Antithrombotic therapy following revascularization for chronic limb-threatening ischaemia: a European survey from the ESC Working Group on Aorta and Peripheral Vascular Diseases
Antithrombotic therapy following revascularization for chronic limb-threatening ischaemia: a European survey from the ESC Working Group on Aorta and Peripheral Vascular Diseases
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DOI：
10.1093/ehjcvp/pvac055
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发表时间：
2022-10-08
影响因子：
7.1
通讯作者：
De Caterina, Raffaele
中科院分区：
文献类型：
--
作者：
De Carlo, Marco;Schlager, Oliver;De Caterina, Raffaele
目的慢性肢体威胁性缺血（CLTI）预后不佳，是下肢血运重建术（LER）的绝对指征。抗血栓治疗在这里是至关重要的，但关于最佳策略（药物的选择、组合、持续时间）的现有证据很少。在ESC主动脉和外周血管疾病工作组的支持下，我们与参与CLTI管理的其他欧洲科学学会合作，并同意将调查发送给其附属机构，对CLTI血运重建后医生使用抗血栓治疗的情况进行了一项基于欧洲互联网的调查。方法与结果对225名被调查者进行问卷调查。抗凝治疗后手术或血管内l千差万别国家和专业,有专用的协议只有少数(36%)的受访者。阿司匹林和氯吡格雷的双重抗血小板治疗是手术（37%）和血管内（79%）LER的首选。16%的应答者开阿司匹林和低剂量利伐沙班的双途径抑制（DPI），与可报销性密切相关（OR 6.88; 95% CI 2.60-18.25），与选择临床医生而不是医生进行血运重建术密切相关（OR 2.69; 95% CI 1.10-6.58）。手术后持续6个月的高强度（双药）抗血栓治疗方案在外科医生中比在内科专家中更常见（OR 2.08; 95% CI 1.10-3.94）。出血风险评估没有标准化，可能被低估。结论目前CLTI患者的抗血栓治疗在很大程度上仍然是随意的，DPI的处方与报销政策有关。对血栓和出血风险的个体化评估在很大程度上是缺失的。
Aims Chronic limb-threatening ischaemia (CLTI) entails dismal outcomes and is an absolute indication to lower extremity revascularization (LER) whenever possible. Antithrombotic therapy is here crucial, but available evidence on best strategies (choice of drugs, combinations, duration) is scarce. We conducted a European internet-based survey on physicians' use of antithrombotic therapy after revascularization for CLTI, under the aegis of the ESC Working Group on Aorta and Peripheral Vascular Disease in collaboration with other European scientific societies involved in CLTI management and agreeing to send the survey to their affiliates. Methods and results 225 respondents completed the questionnaire. Antithrombotic therapy following surgical/endovascular LER varies widely across countries and specialties, with dedicated protocols reported only by a minority (36%) of respondents. Dual antiplatelet therapy with aspirin and clopidogrel is the preferred choice for surgical (37%) and endovascular (79%) LER. Dual pathway inhibition (DPI) with aspirin and low-dose rivaroxaban is prescribed by 16% of respondents and is tightly related to the availability of reimbursement (OR 6.88; 95% CI 2.60-18.25) and to the choice of clinicians rather than of physicians performing revascularization (OR 2.69; 95% CI 1.10-6.58). A >= 6 months-duration of an intense (two-drug) postprocedural antithrombotic regimen is more common among surgeons than among medical specialists (OR 2.08; 95% CI 1.10-3.94). Bleeding risk assessment is not standardised and likely underestimated. Conclusion Current antithrombotic therapy of CLTI patients undergoing LER remains largely discretional, and prescription of DPI is related to reimbursement policies. An individualised assessment of thrombotic and bleeding risks is largely missing.