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Antithrombotic treatment following revascularization for chronic limb-threatening ischaemia: a scientific statement of the European Society of Cardiology Working Group on Aorta and Peripheral Vascular Diseases and the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy

2025-05-21Journal article Open access
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datacite.subject.fosCiências Médicas::Ciências da Saúde
datacite.subject.sdg03:Saúde de Qualidade
datacite.subject.sdg17:Parcerias para a Implementação dos Objetivos
datacite.subject.sdg04:Educação de Qualidade
dc.contributor.authorSchlager, Oliver
dc.contributor.authorDe Carlo, Marco
dc.contributor.authorMazzolai, Lucia
dc.contributor.authorBura-Riviere, Alessandra
dc.contributor.authorHeiss, Christian
dc.contributor.authorPalomares, Jose Rodriguez
dc.contributor.authorMorais, João C. A.
dc.contributor.authorSteiner, Sabine
dc.contributor.authorBrodmann, Marianne
dc.contributor.authorAboyans, Victor
dc.contributor.authorCaterina, Raffaele De
dc.date.accessioned2025-09-30T11:15:39Z
dc.date.available2025-09-30T11:15:39Z
dc.date.issued2025-05-21
dc.description
dc.description.abstractChronic limb-threatening ischaemia (CLTI) is defined as ischaemic rest pain, or non-healing ulceration, requiring endovascular or surgical lower limb revascularization (LLR). Lower limb revascularization in CLTI entails a high risk of major adverse limb events (MALE) and major adverse cardiovascular events (MACE). This scientific statement addresses this risk based on a systematic review. A structured literature search was performed, and articles were independently evaluated by two investigators. In total, 1678 articles were identified, of which 34 were included in the final analysis. Only three randomized controlled trials (RCTs) addressed antithrombotic therapy in CLTI following LLR. None of these demonstrated superiority of any antithrombotic regimen over the other. Eight RCTs investigated antithrombotic therapy following LLR in populations with peripheral arterial disease including CLTI subgroups and suggest a benefit of dual antiplatelet therapy on limb events. One large RCT demonstrated that dual pathway inhibition with aspirin and vascular-dose rivaroxaban reduced the risk of MALE, MACE, and unplanned target limb revascularization. Data from 22 observational studies suggest a benefit of dual antiplatelet therapy on overall survival and amputation-free survival after LLR as compared with single antiplatelet therapy. Intensified antithrombotic treatment should be proposed in patients with CLTI following LLR to reduce the risk of MALE and MACE. Randomized controlled trials on antithrombotic therapy in patients with CLTI following LLR are scarce. Dual pathway inhibition is the only regimen for which an RCT demonstrated a reduction of MALE and MACE following LLR. Dual antiplatelet therapy appears to be associated with a reduced risk of MALE in CLTI following LLR.eng
dc.description.sponsorshipWe acknowledge the work of Brigitte Wildner from the University Library at the Medical University of Vienna, Austria, who substantially contributed to this research effort by assisting with the structured literature search.
dc.identifier.citationOliver Schlager, Marco De Carlo, Lucia Mazzolai, Alessandra Bura-Riviere, Christian Heiss, Jose Rodriguez Palomares, Joao C A Morais, Sabine Steiner, Marianne Brodmann, Victor Aboyans, Raffaele De Caterina, Antithrombotic treatment following revascularization for chronic limb-threatening ischaemia: a scientific statement of the European Society of Cardiology Working Group on Aorta and Peripheral Vascular Diseases and the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy, European Heart Journal, Volume 46, Issue 28, 21 July 2025, Pages 2742–2759, https://doi.org/10.1093/eurheartj/ehaf317
dc.identifier.doi10.1093/eurheartj/ehaf317
dc.identifier.eissn1522-9645
dc.identifier.issn0195-668X
dc.identifier.urihttp://hdl.handle.net/10400.8/14162
dc.language.isoeng
dc.peerreviewedyes
dc.publisherOxford University Press
dc.relation.hasversionhttps://academic.oup.com/eurheartj/article/46/28/2742/8138376
dc.relation.ispartofEuropean Heart Journal
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.subjectAntithrombotic therapy
dc.subjectChronic limb-threatening ischaemia
dc.subjectLower limb revascularization
dc.subjectPeripheral arterial disease
dc.subjectPeripheral percutaneous angioplasty
dc.subjectStenting
dc.subjectVascular surgery
dc.titleAntithrombotic treatment following revascularization for chronic limb-threatening ischaemia: a scientific statement of the European Society of Cardiology Working Group on Aorta and Peripheral Vascular Diseases and the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapyeng
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage2759
oaire.citation.issue28
oaire.citation.startPage2742
oaire.citation.titleEuropean Heart Journal
oaire.citation.volume46
oaire.versionhttp://purl.org/coar/version/c_970fb48d4fbd8a85
person.familyNameMorais
person.givenNameJoão
person.identifier.ciencia-id3614-652A-118E
person.identifier.orcid0000-0003-3406-2878
relation.isAuthorOfPublication3bc0f910-a460-461f-863a-1ca701ee597f
relation.isAuthorOfPublication.latestForDiscovery3bc0f910-a460-461f-863a-1ca701ee597f

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