Antiplatelet therapy and other interventions after revascularisation procedures in patients with peripheral arterial disease: a meta-analysis

Objectives: to evaluate the efficacy of conservative adjuvant therapy after revascularisation procedures in patients with peripheral arterial disease. Design: meta-analysis. Materials: English-language studies published from 1976 to 1997. Methods: reports on conservative therapies in patients with peripheral arte rial disease after percutaneous transluminal angioplasty, endarterectomy, t hromboendarterectomy or bypass grafting were eligible. Uncontrolled or retr ospective studies, double reports or trials without clinical outcomes were excluded. Included studies were graded as level 1 (randomised and double- o r assessor-blind), level 2 (open randomised), or level 3 (non-randomised co mparative). (Loss of) patency, amputation, vascular events and mortality we re the outcomes considered. When feasible, end-of-treatment results, wither continuous or binary, were combined with appropriate statistical methods. Results: thirty-two studies were included. Compared to non-active control, aspirin with dipyridamole improved (loss of) patency (odds ratio (OR) 0.69, 95% confidence interval (CI), 0.53 to 0.90) and mortality (OR 0.80, 95% CI , 0.57 to 1.14); ticlopidine improved (loss of) patency (OR 0.53, 95% CI, 0 .33 to 0.85) and amputation (OR 0.29, 95% CI, 0.08 to 1.01). Data on the ef fectiveness of vitamin-K inhibitors were not conclusive. Conclusions: patients with peripheral arterial disease improve their outcom e by receiving aspirin with dipyridamole or ticlopidine after a revasculari sation procedure.