New Possibilities of Antithrombotic Therapy of Patients with Peripheral and Widespread Atherosclerotic Lesion

Atherosclerotic peripheral artery disease (PAD) is well-known thrombotic risk factor in different cohorts of patients. This current review analyzes epidemiological data of trials and registries about influence both clinical and asymptomatic peripheral atherosclerotic disease on adverse ischemic events. Individual assessment of the atherothrombotic prevalence, which is directly related to vascular thrombotic risk, remains an important problem. Issue of PAD routine screening using traditional methods of ultrasound duplex scanning, measurement of ankle-brachial index is discussed in details. Comparative efficiency of present antiplatelet and anticoagulant drugs is shown in the key of preventing PAD thrombotic complications. PAD detection can be the reason for "intensification" of antithrombotic treatment, the only one option of which until recently was an additional treatment with P2Y12 platelet receptors blockers. However, the routine treatment with dual antiplatelet therapy in stable manifestations of atherothrombosis is not supported by the current guidelines. In this regard, it seems relevant to intensify therapy by simultaneously affecting on the platelet and plasma components of hemostasis in patients with PAD, that was demonstrated in a recently published study COMPASS. Treatment with rivaroxaban small doses in addition to acetylsalicylic acid allowed to improve significantly outcomes in a wide range of patients with stable manifestations of atherothrombosis without high risk of bleeding and severe renal impairment. However, use of this multicomponent therapy has not been approved by relevant clinical recommendations yet, which causes certain difficulties in choosing optimal scheme of antithrombotic treatment among patients with PAD.

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