The Potential Value of Anticoagulation/Anti-Platelet Therapy in CLTI Patients

On Thursday afternoon, R. Kevin Rogers, MD, from the University of Colorado and CPC Clinical Research in Aurora, Colorado, spoke about the role of antithrombotic therapy in managing patients with chronic limb-threatening ischemia (CLTI), particularly those undergoing lower extremity revascularization (LER). The presentation highlighted the limited data available for optimizing antithrombotic strategies in peripheral artery disease (PAD) compared with coronary artery disease (CAD).

Key points of the presentation included: 

• Antithrombotic strategies: Various therapies, including aspirin, clopidogrel, dual anti-platelet therapy (DAPT), ticagrelor, vorapaxar, warfarin, and low-dose Factor Xa inhibitors, have been explored for reducing cardiovascular events.

• VOYAGER-PAD trial: The trial demonstrated that low-dose rivaroxaban (2.5 mg BID) combined with aspirin significantly reduces the risk of acute limb ischemia (ALI) and other major adverse limb events (MALE) in patients post-LER, with both short-term and long-term benefits.

• Safety considerations: While rivaroxaban's efficacy is notable, its use with DAPT increases bleeding risks, particularly in the first 90 days following revascularization.

In conclusion, Dr. Rogers told the attendees that for patients with CLTI, especially those post-LER, low-dose rivaroxaban on a background of aspirin offers a promising strategy for preventing ALI, though careful consideration of bleeding risks is necessary. Further research is needed to refine antithrombotic therapy guidelines in this high-risk patient population.