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Previous Volume 357:217-227 July 19, 2007 Number 3 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Supplementary Material Editorial by Mohler, E. R. Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background Atherosclerotic peripheral arterial disease is associated with an increased risk of myocardial infarction, stroke, and death from cardiovascular causes. Antiplatelet drugs reduce this risk, but the role of oral anticoagulant agents in the prevention of cardiovascular complications in patients with peripheral arterial disease is unclear.

Methods We assigned patients with peripheral arterial disease to combination therapy with an antiplatelet agent and an oral anticoagulant agent (target international normalized ratio [INR], 2.0 to 3.0) or to antiplatelet therapy alone. The first coprimary outcome was myocardial infarction, stroke, or death from cardiovascular causes; the second coprimary outcome was myocardial infarction, stroke, severe ischemia of the peripheral or coronary arteries leading to urgent intervention, or death from cardiovascular causes.

Results A total of 2161 patients were randomly assigned to therapy. The mean follow-up time was 35 months. Myocardial infarction, stroke, or death from cardiovascular causes occurred in 132 of 1080 patients receiving combination therapy (12.2%) and in 144 of 1081 patients receiving antiplatelet therapy alone (13.3%) (relative risk, 0.92; 95% confidence interval [CI], 0.73 to 1.16; P=0.48). Myocardial infarction, stroke, severe ischemia, or death from cardiovascular causes occurred in 172 patients receiving combination therapy (15.9%) as compared with 188 patients receiving antiplatelet therapy alone (17.4%) (relative risk, 0.91; 95% CI, 0.74 to 1.12; P=0.37). Life-threatening bleeding occurred in 43 patients receiving combination therapy (4.0%) as compared with 13 patients receiving antiplatelet therapy alone (1.2%) (relative risk, 3.41; 95% CI, 1.84 to 6.35; P<0.001).

Conclusions In patients with peripheral arterial disease, the combination of an oral anticoagulant and antiplatelet therapy was not more effective than antiplatelet therapy alone in preventing major cardiovascular complications and was associated with an increase in life-threatening bleeding. (ClinicalTrials.gov number, NCT00125671 [ClinicalTrials.gov] .)

Source Information

The members of the writing group (Sonia Anand, M.D., Ph.D., F.R.C.P., Salim Yusuf, D.Phil., Changchun Xie, Ph.D., Janice Pogue, M.Sc., and John Eikelboom, M.B., B.S., McMaster University, Hamilton, ON, Canada; Andrzej Budaj, M.D., Ph.D., Grochowski Hospital, Warsaw, Poland; Bruce Sussex, M.D., M.B., B.S., Memorial University of Newfoundland, St. John's, Canada; Lisheng Liu, M.D., National Center of Cardiovascular Disease, Beijing; Randy Guzman, M.D., F.R.C.S., University of Manitoba, Winnipeg, Canada; Claudio Cina, M.D., Sp.Chir.It., F.R.C.S., Hamilton Health Sciences and St. Joseph's Hospital, Hamilton, ON, Canada; Richard Crowell, M.D., F.R.C.P., Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada; Matyas Keltai, M.D., Ph.D., Hungarian Institute of Cardiology, Semmelweis University, Budapest, Hungary; and Gilbert Gosselin, M.D., Montreal Heart Institute, Montreal) assume responsibility for the overall content and integrity of the article.

Address reprint requests to Dr. Anand at Hamilton General Hospital, Hamilton Health Sciences, 237 Barton St. East, Hamilton, ON L8L 2X2, Canada, or at anands{at}mcmaster.ca.

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