Systematic review of antiplatelet therapy for the prevention of myocardialinfarction, stroke or vascular death in patients with peripheral vascular disease

Antiplatelet agents may prevent vascular events and death in patients with peripheral vascular disease (PVD). A systematic review of 39 randomized controlled trials of antiplatelet ther apy in patients with PVD was performed. For patients with PVD the number suffering a non-fatal myocardial infarctio n, non-fatal stroke or vascular death in the antiplatelet group was 6.5 per cent compared with 8.1 per cent in the placebo group (odds ratio 0.78 (95 per cent confidence interval (c.i.) 0.63-0.96); P = 0.02), favouring antipl atelet treatment. For infrainguinal bypass surgery (ten trials) and balloon angioplasty (two) the differences were still in favour of antiplatelet the rapy, but they did not reach statistical significance. In five trials of as pirin against another antiplatelet agent, 8.4 per cent in the aspirin group suffered a vascular event compared with 6.6 per cent in the second antipla telet group (odds ratio 0.76 (95 per cent c.i. 0.64-0.91); P < 0.01), favou ring ticlopidine/clopidogrel/aspirin + dipyridamole against aspirin alone. Antiplatelet therapy reduces serious vascular events and vascular death in patients with PVD. For infrainguinal arterial surgery or balloon angioplast y the benefit remains unproven, but the number of trials to date is small. There is also evidence to support the use of antiplatelet drugs other than aspirin for the prevention of vascular events in those with PVD.