What role do antiplatelet agents play in the management of PAD, and which ones are preferred?

Role of antiplatelet agents in peripheral arterial disease (PAD): Antiplatelet therapy is a key component in the management of peripheral arterial disease to reduce the risk of cardiovascular events such as heart attack and stroke. It is part of the secondary prevention strategy alongside managing other cardiovascular risk factors like smoking cessation, lipid modification, hypertension, and diabetes control. Antiplatelet agents help prevent occlusive vascular events by inhibiting platelet aggregation, which is crucial in atherosclerotic disease management ¹,³.

Preferred antiplatelet agents: Clopidogrel is the preferred antiplatelet agent for people with PAD, as it has been shown to be more effective than aspirin in preventing cardiovascular events in this population, based on evidence from the CAPRIE trial and NICE technology appraisals ²,³. Aspirin is recommended as a second-line option if clopidogrel is unsuitable or not tolerated ².

Additionally, for patients with symptomatic PAD at high risk of ischemic events and low bleeding risk, a combination of low-dose rivaroxaban (2.5 mg daily) plus aspirin is recommended, as this combination has demonstrated a significant reduction in cardiovascular death, stroke, or myocardial infarction compared to either agent alone, despite an increased bleeding risk ²,³.