Antiplatelet therapy in patients with claudication: lessons from large trials
Vascular Division, St George's Hospital, London, U.K.
* Correspondence: John A. Dormandy, Clinical Research Centre - Vascular Division, Level 1, Ingleby House, St George's Hospital, Blackshaw Road, SW 17 OQT, London, U.K.
Abstract
There is now overwhelming evidence that the use of antiplatelet drugs in patients with intermittent claudication should be mandatory. The greater risk to patients with intermittent claudication is not progression of disease in the legs, but rather the increased risk for fatal and non-fatal cardiovascular events in other circulations. The incidence of such events can be reduced by the use of low-dose aspirin or clopidogrel. The effect of clopidogrel alone is greater than that of low-dose aspirin alone, but to obtain a significantly greater benefit from antiplatelet therapy the future probably lies in a combination of these two drugs, which affect platelet function through different pathways.
Key Words: Antiplatelet therapy • intermittent claudication • peripheral arterial disease • risk factors
References
- Dormandy JA, Heeck L, Vig S. Peripheral arterial occlusive disease: clinical data for decision making. Semin Vase Surg. 1999;12:93–162
- Criqui MH. Peripheral arterial disease and subsequent cardiovascular mortality. Circulation. 1990;82:2246–2247
[Free Full Text] - Smith GD, Shipley MJ, Rose G. Intermittent claudication, heart disease risk factors, and mortality. Circulation. : The Whitehall Study; 1990. p. 1925–1931
- Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet. 1994;344:1383–1389 Anonymous[CrossRef][Web of Science][Medline]
- Byrne CD, Wild SH. Lipids and the secondary prevention of ischaemic heart disease. BMJ. 1996;313:1273–1274
[Free Full Text] - Antiplatelet Trialists' Collaboration. Collaborative overview of randomised trials of antiplatelet treatment. I. Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. BMJ. 1994;308:81–106
[Abstract/Free Full Text] - Antiplatelet Trialists' Collaboration. Collaborative overview of randomised trials of antiplatelet treatment. II. Maintenance of vascular graft or arterial patency by antiplatelet therapy. BMJ. 1994;308:159–168
[Abstract/Free Full Text] - Antiplatelet Trialists' Collaboration. Collaborative overview of randomised trials of antiplatelet treatment. III. Reduction in venous thrombosis and pulmonary embolism by antiplatelet prophylaxis among surgical and medical patients. BMJ. 1994;308:235–246
[Abstract/Free Full Text] - Underwood MJ, Moore RS. The aspirin papers. BMJ. 1994;308:71–72
[Free Full Text] - Shonis PJ, Cannon CP, Loscalzo J. The antiplatelet effects of ticlopidine and clopidogel. Ann Intern Med. 1998;129:394–405
[Abstract/Free Full Text] - Leizorovicz, et al. Prevention of major cardiovascular events by Ticlopidine in peripheral arterial disease patients: a meta-analysis of pooled database. [abstract]BirminghamPresented at the European Congress of Cardiology. 1996.
- CAPRIE Steering Committee. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet. 1996;348:1329–1339[CrossRef][Web of Science][Medline]
- Lefkovits J, Plow EF, Tofol EJ. Platelet glycoprotein IIb/IIIa receptors in cardiovascular medicine. N Engl J Med. 1995;332:1553–1559
[Free Full Text] - Sanderson S. Hypertension in the elderly: pressure to treat? Health Trends. 1996;28:117–121
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||