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• W3036506321 abstract "The aim of this study was to explore current practice patents for prescribing single versus dual antiplatelet therapy after lower extremity endovascular interventions and to explore the effects of various antiplatelet therapy regimens on 1-year patency and reintervention rates. All lower extremity endovascular interventions performed for occlusive disease and entered into the national Vascular Quality Initiative database from 2010 to 2018 were investigated. Two cohorts were created based on antiplatelet regimen at discharge: aspirin vs dual antiplatelet therapy (DAPT). Multivariable logistic regression evaluated predictors of discharge on DAPT. Controlling for preoperative demographics and operatic characteristics (lesion and treatment variables), Cox regression analyzed 1-year vessel patency and reintervention rates. During the study period, 65,956 patients met inclusion criteria. Treated lesions involved the following distributions: 37.9% iliac, 60.1% femoral/popliteal, and 22.6% infrapopliteal. Of the interventions, 84.7% involved percutaneous transluminal angioplasty, 60.6% stenting, and 14.9% atherectomy. Of the patients, 27.9% were on DAPT preoperatively, rising to 57.54% at discharge, and dropping to 44.0% at the 1-year follow-up. Discharge on anticoagulation (odds ratio [OR], 0.19; 95% confidence interval [CI], 0.17-0.20; P < .001), advancing age (OR, 0.98; 95% CI, 0.98-0.99; P < .001), and iliac treatment (OR, 0.81; 95% CI, 0.75-0.87; P < .001) were the strongest predictors of discharge on aspirin only, while prior coronary artery bypass grafting/percutaneous coronary intervention (OR, 1.52; 95% CI, 1.43-1.62; P < .001), stenting as intervention (OR, 1.73; 95% CI, 1.63-1.84; P < .001), femoral/popliteal lesion location (OR, 1.32; 95% CI, 1.23-1.42; P < .001), and increasing TransAtlantic Inter-Society Consensus (TASC) lesion grade (TASC D, OR, 1.51; 95% CI, 1.37-1.68; P < .001) were the strongest predictors of discharge on DAPT (Table). Cox regression found no effect of DAPT on 1-year vessel patency (hazard ratio [HR], 0.95; 95% CI, 0.85-1.07; P = .42) or vessel reintervention rate (HR, 0.96; 95% CI, 0.89-1.03; P = .21) (Figure). Cox regression was repeated on a more selective, higher risk vascular disease cohort (stenting intervention, TASC grade C or D, femoral/popliteal or infrapopliteal lesion location) and again no effect on 1-year vessel patency (HR, 0.93; 95% CI, 0.75-1.16; P = .524) or reintervention (HR, 1.01; 95% CI, 0.86-1.19; P = .89) was found. Dual antiplatelet therapy is prescribed after the majority of lower extremity endovascular interventions and is most often used in more complex and higher risk patients with higher TASC lesion classifications, femoral and popliteal lesion locations, and interventions requiring stenting. Despite its widespread use, no beneficial effect of DAPT therapy on 1-year reintervention or vessel patency was found.Table IMultivariable logistic regression predicting variables associated with discharge on dual antiplatelet therapy (DAPT)Variables associated with discharge on DAPT therapyOR95% CIP valueDischarge on anticoagulation0.19(0.17-0.20)<.001Treated lesion location Iliac0.81(0.75-0.87)<.001 Femoral/popliteal1.32(1.23-1.42)<.001 Infrapopliteal1.10(1.02-1.18)0.02 Creatinine >1.8 mg/dL0.82(0.76-0.89)<.001Symptoms (compared to claudication)<.001 Rest pain0.80(0.75-0.84)<.001 Tissue loss/acute limb ischemia0.77(0.68-0.88)<.001Age0.98(0.98-0.99)<.001Non-white race1.09(1.02-1.17)0.01Hypertension1.16(1.08-1.24)<.001Atherectomy1.19(1.10-1.28)<.001Prior lower extremity intervention1.20(1.14-1.26)<.001Coronary artery disease1.23(1.16-1.31)<.001Prior carotid stent or endarterectomy1.32(1.13-1.53)0.001TASC lesion (compared to A)<.001 B1.13(1.07-1.20)<.001 C1.19(1.12-1.27)<.001 D1.51(1.36-1.68)<.001Prior CABG or PCI1.52(1.43-1.62)<.001Stent (compared to angioplasty alone)1.73(1.63-1.84)<.001CABG, Coronary artery bypass grafting; CI, confidence interval; OR, odds ratio; PCI, percutaneous coronary intervention; TASC, TransAtlantic Inter-Society Consensus. Open table in a new tab" @default.
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• W3036506321 date "2020-07-01" @default.
• W3036506321 modified "2023-09-28" @default.
• W3036506321 title "Evaluating Practice Patterns and Effects on One-Year Patency and Reintervention of Single Versus Dual Antiplatelet Therapy After Lower Extremity Endovascular Intervention" @default.
• W3036506321 doi "https://doi.org/10.1016/j.jvs.2020.04.242" @default.
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