Antiplatelet agents have a beneficial effect in reducing all cause mortality and fatal cardiovascular events in patients with IC .
BACKGROUND Peripheral arterial disease ( PAD ) is common and is a marker of systemic atherosclerosis .
Patients with symptoms of intermittent claudication ( IC ) are at increased risk of cardiovascular events ( myocardial infa rct ion ( MI ) and stroke ) and of both cardiovascular and all cause mortality .
OBJECTIVES To determine the effectiveness of antiplatelet agents in reducing mortality ( all cause and cardiovascular ) and cardiovascular events in patients with intermittent claudication .
Managing PAD with multiple platelet inhibitors: the effect of combination therapy on bleeding time.
PURPOSE Patients with lower-extremity peripheral arterial disease ( PAD ) face a high risk of cardiovascular morbidity and mortality . Platelet inhibition ( PI ) significantly reduces this risk . Combination PI is common and increasingly indicated in patients with PAD ; however , the effect on platelet function has not been objective ly evaluated . Aspirin ( ASA ) , clopidogrel ( Clop ) , and cilostazol ( Cilo ) are the three most commonly used PI drugs in patients with PAD . A prospect i ve , sequential evaluation of platelet function using the template bleeding time ( BT ) was performed for PAD patients taking these medications singly and in combination . METHODS Twenty-one patients with PAD , averaging 65.9 years of age , were studied . Patients were placed on sequential two-week regimens of the following therapies : washout ( no PI ) , ASA ( 325 mg daily ) , ASA + Cilo ( 100 mg twice daily ) , washout , Cilo , Cilo + Clop ( 75 mg each day ) , washout , Clop , Clop + ASA , and Clop + ASA + Cilo . At the end of each phase , trained personnel measured the BT . RESULTS Baseline bleeding time for the group was 4.29 + /- 1.69 minutes . ASA ( BT = 6.64 + /- 3.52 ) and Clop ( BT = 10.17 + /- 5.4 ) significantly prolonged bleeding time ( P < 0.01 ) ; however , no significant effect was observed with Cilo alone ( BT = 5.41 + /- 2.69 ) . Combined treatment with ASA + Clop ( BT = 17.39 + /- 4.59 ) had a more pronounced effect on BT compared with either agent alone ( P < 0.01 ) . The addition of Cilo to either ASA ( BT = 8.3 + /- 4.27 ) or Clop ( BT = 12.7 + /- 7.46 ) or the combination of ASA + Clop ( BT = 17.92 + /- 4.69 ) did not prolong BT . CONCLUSION All patients with PAD require platelet inhibition , and many require pharmacotherapy for intermittent claudication . The platelet inhibitors aspirin and clopidogrel are used for the reduction of ischemic events . They significantly prolong bleeding time individually and to a greater extent in combination . Cilo is used to improve walking distance in patients with intermittent claudication . When Cilo is added to ASA , Clop , or the combination of the two , there is no additional increase in bleeding time . Therefore , Cilo can be used in combination with other platelet inhibitors without an additional effect on platelet function as reflected by the bleeding time
Antiplatelet agents have a beneficial effect in reducing all cause mortality and fatal cardiovascular events in patients with IC .
BACKGROUND Peripheral arterial disease ( PAD ) is common and is a marker of systemic atherosclerosis .
Patients with symptoms of intermittent claudication ( IC ) are at increased risk of cardiovascular events ( myocardial infa rct ion ( MI ) and stroke ) and of both cardiovascular and all cause mortality .
OBJECTIVES To determine the effectiveness of antiplatelet agents in reducing mortality ( all cause and cardiovascular ) and cardiovascular events in patients with intermittent claudication .