The PAD population is at increased risk of major adverse cardiovascular events (MACE) and major adverse limb events (MALE). Risk factor modification, symptom control, antithrombotic, and lipid therapies are the mainstays of PAD medical therapy. Recent data has challenged prior recommendations regarding the optimal secondary prevention strategies in PAD.
Purpose of Review
To review clinical evidence from large randomized controlled trials showing the benefit of antithrombotic and lipid therapy in the PAD population.
The COMPASS trial challenged prior recommendations regarding anticoagulation in PAD. Among the PAD subgroup, rivaroxaban 2.5 mg plus aspirin reduced MACE (HR 0.72, 95% CI 0.57–0.90, p = 0.0047), MALE (HR 0.54, 95% CI 0.35–0.82, p = 0.0037), and major amputation (HR 0.30, 95% CI 0.11–0.80, p = 0.011) compared with aspirin monotherapy. The THEMIS trial showed a 55% risk reduction for MALE with ticagrelor DAPT compared with aspirin monotherapy (HR 0.45, 95% CI 0.23–0.86). The FOURIER trial revealed that lowering LDL cholesterol below current targets with a PCSK9 inhibitor reduced MACE (HR 0.73, 95% CI 0.59–0.91, p = 0.0040) and MALE (HR 0.43, 95% CI 0.19–0.99, p = 0.042) in subjects with symptomatic PAD.
Recent high-quality evidence shows the benefit of antiplatelet therapy, anticoagulation therapy, and lipid therapy in reducing MACE and MALE in PAD. Despite these findings, implementation remains a challenge and focus should now shift towards adopting evidence-based recommendations in clinical practice.
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Shu J, Santulli G. Update on peripheral artery disease: epidemiology and evidence-based facts. Atherosclerosis. 2018;275:379–81. https://doi.org/10.1016/j.atherosclerosis.2018.05.033.
Gerhard-Herman MD, Gornik HL, Barrett C, Barshes NR, Corriere MA, Drachman DE, et al. 2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2017;135(12):e686–725. https://doi.org/10.1161/cir.0000000000000470.
Schorr EN, Treat-Jacobson D. Methods of symptom evaluation and their impact on peripheral artery disease (PAD) symptom prevalence: a review. Vasc Med. 2013;18(2):95–111. https://doi.org/10.1177/1358863x13480001.
Mach F, Baigent C, Catapano AL, Koskinas KC, Casula M, Badimon L, et al. 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk: the task force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS). Eur Heart J. 2019. https://doi.org/10.1093/eurheartj/ehz455.
Bonaca MP, Creager MA. Pharmacological treatment and current management of peripheral artery disease. Circ Res. 2015;116(9):1579–98. https://doi.org/10.1161/circresaha.114.303505.
Hess CN, Norgren L, Ansel GM, Capell WH, Fletcher JP, Fowkes FGR, et al. A structured review of antithrombotic therapy in peripheral artery disease with a focus on revascularization: a TASC (InterSociety Consensus for the Management of Peripheral Artery Disease) initiative. Circulation. 2017;135(25):2534–55. https://doi.org/10.1161/circulationaha.117.024469.
Criqui MH, Ninomiya JK, Wingard DL, Ji M, Fronek A. Progression of peripheral arterial disease predicts cardiovascular disease morbidity and mortality. J Am Coll Cardiol. 2008;52(21):1736–42. https://doi.org/10.1016/j.jacc.2008.07.060.
Fakhry F, Spronk S, van der Laan L, Wever JJ, Teijink JA, Hoffmann WH, et al. Endovascular revascularization and supervised exercise for peripheral artery disease and intermittent claudication: a randomized clinical trial. Jama. 2015;314(18):1936–44. https://doi.org/10.1001/jama.2015.14851.
Hamburg NM, Balady GJ. Exercise rehabilitation in peripheral artery disease: functional impact and mechanisms of benefits. Circulation. 2011;123(1):87–97. https://doi.org/10.1161/circulationaha.109.881888.
Dawson DL, Cutler BS, Meissner MH, Strandness DE Jr. Cilostazol has beneficial effects in treatment of intermittent claudication: results from a multicenter, randomized, prospective, double-blind trial. Circulation. 1998;98(7):678–86. https://doi.org/10.1161/01.cir.98.7.678.
Pande RL, Hiatt WR, Zhang P, Hittel N, Creager MA. A pooled analysis of the durability and predictors of treatment response of cilostazol in patients with intermittent claudication. Vasc Med. 2010;15(3):181–8. https://doi.org/10.1177/1358863x10361545.
Thompson PD, Zimet R, Forbes WP, Zhang P. Meta-analysis of results from eight randomized, placebo-controlled trials on the effect of cilostazol on patients with intermittent claudication. Am J Cardiol. 2002;90(12):1314–9. https://doi.org/10.1016/s0002-9149(02)02869-2.
Criqui MH. Peripheral arterial disease—epidemiological aspects. Vasc Med. 2001;6(3 Suppl):3–7. https://doi.org/10.1177/1358836X0100600i102.
Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;139(25):e1046–e81. https://doi.org/10.1161/cir.0000000000000624.
Antiplatelet Trialists’. Collaborative overview of randomised trials of antiplatelet therapy—II: maintenance of vascular graft or arterial patency by antiplatelet therapy. Antiplatelet Trialists' Collaboration. Bmj. 1994;308(6922):159–68.
Baigent C, Sudlow C, Collins R, Peto R. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. Bmj. 2002;324(7329):71–86. https://doi.org/10.1136/bmj.324.7329.71.
Belch J, MacCuish A, Campbell I, Cobbe S, Taylor R, Prescott R, et al. The prevention of progression of arterial disease and diabetes (POPADAD) trial: factorial randomised placebo controlled trial of aspirin and antioxidants in patients with diabetes and asymptomatic peripheral arterial disease. Bmj. 2008;337:a1840. https://doi.org/10.1136/bmj.a1840.
Berger JS, Krantz MJ, Kittelson JM, Hiatt WR. Aspirin for the prevention of cardiovascular events in patients with peripheral artery disease: a meta-analysis of randomized trials. Jama. 2009;301(18):1909–19. https://doi.org/10.1001/jama.2009.623.
Fowkes FG, Price JF, Stewart MC, Butcher I, Leng GC, Pell AC, et al. Aspirin for prevention of cardiovascular events in a general population screened for a low ankle brachial index: a randomized controlled trial. Jama. 2010;303(9):841–8. https://doi.org/10.1001/jama.2010.221.
Gent M, Beumont D, Blanchard J, Bousser M-G, Coffman J, Easton JD, et al. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). CAPRIE Steering Committee. Lancet. 1996;348(9038):1329–39. https://doi.org/10.1016/s0140-6736(96)09457-3.
Bhatt DL, Fox KA, Hacke W, Berger PB, Black HR, Boden WE, et al. Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events. N Engl J Med. 2006;354(16):1706–17. https://doi.org/10.1056/NEJMoa060989.
Cacoub PP, Bhatt DL, Steg PG, Topol EJ, Creager MA. Patients with peripheral arterial disease in the CHARISMA trial. Eur Heart J. 2009;30(2):192–201. https://doi.org/10.1093/eurheartj/ehn534.
• Hiatt WR, Fowkes FG, Heizer G, Berger JS, Baumgartner I, Held P, et al. Ticagrelor versus Clopidogrel in symptomatic peripheral artery disease. N Engl J Med. 2017;376(1):32–40. https://doi.org/10.1056/NEJMoa1611688 This was a large trial of patients with symptomatic PAD. It was neutral demonstrating that ticagrelor was not superior to clopidogrel as monotherapy.
Wallentin L, Becker RC, Budaj A, Cannon CP, Emanuelsson H, Held C, et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2009;361(11):1045–57. https://doi.org/10.1056/NEJMoa0904327.
Patel MR, Becker RC, Wojdyla DM, Emanuelsson H, Hiatt WR, Horrow J, et al. Cardiovascular events in acute coronary syndrome patients with peripheral arterial disease treated with ticagrelor compared with clopidogrel: data from the PLATO trial. Eur J Prev Cardiol. 2015;22(6):734–42. https://doi.org/10.1177/2047487314533215.
Bonaca MP, Bhatt DL, Cohen M, Steg PG, Storey RF, Jensen EC, et al. Long-term use of ticagrelor in patients with prior myocardial infarction. N Engl J Med. 2015;372(19):1791–800. https://doi.org/10.1056/NEJMoa1500857.
Bonaca MP, Bhatt DL, Storey RF, Steg PG, Cohen M, Kuder J, et al. Ticagrelor for prevention of ischemic events after myocardial infarction in patients with peripheral artery disease. J Am Coll Cardiol. 2016;67(23):2719–28. https://doi.org/10.1016/j.jacc.2016.03.524.
• Steg PG, Bhatt DL, Simon T, Fox K, Mehta SR, Harrington RA, et al. Ticagrelor in patients with stable coronary disease and diabetes. N Engl J Med. 2019. https://doi.org/10.1056/NEJMoa1908077 This trial showed a 55% risk reduction for MALE with Ticagrelor DAPT compared with aspirin monotherapy in PAD subgroup. These results may be offset by significant bleeding risks.
Tricoci P, Huang Z, Held C, Moliterno DJ, Armstrong PW, Van de Werf F, et al. Thrombin-receptor antagonist vorapaxar in acute coronary syndromes. N Engl J Med. 2012;366(1):20–33. https://doi.org/10.1056/NEJMoa1109719.
Jones WS, Tricoci P, Huang Z, Moliterno DJ, Harrington RA, Sinnaeve PR, et al. Vorapaxar in patients with peripheral artery disease and acute coronary syndrome: insights from Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome (TRACER). Am Heart J. 2014;168(4):588–96. https://doi.org/10.1016/j.ahj.2014.06.017.
Morrow DA, Braunwald E, Bonaca MP, Ameriso SF, Dalby AJ, Fish MP, et al. Vorapaxar in the secondary prevention of atherothrombotic events. N Engl J Med. 2012;366(15):1404–13. https://doi.org/10.1056/NEJMoa1200933.
Bonaca MP, Scirica BM, Creager MA, Olin J, Bounameaux H, Dellborg M, et al. Vorapaxar in patients with peripheral artery disease: results from TRA2P-TIMI 50. Circulation. 2013;127(14):1522–9, 9e1-6. https://doi.org/10.1161/circulationaha.112.000679.
Anand S, Yusuf S, Xie C, Pogue J, Eikelboom J, Budaj A, et al. Oral anticoagulant and antiplatelet therapy and peripheral arterial disease. N Engl J Med. 2007;357(3):217–27. https://doi.org/10.1056/NEJMoa065959.
Patel MR, Mahaffey KW, Garg J, Pan G, Singer DE, Hacke W, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011;365(10):883–91. https://doi.org/10.1056/NEJMoa1009638.
Jones WS, Hellkamp AS, Halperin J, Piccini JP, Breithardt G, Singer DE, et al. Efficacy and safety of rivaroxaban compared with warfarin in patients with peripheral artery disease and non-valvular atrial fibrillation: insights from ROCKET AF. Eur Heart J. 2014;35(4):242–9. https://doi.org/10.1093/eurheartj/eht492.
Eikelboom JW, Connolly SJ, Bosch J, Dagenais GR, Hart RG, Shestakovska O, et al. Rivaroxaban with or without aspirin in stable cardiovascular disease. N Engl J Med. 2017;377(14):1319–30. https://doi.org/10.1056/NEJMoa1709118.
• Anand SS, Bosch J, Eikelboom JW, Connolly SJ, Diaz R, Widimsky P, et al. Rivaroxaban with or without aspirin in patients with stable peripheral or carotid artery disease: an international, randomised, double-blind, placebo-controlled trial. Lancet. 2018;391(10117):219–29. https://doi.org/10.1016/s0140-6736(17)32409-1 This trial provided the basis for FDA approval of rivaroxaban for MACE reduction in PAD patients.
Mehta SR, Yusuf S. The Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) trial programme; rationale, design and baseline characteristics including a meta-analysis of the effects of thienopyridines in vascular disease. Eur Heart J. 2000;21(24):2033–41. https://doi.org/10.1053/euhj.2000.2474.
Hess CN, Hiatt WR. Antithrombotic therapy for peripheral artery disease in 2018. Jama. 2018;319(22):2329–30. https://doi.org/10.1001/jama.2018.5422.
U.S. FDA approves XARELTO® (rivaroxaban) to reduce the risk of major cardiovascular events in patients with chronic coronary artery disease (CAD) or peripheral artery disease (PAD). Janssen. 2018. https://www.janssen.com/us-fda-approves-xareltor-rivaroxaban-reduce-risk-major-cardiovascular-events-patients-chronic. Accessed 20 Aug 2019.
• Capell WH, Bonaca MP, Nehler MR, Chen E, Kittelson JM, Anand SS, et al. Rationale and design for the vascular outcomes study of ASA along with rivaroxaban in endovascular or surgical limb revascularization for peripheral artery disease (VOYAGER PAD). Am Heart J. 2018;199:83–91. https://doi.org/10.1016/j.ahj.2018.01.011 This is an ongoing trial evaluating the addition of rivaroxaban to aspirin after lower extremity revascularization in PAD population.
LIPID Study Group. Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med. 1998;339(19):1349–57. https://doi.org/10.1056/nejm199811053391902.
Pedersen TR, Kjekshus J, Berg K, Haghfelt T, Faergeman O, Faergeman G, et al. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). 1994. Atheroscler Suppl. 2004;5(3):81–7. https://doi.org/10.1016/j.atherosclerosissup.2004.08.027.
Ridker PM, Danielson E, Fonseca FA, Genest J, Gotto AM Jr, Kastelein JJ, et al. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N Engl J Med. 2008;359(21):2195–207. https://doi.org/10.1056/NEJMoa0807646.
Mohler ER 3rd, Hiatt WR, Creager MA. Cholesterol reduction with atorvastatin improves walking distance in patients with peripheral arterial disease. Circulation. 2003;108(12):1481–6. https://doi.org/10.1161/01.Cir.0000090686.57897.F5.
Bulbulia R, Bowman L, Wallendszus K, Parish S, Armitage J, Collins R. Randomized trial of the effects of cholesterol-lowering with simvastatin on peripheral vascular and other major vascular outcomes in 20,536 people with peripheral arterial disease and other high-risk conditions. J Vasc Surg. 2007;45(4):645–54; discussion 53-4. https://doi.org/10.1016/j.jvs.2006.12.054.
Aung PP, Maxwell HG, Jepson RG, Price JF, Leng GC. Lipid-lowering for peripheral arterial disease of the lower limb. Cochrane Database Syst Rev. 2007(4):Cd000123. doi:https://doi.org/10.1002/14651858.CD000123.pub2.
Momsen AH, Jensen MB, Norager CB, Madsen MR, Vestersgaard-Andersen T, Lindholt JS. Drug therapy for improving walking distance in intermittent claudication: a systematic review and meta-analysis of robust randomised controlled studies. Eur J Vasc Endovasc Surg. 2009;38(4):463–74. https://doi.org/10.1016/j.ejvs.2009.06.002.
Pedersen TR, Faergeman O, Kastelein JJ, Olsson AG, Tikkanen MJ, Holme I, et al. High-dose atorvastatin vs usual-dose simvastatin for secondary prevention after myocardial infarction: the IDEAL study: a randomized controlled trial. Jama. 2005;294(19):2437–45. https://doi.org/10.1001/jama.294.19.2437.
Stoekenbroek RM, Boekholdt SM, Fayyad R, Laskey R, Tikkanen MJ, Pedersen TR, et al. High-dose atorvastatin is superior to moderate-dose simvastatin in preventing peripheral arterial disease. Heart. 2015;101(5):356–62. https://doi.org/10.1136/heartjnl-2014-306906.
Cannon CP, Blazing MA, Giugliano RP, McCagg A, White JA, Theroux P, et al. Ezetimibe added to statin therapy after acute coronary syndromes. N Engl J Med. 2015;372(25):2387–97. https://doi.org/10.1056/NEJMoa1410489.
Bonaca MP, Gutierrez JA, Cannon C, Giugliano R, Blazing M, Park JG, et al. Polyvascular disease, type 2 diabetes, and long-term vascular risk: a secondary analysis of the IMPROVE-IT trial. Lancet Diabetes Endocrinol. 2018;6(12):934–43. https://doi.org/10.1016/s2213-8587(18)30290-0.
Keech A, Simes RJ, Barter P, Best J, Scott R, Taskinen MR, et al. Effects of long-term fenofibrate therapy on cardiovascular events in 9795 people with type 2 diabetes mellitus (the FIELD study): randomised controlled trial. Lancet. 2005;366(9500):1849–61. https://doi.org/10.1016/s0140-6736(05)67667-2.
Rajamani K, Colman PG, Li LP, Best JD, Voysey M, D'Emden MC, et al. Effect of fenofibrate on amputation events in people with type 2 diabetes mellitus (FIELD study): a prespecified analysis of a randomised controlled trial. Lancet. 2009;373(9677):1780–8. https://doi.org/10.1016/s0140-6736(09)60698-x.
Yokoyama M, Origasa H, Matsuzaki M, Matsuzawa Y, Saito Y, Ishikawa Y, et al. Effects of eicosapentaenoic acid on major coronary events in hypercholesterolaemic patients (JELIS): a randomised open-label, blinded endpoint analysis. Lancet. 2007;369(9567):1090–8. https://doi.org/10.1016/s0140-6736(07)60527-3.
Ishikawa Y, Yokoyama M, Saito Y, Matsuzaki M, Origasa H, Oikawa S, et al. Preventive effects of eicosapentaenoic acid on coronary artery disease in patients with peripheral artery disease. Circ J. 2010;74(7):1451–7. https://doi.org/10.1253/circj.cj-09-0520.
Bhatt DL, Steg PG, Miller M, Brinton EA, Jacobson TA, Ketchum SB, et al. Cardiovascular risk reduction with icosapent ethyl for hypertriglyceridemia. N Engl J Med. 2019;380(1):11–22. https://doi.org/10.1056/NEJMoa1812792.
Sabatine MS, Giugliano RP, Keech AC, Honarpour N, Wiviott SD, Murphy SA, et al. Evolocumab and clinical outcomes in patients with cardiovascular disease. N Engl J Med. 2017;376(18):1713–22. https://doi.org/10.1056/NEJMoa1615664.
• Bonaca MP, Nault P, Giugliano RP, Keech AC, Pineda AL, Kanevsky E, et al. Low-density lipoprotein cholesterol lowering with evolocumab and outcomes in patients with peripheral artery disease: insights from the FOURIER Trial (Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Subjects With Elevated Risk). Circulation. 2018;137(4):338–50. https://doi.org/10.1161/circulationaha.117.032235 This trial showed that lowering LDL below current targets with PCSK9 inhibitors reduces MACE and MALE in the PAD population.
Schwartz GG, Steg PG, Szarek M, Bhatt DL, Bittner VA, Diaz R, et al. Alirocumab and cardiovascular outcomes after acute coronary syndrome. N Engl J Med. 2018;379(22):2097–107. https://doi.org/10.1056/NEJMoa1801174.
Jukema JW, Szarek M, Zijlstra LE, de Silva HA, Bhatt DL, Bittner VA, et al. Alirocumab in patients with polyvascular disease and recent acute coronary syndrome: ODYSSEY OUTCOMES trial. J Am Coll Cardiol. 2019. https://doi.org/10.1016/j.jacc.2019.03.013.
Mondillo S, Ballo P, Barbati R, Guerrini F, Ammaturo T, Agricola E, et al. Effects of simvastatin on walking performance and symptoms of intermittent claudication in hypercholesterolemic patients with peripheral vascular disease. Am J Med. 2003;114(5):359–64. https://doi.org/10.1016/s0002-9343(03)00010-x.
Aronow WS, Nayak D, Woodworth S, Ahn C. Effect of simvastatin versus placebo on treadmill exercise time until the onset of intermittent claudication in older patients with peripheral arterial disease at six months and at one year after treatment. Am J Cardiol. 2003;92(6):711–2. https://doi.org/10.1016/s0002-9149(03)00833-6.
Arya S, Khakharia A, Binney ZO, DeMartino RR, Brewster LP, Goodney PP, et al. Association of statin dose with amputation and survival in patients with peripheral artery disease. Circulation. 2018;137(14):1435–46. https://doi.org/10.1161/circulationaha.117.032361.
Katsiki N, Nikolic D, Montalto G, Banach M, Mikhailidis DP, Rizzo M. The role of fibrate treatment in dyslipidemia: an overview. Curr Pharm Des. 2013;19(17):3124–31. https://doi.org/10.2174/1381612811319170020.
Lobb R, Colditz GA. Implementation science and its application to population health. Annu Rev Public Health. 2013;34:235–51. https://doi.org/10.1146/annurev-publhealth-031912-114444.
Jeevanantham V, Sharma S, Thapa R, Myers T, Vacek J, Dawn B et al. Disparities in lipid management in patients with peripheral artery disease versus coronary artery disease: comparison between Atp III And 2013 AHA/ACC Guidelines. J Am Coll Cardiol. 2015;65(10S). doi:https://doi.org/10.1016/s0735-1097(15)61433-4.
Dopheide JF, Papac L, Schindewolf M, Baumgartner I, Drexel H. Poor attainment of lipid targets in patients with symptomatic peripheral artery disease. J Clin Lipidol. 2018;12(3):711–7. https://doi.org/10.1016/j.jacl.2018.02.013.
Bartline PB, Brooke BS. Using implementation science to help integrate preoperative evidence- based measures into practice for vascular surgery patients. Semin Vasc Surg. 2015;28(2):68–79. https://doi.org/10.1053/j.semvascsurg.2015.10.005.
Rodriguez F, Cannon CP, Steg PG, Kumbhani DJ, Goto S, Smith SC, et al. Predictors of long-term adherence to evidence-based cardiovascular disease medications in outpatients with stable atherothrombotic disease: findings from the REACH registry. Clin Cardiol. 2013;36(12):721–7. https://doi.org/10.1002/clc.22217.
Jones WS, Mi X, Qualls LG, Turley RS, Vemulapalli S, Peterson ED, et al. Significant variation in P2Y12 inhibitor use after peripheral vascular intervention in Medicare beneficiaries. Am Heart J. 2016;179:10–8. https://doi.org/10.1016/j.ahj.2016.06.002.
Sobieszczyk P, Eisenhauer A. Management of patients after endovascular interventions for peripheral artery disease. Circulation. 2013;128(7):749–57. https://doi.org/10.1161/circulationaha.113.001560.
Conflict of Interest
Nicholas Govsyeyev has nothing to disclose.
Mark R. Nehler reports receiving salary support from CPC Clinical Research.
William R. Hiatt reports receiving clinical trial research grants to CPC Clinical Research from: NIH, Bayer, Janssen, and Amgen.
Marc P. Bonaca reports receiving research grants and personal fees from Amgen, AstraZeneca, Bayer, Merck, NovoNordisk, Pfizer, and Sanofi. He also reports receiving additional grants from Regeneron and personal fees from Janssen.
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Govsyeyev, N., Nehler, M.R., Hiatt, W.R. et al. Tackling Elevated Risk in PAD: Focus on Antithrombotic and Lipid Therapy for PAD. Curr Cardiol Rep 22, 13 (2020). https://doi.org/10.1007/s11886-020-1264-z
- Peripheral artery disease
- Antithrombotic therapy
- Antiplatelet therapy
- Anticoagulation therapy
- Lipid therapy