Comparative Outcomes of Peripheral Vascular Intervention in Patients Discharged on Clopidogrel in Combination With Factor Xa Inhibitors or Aspirin

Document Type

Conference Proceeding

Publication Date

6-1-2024

Publication Title

J Vasc Surg

Abstract

Objectives: Dual antiplatelet therapy with clopidogrel and aspirin (DAPT) is commonly prescribed following peripheral vascular interventions (PVI) for peripheral arterial disease (PAD). Although clopidogrel is frequently used after PVI for various indications, its use in combination with Factor Xa inhibitors (FXaI) has not been assessed. While societal guidelines provide mixed support for combination antithrombotic regimens in patients with PAD, the utility of FXaI and clopidogrel (FXaI+C) in comparison to DAPT following PVI remains unexplored. This study aims to investigate outcomes of PVI for PAD in patients discharged on FXaI+C compared with those receiving traditional DAPT. Methods: The Vascular Quality Initiative-PVI (VQI-PVI) database was used. For patients with multiple PVI in the database, only the index procedure was analyzed. Patients with a history of atrial fibrillation or absent follow-up data were excluded. All remaining patients discharged on DAPT or FXaI+C without aspirin were included. Nearest neighbor logistic regression propensity score matching was used to generate patient populations with similar comorbidities and procedural characteristics. Patient demographics, procedural details, and outcomes following PVI were compared. Cox proportional hazard regression and Kaplan-Meier curves were used to assess patient survival outcomes. Results: A total of 225,514 PVI were reviewed, and 161,550 patients undergoing primary PVI were included. Following index PVI, 50.9% (n = 82,255) of patients received DAPT and 3.3% (n = 5291) received FXaI+C at discharge. Excluding individuals with a history of atrial fibrillation, 52,584 patients were discharged on either DAPT (30.7%; n = 49,571) or FXaI+C (1.9%; n = 3013). After four-to-one matching, 8356 patients receiving DAPT were compared with 2089 patients taking FXaI+C. Patient demographics, procedural indication, and urgency were comparable between the matched groups (Table). After mean follow-up of 400 days, patients discharged on FXaI+C had significantly higher rates of reintervention (20.4% vs 15.9%; P <.001) and 1-year mortality (13.3% vs 11.3%; P <.001) compared with patients discharged on DAPT (Table). Kaplan-Meier analysis demonstrated that patients discharged on DAPT had improved survival compared with those discharged on FXaI+C (Fig). Cox proportional hazard regression analysis showed that discharge on FXaI+C was independently associated with increased mortality compared with DAPT (HR, 1.22; 95% CI, 1.01-1.47), but was not significantly associated with combined amputation or death (HR, 1.11; 95% CI, 0.85-1.45) after PVI. Conclusions: Discharge regimens of FXaI in combination with clopidogrel after PVI seem to be associated with worse outcomes compared to traditional DAPT. Further research is needed to determine the optimal combination of antithrombotic medications for patients with PAD undergoing PVI. [Formula presented] [Formula presented]

Volume

79

Issue

6

First Page

e290-e292

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