Oral anticoagulant therapy in patients with peripheral artery disease

Patients with peripheral artery disease suffer from a high incidence of ischemic vascular complications in coronary, cerebral, and peripheral vascular beds. Reduction of atherothrombotic complications with aspirin or clopidogrel has proven to be successful. The role of oral anticoagulants in patients with symptomatic peripheral artery is limited. Randomized controlled trials comparing the effects of aspirin with oral anticoagulants are scarce. Oral anticoagulants (International Normalized Ratio = 2.5 to 4.5) are more effective than aspirin in preventing infrainguinal bypass occlusion only when venous graft material is used and the bypass is considered to be at high risk for occlusion. Whether the use of oral anticoagulants reduces all-cause morbidity and mortality is not unequivocally clear. The risk of ischemic events is reduced at the expense of an increased number of bleeding complications, which is one of the main reasons that therapy has not been widely adopted.