What is the treatment for Peripheral Artery Disease (PAD)?

From the Guidelines

The most effective treatment for Peripheral Artery Disease (PAD) is a combination of lifestyle modifications and medical therapies, including antiplatelet and antithrombotic therapy, lipid-lowering therapy, antihypertensive therapy, management of diabetes, and smoking cessation, with Rivaroxaban (2.5 mg twice daily) combined with low-dose aspirin (81 mg daily) being a recommended option for preventing major adverse cardiovascular events and major adverse limb events. According to the 2024 lower extremity peripheral artery disease guideline-at-a-glance 1, the detection of PAD is typically accomplished through history, physical examination, and the resting ankle-brachial index. The guideline defines four clinical subsets of PAD: asymptomatic PAD, chronic symptomatic PAD, chronic limb-threatening ischemia, and acute limb ischemia. Some key aspects of treatment include:

• Antiplatelet therapy, such as single antiplatelet therapy, to prevent blood clots
• Lipid-lowering therapy, such as high-intensity statin, to reduce cholesterol levels
• Antihypertensive therapy to control blood pressure
• Management of diabetes to prevent complications
• Smoking cessation to reduce the risk of disease progression The use of Rivaroxaban combined with low-dose aspirin has been shown to be effective in preventing major adverse cardiovascular events and major adverse limb events in patients with PAD, as stated in the guideline 1. Regular follow-up with healthcare providers is crucial to monitor disease progression and adjust treatment as needed. Additionally, addressing health disparities in PAD is essential to improve limb and cardiovascular outcomes, and this can be achieved through coordinated interventions between multiple stakeholders across the cardiovascular community and public health infrastructure 1.

From the FDA Drug Label

1. 2 Recent MI, Recent Stroke, or Established Peripheral Arterial Disease

In patients with established peripheral arterial disease or with a history of recent myocardial infarction (MI) or recent stroke clopidogrel tablets are indicated to reduce the rate of MI and stroke.

The treatment for Peripheral Arterial Disease (PAD) includes clopidogrel to reduce the rate of myocardial infarction and stroke 2.

• Clopidogrel is indicated for patients with established PAD.
• It should be administered in conjunction with aspirin. Another option is pentoxifylline, which has been used safely for treatment of peripheral arterial disease 3.
• Pentoxifylline is used to treat PAD, but patients should be monitored for bleeding and other adverse effects.

From the Research

Treatment Approaches for PAD

The treatment for Peripheral Artery Disease (PAD) involves a combination of lifestyle modifications and pharmacological interventions. The primary goal is to manage symptoms, reduce cardiovascular risk, and improve quality of life.

• Lifestyle modifications:
  • Smoking cessation 4, 5, 6, 7
  • Healthy diet 4, 5, 6, 7
  • Weight loss 4, 5, 6, 7
  • Regular physical exercise 4, 5, 6, 7
• Pharmacological interventions:
  • Lipid-lowering drugs 4, 5, 6
  • Antihypertensive drugs 4, 5
  • Antidiabetic agents 4, 5
  • Antithrombotics 4, 5, 8
  • Statins to reduce cardiovascular risk and improve symptoms associated with PAD 6

Medical Therapy

Medical therapy for PAD includes the use of antiplatelet therapy, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and statins 5. The choice of antithrombotic therapy depends on the individual patient's risk factors and medical history 8.

• Antiplatelet therapy:
  • Aspirin or clopidogrel for symptomatic PAD 8
  • Ticagrelor may be preferred over aspirin 8
• Dual antiplatelet therapy (DAPT) with clopidogrel and aspirin may not provide benefit over single antiplatelet therapy (SAPT) with aspirin alone 8
• Rivaroxaban (2.5 mg b.i.d.) plus aspirin (100 mg daily) has shown significant benefit for PAD patients in terms of total mortality and cardiovascular mortality 8

Revascularization and Surgical Interventions

Surgical revascularization should be considered for patients with lifestyle-limiting claudication who have an inadequate response to lifestyle modifications and medical therapy 5. Patients with acute or limb-threatening limb ischemia should be referred immediately to a vascular surgeon 5.

• Endovascular interventions can restore circulation based on appropriate diagnostic testing to pinpoint vascular targets 7
• Limb-sparing endovascular interventions can improve symptoms and quality of life 7
• A multidisciplinary team approach is recommended for the diagnosis and management of PAD, including collaboration between primary care physicians, specialists, and other healthcare professionals 7