (50 mg/d or 100 mg/d) or high dose (900 mg/d or 1,000 mg/d) of aspirin. GI side effects were greater in the […]

Antithrombotic Therapy in Peripheral Arterial Occlusive Disease: Peripheral angioplasty

The combined use of aspirin and ticlopidine after coronary angioplasty and stenting appears to result in synergistic platelet inhibition compared to monotherapy with either agent; however, differences in clinical outcome were not shown in a trial that evaluated changes in platelet activation In a randomized clinical trial comparing ticlopidine and aspirin to aspirin alone in […]

Antithrombotic Therapy in Peripheral Arterial Occlusive Disease: Percutaneous Transluminal Angioplasty

The mechanism of transluminal dilation of stenotic arteries involves overstretching of the arterial wall leading to longitudinal splits and fractures of the plaque and intima, with splits often extending into the media. Platelet-rich thrombi rapidly accumulate on areas of intimal disruption, and studies with indium-Ill-labeled platelets demonstrate marked uptake of labeled platelets at angioplasty sites. […]

Antithrombotic Therapy in Peripheral Arterial Occlusive Disease: Protective effects of aspirin

Based on these considerations, perioperative aspirin therapy, 80 to 650 mg twice daily, can be recommended in patients undergoing carotid endarterectomy. Therapy should be started at the time of clinical presentation and continued through the perioperative period. Bleeding complications, particularly wound hematomas, occur in 1.4 to 3.0% of patients undergoing carotid endarterectomy and are associated […]

Antithrombotic Therapy in Peripheral Arterial Occlusive Disease: Carotid Endarterectomy

In patients undergoing carotid endarterectomy, aspirin therapy may be an important adjunct. The goal of antithrombotic therapy in this setting is to prevent immediate, perioperative, and long-term neurologic complications stemming from thrombus formation at the endarterectomy site. Scintigraphic studies with indium-ill-labeled platelets document marked deposition of platelets at the endarterectomy site immediately after operation. The […]

Antithrombotic Therapy in Peripheral Arterial Occlusive Disease: Vascular surgeons

Amounts of heparin to achieve conventional systemic anticoagulation may not be adequate to prevent local clotting at the site of vascular reconstruction. This consideration, coupled with the highly variable response to heparin among patients undergoing vascular reconstruction, argues for relatively high-dose heparin therapy. Based on these considerations, a rational heparin regimen is to administer 100 […]

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