Experts Call for Enhanced Blood Clot Prevention Strategies After Leg Artery Procedures in High-Risk Patients

A recent statement by leading cardiovascular specialists across Europe emphasizes the urgent need for improved blood clot prevention methods in patients suffering from chronic limb-threatening ischemia (CLTI) following revascularization procedures. CLTI, a severe stage of peripheral artery disease (PAD), often results in critical leg pain, non-healing wounds, and a heightened risk of limb loss or cardiovascular events.

The European Society of Cardiology (ESC) Working Groups on Aorta and Peripheral Vascular Diseases and on Cardiovascular Pharmacotherapy collaborated on this comprehensive guidance, which is founded on a systematic review of 34 scientific studies. Despite the scarcity of large-scale randomized controlled trials (RCTs) directly addressing post-procedure anticoagulation in CLTI patients, emerging evidence suggests promising benefits of certain therapies.

Current treatments like angioplasty, stenting, and bypass surgery aim to restore blood flow but do not eliminate the risk of major adverse limb events (MALE) or major adverse cardiovascular events (MACE), which include limb loss, heart attacks, strokes, or death. The review highlights that only one high-quality RCT demonstrated significant improvements using dual pathway inhibition (DPI)—a combination of aspirin and rivaroxaban, a low-dose blood thinner—showing reduced risks of limb complications and cardiovascular incidents.

Findings also indicate that dual antiplatelet therapy (DAPT), involving aspirin and clopidogrel, may provide benefits in preventing limb-related issues based on observational studies and smaller RCTs, which showed lower rates of limb failure, amputations, and better survival outcomes.

Professor Christian Heiss, a leading researcher and author of the ESC statement, stressed a significant gap in research specifically targeting CLTI patients. He emphasized the necessity for dedicated studies comparing therapies like DPI and DAPT to determine the most effective approach.

This publication underscores the critical need to develop tailored therapeutic strategies that account for the unique risks facing CLTI patients, including their propensity for bleeding complications. Improved, evidence-based prevention protocols could significantly reduce the occurrence of limb loss and cardiovascular events in this vulnerable population.