What is the recommended duration of anticoagulation and antiplatelet therapy after peripheral arterial angioplasty?

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Duración de Anticoagulación y Antiagregación después de Angioplastia Arterial Periférica

Después de una angioplastia arterial periférica, se recomienda terapia antiagregante dual (DAPT) durante 1 a 3 meses, seguida de monoterapia antiagregante a largo plazo. 1

Régimen Antitrombótico Recomendado

Fase Aguda Post-Angioplastia

  • Anticoagulación durante el procedimiento:
    • Se recomienda anticoagulación durante la intervención (heparina no fraccionada, enoxaparina o bivalirudin) 1
    • La anticoagulación se suspende después del procedimiento a menos que exista otra indicación

Terapia Antiagregante Post-Procedimiento

  1. Terapia antiagregante dual (DAPT):

    • Duración estándar: 1-3 meses después de angioplastia/stent periférico 1, 2
    • Composición: Aspirina 75-100 mg/día + clopidogrel 75 mg/día 2

  2. Después de completar DAPT:

    • Monoterapia antiagregante indefinida (generalmente aspirina 75-100 mg/día o clopidogrel 75 mg/día) 2
    • El clopidogrel podría ser preferible sobre la aspirina como monoterapia a largo plazo 2, 3

Consideraciones Específicas

Según Localización de la Intervención

  • Stent femoral superficial:

    • DAPT durante 1-3 meses en pacientes de bajo riesgo 4
    • Considerar DAPT prolongada (>3 meses) en casos complejos o alto riesgo 4

  • Stent ilíaco o carotídeo:

    • DAPT durante aproximadamente 1 mes 4

Factores que Pueden Modificar la Duración

  • Factores para considerar DAPT prolongada:
    • Enfermedad difusa
    • Calidad deficiente del flujo de entrada/salida
    • Isquemia crítica de miembros
    • Extensión del stenting
    • Uso de stents recubiertos
    • Alto riesgo de fractura del stent 4

Pacientes con Indicación para Anticoagulación Oral

  • Después de intervención endovascular/stenting:
    • Continuar o cambiar a monoterapia antiagregante (preferiblemente clopidogrel) + anticoagulante oral (preferiblemente DOAC)
    • Si ha finalizado la duración estándar de DAPT (1-3 meses), se puede suspender toda terapia antiagregante y tratar solo con anticoagulante oral 1

Seguridad del Tratamiento

  • El clopidogrel no se asocia con complicaciones hemorrágicas mayores durante la cirugía arterial periférica 5
  • La terapia antiagregante dual no parece superior a la monoterapia antiagregante en la prevención de infarto de miocardio, accidente cerebrovascular y muerte en la población general con enfermedad arterial periférica 4

Puntos Clave

  • La duración de la DAPT es menos estandarizada para intervenciones periféricas que para intervenciones coronarias
  • La tendencia actual favorece duraciones más cortas de DAPT (1-3 meses) para la mayoría de los pacientes
  • La monoterapia antiagregante debe mantenerse indefinidamente después de completar la DAPT
  • El balance entre el riesgo trombótico y hemorrágico debe considerarse al determinar la duración exacta de la terapia

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

2
Research

Antithrombotic treatment in peripheral artery disease.

VASA. Zeitschrift fur Gefasskrankheiten, 2018

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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