[Signifi cance of the choice of antithrombotic therapy for a patient after revascularization of lower limbs in a long-term perspective (literature review)].

Abstract

Occlusive disease of lower limb arteries is one of manifestations of systemic atherosclerosis. In this pathology, the probability of systemic complications combined with acute or progressive chronic ischemia of lower limbs is extremely high. The number of open and endovascular operations in occlusion of arteries below the inguinal ligament is constantly growing, but even a successfully performed restorative operation decreases only the threat of limb loss and cannot influence progression of the disease or diminish the risk of ischemic complications. The VOYAGER PAD randomized international double-blind, placebo-controlled trial studying the profile of efficacy and safety of rivaroxaban at a dose of 2.5 mg twice daily added to conventional therapy with acetylsalicylic acid or to dual antiplatelet therapy (acetylsalicylic acid and clopidogrel) demonstrated the capability of combined antithrombotic therapy to improve the results of surgical treatment of patients with lower limb artery pathology. The VOYAGER PAD trial showed that patients receiving combined therapy with rivaroxaban at a dose of 2.5 mg twice daily + acetylsalicylic acid 100 mg/day had a significantly lower risk for the development of acute limb ischemia, major amputation, myocardial infarction and cardiovascular death as compared with those taking therapy with acetylsalicylic acid alone (HR 0.85; 95% CI 0.76-0.96; p=0.0085). The frequency of major hemorrhage did not significantly differ between the groups (HR 1.43; 95% CD 0.97-2.10; p=0.07). Thus, the choice of pathogenetically substantiated antithrombotic therapy inhibiting both links of thrombus formation in patients after endured revascularization of lower limbs may help preserve patency of the reconstructed zone, decrease the risk of limb loss and systemic thrombotic complications in a long-term perspective.