thienopyridine and Peripheral-Vascular-Diseases

Patients with peripheral arterial disease (PAD) bear a substantial risk for vascular events in the coronary, cerebral and peripheral circulations. In addition, this disorder is associated with a systemic milieu characterised by ongoing platelet activation and heightened thrombogenesis.. To determine the optimal antithrombotic prophylaxis for patients with PAD.. Using terms related to PAD and antithrombotic agents, we searched the following databases for relevant articles: MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, the National Institutes of Health Clinical Trials Database, Web of Science, and the International Pharmaceutical Abstracts Database (search dates: 1 January 1990 to 1 January 2007). Additional articles were identified from cardiovascular and vascular surgery conference proceedings, bibliographies of review articles, and personal files.. We focused on randomised trials, systematic reviews and consensus guidelines of antithrombotic therapies for PAD.. Detailed study information was abstracted by each author working independently.. Multiple studies show that patients with PAD manifest platelet hyperaggregability, increased levels of soluble platelet activation markers, enhanced thrombin generation and altered fibrinolytic potential. Many of these markers predict subsequent cardiovascular events. Available randomised trials and meta-analyses show that most available antithrombotic agents prevent major cardiovascular events and death in patients with PAD, including aspirin, aspirin/dipyridamole, clopidogrel, ticlopidine, picotamide and oral anticoagulants.. Although the most favourable risk-benefit profile, cost-effectiveness and overall evidence base supports aspirin in this setting, we provide scenarios in which alternatives to aspirin should be considered.

Topics: Anticoagulants; Fibrinolytic Agents; Forecasting; Humans; Peripheral Vascular Diseases; Pyridines; Thromboxanes

Patients with peripheral arterial disease are at greatly elevated risk for stroke and myocardial infarction and are six times more likely to die from cardiovascular causes than those without the disease. The available evidence supports the provision of an antiplatelet agent, a statin, and an angiotensin-converting enzyme inhibitor for cardiovascular protection in these patients. When used together, these approaches are expected to produce a cumulative relative risk reduction of approximately 80%. Given the high baseline risk of this population and the effectiveness of these interventions, a combination of multiple drug therapies, in concert with aggressive lifestyle change and revascularization (where appropriate), can substantially reduce the burden of morbidity and mortality in patients with peripheral arterial disease.

Topics: Angiotensin-Converting Enzyme Inhibitors; Anticoagulants; Aspirin; Drug Therapy, Combination; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Life Style; Peripheral Vascular Diseases; Pyridines; Risk Factors

Peripheral arterial disease (PAD) is a frequent and serious condition with a risk of mortality comparable to that of certain cancers. However, in France, the literature on this medical condition is scarce and data on management, incidence of complications and prognosis are lacking.. The COPART I registry, set up in June 2004, in the Vascular Medicine Department of the University Hospital of Toulouse, France, constitutes an observational database on hospitalized patients with PAD, in order to evaluate management, follow-up and prognosis of the patients. The aim of the present work is to compare medical prescriptions at hospital discharge, with the recent guidelines of the French High Authority of Health.. All consecutive patients with PAD, hospitalized in the Vascular Medicine Department of the University of Toulouse, between June 1, 2004 and July 31, 2006 were included. Only surviving patients were analysed.. Four hundred patients were included in the study. As expected, the majority were male (70%). Common cardiovascular risk factors were: arterial hypertension (66.7%), dyslipidemia (58.9%), diabetes (42.9%), and smoking (27.4%). Three patients out of 10 had claudication intermittens, nearly two out of 10 patients complained of persistent pain, and four out of 10 patients had Leriche and Fontaine stage IV arteriopathy. At hospital discharge, 86.9% of the patients were taking at least one antiplatelet treatment, 71.2% a statin, 54% a renin-angiotensin-system inhibitor. Nearly 66% of the patients (65.8%) received at least one antiplatelet agent and a statin. Nearly 50% of the patients (49.4%) had the three drugs recommended by the French High Authority of Health. We observed a change in prescription practices for statins (+30%), as well as for prescription of evidence-based tri-therapy (+29%) between 2004 and 2006.. Treatments prescribed at hospital discharge of patient with PAD included in the COPART I registry are in compliance with the French High Authority of Health guidelines concerning antiplatelet drugs and statins. Inhibitors of the renin-angiotensin system seem insufficiently used. However, favorable trends in medical practices between 2004 and 2006 have been observed.

Topics: Adrenergic beta-Antagonists; Aged; Aged, 80 and over; Angiotensins; Aspirin; Cohort Studies; Drug Prescriptions; Female; France; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Male; Middle Aged; Patient Discharge; Peripheral Vascular Diseases; Platelet Aggregation Inhibitors; Practice Guidelines as Topic; Pyridines; Registries; Renin; Renin-Angiotensin System; Retrospective Studies