Zoltán  Paluch,Pavel Chrbolka,Gergely  Pallag,
Antiplatelet Therapy in Secondary Prevention in Patients with Ischaemic Peripheral Arterial Disease
Journal of Integrative Cardiology Open Access
2020
2674-2489
http://dx.doi.org/10.31487/j.JICOA.2020.06.05
https://www.sciencerepository.org/antiplatelet-therapy-in-secondary-prevention-in-patients-with-ischaemic_JICOA-2020-6-105 
Abstract: Introduction: Globally, peripheral arterial disease affects almost 200 million individuals at high risk of
developing another type of cardiovascular disease with an annual incidence of cardiovascular events and
cardiovascular mortality of 4-5% and a risk of acute limb ischaemia and amputation of 5%. All patients with
clinical symptomatology of peripheral arterial disease should be treated with statins and antiplatelet drugs.
Evidence Acquisition: The authors provide an overview, from the perspective of a clinical pharmacologist,
of the pharmacokinetic properties of the antiplatelet agents available, mechanisms of their action, and
differences among individual agents in side effects, efficacy and safety as well as a comparison of clinical
trials.
Evidence Synthesis: In a significant proportion of patients, therapy with clopidogrel is modified, with
genetic polymorphism demonstrably preventing effective therapy in a proportion of patients. In cases where
an antiplatelet agent other than aspirin is chosen, clopidogrel therapy is rational only if a genetic mutation
resulting in ineffective therapy has been ruled out. Effective therapy can be accomplished using the more
modern antiplatelet agents with balanced pharmacokinetic and pharmacodynamic properties.
Conclusions: Several questions related to treatment of patients with peripheral arterial disease remain to be
answered. Expert views on recommended antiplatelet therapy diverge. It would be unethical to ignore the
fact that therapy may be ineffective in a proportion of clopidogrel-treated patients. Guidelines for the
treatment and prevention of peripheral arterial disease should offer alternative antiplatelet drugs or
recommendations to verify a patient´s genetic predisposition. Further clinical trials are warranted to assess
the efficacy of individual antiplatelet agents and doses thereof in patients with peripheral arterial disease.Keywords:  Anti-platelet therapy, cardiovascular disease, acute limb ischaemia, arterial disease, clopidogrel