Direct oral anticoagulants and peripheral arterial disease

Abstract

Peripheral arterial disease (PAD) is a disease of the arteries of the lower extremities and represents a global health problem with an increasing prevalence rate. Evidence for the use of standard anticoagulant therapy in patients with PAB is limited. Direct oral anticoagulants are selective inhibitors of activated coagulation factor X and thrombin, thereby blocking the common pathway of the coagulation cascade and preventing fibrin formation. In addition to their procoagulant role, these drugs potentially participate in the regulation of the process of inflammation and tissue fibrosis, which may inhibit the progression of atherosclerotic plaque. The first large study examining the effects of DOAC in patients with atherosclerosis was COMPASS (Cardiovascular Outcomes for People Using Anticoagulation Strategies). This study showed the first encouraging results, although the design was not adapted exclusively to patients with PAD. The VOYAGER PAD (Vascular Outcomes of ASA Along with Rivaroxaban in Endovascular or Surgical Limb Revascularization for PAD) study laid the groundwork for the use of low doses of direct oral anticoagulants in patients with PAB after revascularization. The applicability of the results of the COMPASS and VOYAGER PAD studies in everyday practice is still questionable. There is clear evidence that the use of direct oral anticoagulants in patients with the peripheral arterial disease may play an important role in the secondary prevention of adverse cardiovascular events, with an acceptable risk of hemorrhagic complications. Additional studies are needed to clarify which groups of patients these drugs have the greatest effect on, in everyday practice.