Pharmacotherapy Before and After Revascularization: Anticoagulation, Antiplatelet Agents, and Statins

Nabil N. Dagher, J. Gregory Modrall

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Proper medical management may enhance perioperative and long-term outcomes for patients with peripheral arterial disease (PAD). For patients with PAD, aspirin and statin drugs remain the mainstay of medical management, based on results from multiple randomized clinical trials that have demonstrated improvements in long-term survival and a decrease in cardiovascular events with these agents. There may additional, unintended positive consequences of treatment with statin drugs, including potential improvements in symptoms of claudication and enhanced graft patency after infrainguinal bypass. For patients undergoing surgical or endovascular revascularization, aspirin remains the standard of care for antithrombotic therapy. Beyond this, use of warfarin should be reserved for patients with high-risk surgical bypass grafts to prolong graft patency, because it carries a significant risk of bleeding complications. The utility of clopidogrel after surgical and endovascular infrainguinal revascularization remains undefined but warrants additional study. At this time the only clear indication for clopidogrel in patients with infrainguinal arterial occlusive disease is for PAD patients who are intolerant of aspirin or have a history of coronary artery stenting within the past 6 months. Proper adjunctive pharmacotherapy for the patient with PAD has the potential to improve symptoms, graft patency, and survival in this challenging subset of patients.

Original languageEnglish (US)
Pages (from-to)10-14
Number of pages5
JournalSeminars in Vascular Surgery
Volume20
Issue number1
DOIs
StatePublished - Mar 2007

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Hydroxymethylglutaryl-CoA Reductase Inhibitors
Platelet Aggregation Inhibitors
Anticoagulants
Drug Therapy
clopidogrel
Peripheral Arterial Disease
Aspirin
Transplants
Arterial Occlusive Diseases
Graft Survival
Warfarin
Standard of Care
Pharmaceutical Preparations
Coronary Vessels
Randomized Controlled Trials
Hemorrhage
Survival
Therapeutics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Pharmacotherapy Before and After Revascularization : Anticoagulation, Antiplatelet Agents, and Statins. / Dagher, Nabil N.; Modrall, J. Gregory.

In: Seminars in Vascular Surgery, Vol. 20, No. 1, 03.2007, p. 10-14.

Research output: Contribution to journalArticle

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