What are the medications for Peripheral Artery Disease (PAD)?

From the Guidelines

Medications for peripheral arterial disease (PAD) should prioritize antiplatelet therapy with aspirin (75-325 mg daily) or clopidogrel (75 mg daily) to reduce cardiovascular risk and improve symptoms, as recommended by the most recent guidelines 1.

Key Medications for PAD

• Antiplatelet therapy: aspirin (75-325 mg daily) or clopidogrel (75 mg daily) to prevent heart attack and stroke, as supported by the 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS guideline 1
• Statins: high-intensity options like atorvastatin (40-80 mg daily) or rosuvastatin (20-40 mg daily) to reduce cardiovascular events and improve limb outcomes, as recommended by the 2016 AHA/ACC guideline 1
• Blood pressure control: ACE inhibitors like ramipril (2.5-10 mg daily) or ARBs like losartan (25-100 mg daily) to target blood pressure below 140/90 mmHg, as suggested by the 2016 AHA/ACC guideline 1
• Symptom management: cilostazol (100 mg twice daily) can improve walking distance, though it's contraindicated in heart failure patients, as noted in the 2013 ACCF/AHA guideline 1

Additional Considerations

• Rivaroxaban (2.5 mg twice daily) combined with aspirin may be considered in high-risk patients for additional protection against major adverse limb events, though this increases bleeding risk, as discussed in the 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS guideline 1
• Good glycemic control is important for diabetic PAD patients, with metformin typically as first-line therapy
• Dual antiplatelet therapy has uncertain benefits and risks in patients with PAD, and its use should be individualized, as noted in the 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS guideline 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.

Medications for PAD:

• Clopidogrel is indicated to reduce the rate of myocardial infarction and stroke in patients with established peripheral arterial disease 2 2.
• Pentoxifylline is used for the treatment of peripheral arterial disease, but the provided drug label does not explicitly state its effectiveness in reducing the rate of MI and stroke in these patients 3.

Key points to consider:

• The use of clopidogrel in patients with established peripheral arterial disease to reduce the rate of MI and stroke.
• The potential use of pentoxifylline in patients with peripheral arterial disease, although its effectiveness in reducing MI and stroke is not explicitly stated in the provided label.

From the Research

Medications for Peripheral Artery Disease (PAD)

Medications for PAD can be categorized into several types, including:

• Antiplatelet therapy
• Anticoagulation therapy
• Lipid-lowering therapy

Antiplatelet Therapy

Antiplatelet therapy is a key component of PAD management, with the following options:

• Single antiplatelet therapy (SAPT) with aspirin or clopidogrel is indicated for symptomatic PAD patients 4, 5, 6, 7, 8
• Clopidogrel may be preferred over aspirin due to its efficacy in reducing major adverse cardiovascular events 4, 8
• Dual antiplatelet therapy (DAPT) with clopidogrel and aspirin may not provide benefit over SAPT with aspirin alone and is associated with increased risk of major bleeding 4, 7, 8
• DAPT with ticagrelor 60 mg b.i.d. and aspirin may be considered in PAD patients with prior myocardial infarction 4

Anticoagulation Therapy

Anticoagulation therapy may be used in certain situations, including:

• Vorapaxar, a new thrombin receptor antagonist, may be used on top of SAPT or DAPT with aspirin and/or clopidogrel to reduce the risk of acute limb ischemia and peripheral artery revascularization 4, 6
• Rivaroxaban (2.5 mg b.i.d.) plus aspirin (100 mg daily) has been shown to be effective in reducing total mortality and cardiovascular mortality in PAD patients 4, 5, 6
• Anticoagulation with vitamin K antagonists may be considered after autologous vein infrainguinal bypass 4

Lipid-Lowering Therapy

Lipid-lowering therapy is also important in PAD management, with the following recommendations:

• Low-density lipoprotein cholesterol (LDL-C) goal of more than 50% reduction from baseline and <1.4 mmol/L (<55 mg/dL) is recommended for PAD patients 5
• Statin-based treatment has been shown to improve walking performance and reduce the risk of major adverse limb events (MALE) 5
• Addition of ezetimibe or a PCSK9 inhibitor may further decrease the risk of cardiovascular events and MALE 5