Analysis Details Use of Antiplatelet Therapy After Peripheral Vascular Interventions

August 21, 2020

An analysis of data from a Society of Vascular Surgeons registry is shedding light on the use of DAPT in patients following peripheral vascular interventions.

An analysis of data by investigators at the USC Keck School of Medicine found there was little consensus among discharge prescribing patterns for antiplatelet therapy following peripheral vascular intervention.

Despite current guidelines suggesting benefit from dual antiplatelet therapy (DAPT), a retrospective look at data from more than 32k patients who underwent PVI between 2017-2018 found DAPT was initiated in less than half of patients and multiple factors were associated with initiating DAPT versus single antiplatelet therapy.

“The factors associated with antiplatelet therapy regimen choice post-intervention currently seem to be less evidence based and more reliant upon subjectively perceived high risk features, with an unknown impact on clinical outcomes,” wrote study investigators.

To learn more about the discharge patterns for antiplatelet therapy following endovascular peripheral intervention for peripheral artery disease (PAD), investigates designed a retrospective observational study using data from the Society of Vascular Surgery (SVS) Vascular Quality Initiative (VQI) database. Using a subsection of the database pertaining to patients undergoing lower extremity peripheral vascular intervention between 2017-2018, investigators identified 32,338 patients for inclusion in their study after the application of inclusion criteria.

For inclusion in the analysis, patients were required to be at least 18 years of age, undergoing lower extremity peripheral vascular intervention, and have data related to demographic information and clinical variables of interest. Of note, variables of interest and demographic data included insurance status as well as data related to cardiovascular risk factors and disease history.

For the purpose of analysis, post-discharge antiplatelet therapy regimens were defined as none, aspirin only, P2Y12 inhibitor only, and DAPT. Multivariate logistic regression analysis was performed to examine what variables were associated with DAPT initiation compared with those discharged on single-agent or no antiplatelet therapy.

The study population had a mean age of 68.5±11.1 years, 61% were men, 79% were white, and 49% received DAPT on discharge. In their analyses, investigators found 25% of patients already on anticoagulation received a prescription of DAPT on discharge compared to 95% for those not on anticoagulants but already on DAPT prior to the procedure. Further analysis indicated 49% of patients receiving neither anticoagulants or DAPT prior to the procedure received DAPT at discharge.

In multivariate analyses, investigators identified multiple factors associated with increased odds of receiving DAPT at discharge. Of note, male sex (OR, 1.12; 95% CI, 1.05-1.20), current or prior history of smoking (OR, 1.20; 95% CI, 1.09-1.32), and coronary artery disease (OR, 1.19; 95% CI, 1.11-1.27) were all associated with increased likelihood of receiving a DAPT prescription.

Certain procedural characteristics were also associated with increased likelihood of receiving a DAPT prescription. Specific procedural characteristics associated with increased likelihood were those requiring multiple types of interventions (OR, 1.28; 95% CI, 1.15-1.42), stent placement (OR, 1.16; 95% CI, 1.06–1.27), and with complications (OR, 1.31; 95% CI, 1.14-1.52).

Investigators also pointed out those without insurance (OR, 0.70; 95% CI, 0.56-0.86), underwent a technically unsuccessful procedure (OR, 0.61; 95% CI, 0.52-0.70), or had undergone a prior peripheral vascular intervention were less likely to receive a DAPT prescription at discharge.

This study, “Discharge Prescription Patterns for Antiplatelet Therapy Following Lower Extremity Peripheral Vascular Intervention,” was published in Circulation: Cardiovascular Interventions.