158 - PADing Your Understanding of Peripheral Arterial Disease: A Brief Treatment Overview
HelixTalk - Rosalind Franklin University's College of Pharmacy Podcast
Sean P. Kane, PharmD, BCPS
5 • 644 Ratings
🗓️ 21 December 2022
⏱️ 49 minutes
🧾️ Download transcript
Summary
In this episode, we will discuss all things peripheral arterial disease – definitions, staging, clinical presentation, risk factors, goals of therapy, and guideline-directed medication therapy recommendations including the newest evidence for the use of DOACs.
Key Concepts
- Addressing modifiable risk factors (weight loss, smoking cessation, blood pressure and blood glucose control, dyslipidemia, structured exercise program, etc.) are recommended for the treatment of PAD.
- Single antiplatelet therapy with either aspirin 81 mg or clopidogrel 75 mg daily are recommended in patients to reduce stroke, MI and other vascular deaths in symptomatic (1A) and asymptomatic patients (IIa- C-EO).
- Rivaroxaban 2.5 mg BID, when added to aspirin 81 mg daily, is superior to aspirin alone in preventing composite outcome of stroke, MI, and CV death in PAD patients with recent revascularization surgery for PAD but increases the risk of major bleeding.
- In the absence of heart failure, cilostazol is effective in improving symptoms, quality of life, and increasing walking distance in patients with intermittent claudication.
References
- Gerhard-Herman MD, Gornik HL, Barrett C, et al. 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2017;135:e686–e725. https://doi.org/10.1161/CIR.0000000000000470
- Criqui MH, Matsushita K, Aboyans V, et al. Lower Extremity Peripheral Artery Disease: Contemporary Epidemiology, Management Gaps, and Future Directions: A Scientific Statement From the American Heart Association. Circulation. 2021;144:e171–e191. https://doi.org/10.1161/CIR.0000000000001005
- Alonso-Coello P, Bellmunt S, McGorrian C, Anand SS, Guzman R, Criqui MH, Akl EA, Vandvik PO, Lansberg MG, Guyatt GH, Spencer FA. Antithrombotic therapy in peripheral artery disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 Feb;141(2 Suppl):e669S-e690S. doi: 10.1378/chest.11-2307. PMID: 22315275; PMCID: PMC3278062.
- Eikelboom JW, Connolly SJ, Bosch J, et al. Rivaroxaban with or without aspirin in stable cardiovascular disease. N Engl J Med. 2017; 377:1319-1330. https://www.nejm.org/doi/full/10.1056/nejmoa1709118
- Bonaca MP, Bauersachs RM, Anand SS, et al. Rivaroxaban in peripheral arterial disease after revascularization. N Engl J Med. 2020; 382:1994-2004. https://www.nejm.org/doi/full/10.1056/nejmoa2000052
Transcript
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| 0:00.0 | Welcome to Helix Talk, an educational podcast for healthcare students and providers covering real-life clinical pearls, professional pharmacy topics, and drug therapy discussions. |
| 0:11.0 | This podcast is provided by pharmacists and faculty members at Rosal Franklin University College of Pharmacy. |
| 0:17.0 | This podcast contains general information for educational purposes only. This is not professional |
| 0:22.4 | advice and should not be used in lieu of obtaining advice from a qualified health care provider. |
| 0:27.2 | And now on to the show. Welcome to Helix Talk episode 158. I'm your co-host, Dr. Kane. |
| 0:35.7 | And I'm Dr. Patel. And the title of today's episode is |
| 0:39.5 | Padding, P-A-D, Padding, your understanding of peripheral arterial disease, a brief treatment overview. |
| 0:47.4 | Dr. Kane, I'm really excited to talk about all things peripheral arterial disease, you know, |
| 0:52.3 | starting from definition, sort of like the staging |
| 0:54.9 | we have, how we categorize severity of this condition, how patients present, what are the risk |
| 1:00.5 | factors, what are some of the goals of therapy, and then guideline directed medication |
| 1:05.4 | therapy recommendation that are outlined by a couple different guidelines that we have referenced |
| 1:10.1 | in our show notes. |
| 1:11.7 | Yeah, and just to add to that, this was actually a listener-suggested topic. |
| 1:15.8 | So we had a listener that wanted to know more about PAD and get our take on it, and we're doing the episode. |
| 1:21.7 | So if you, the listener, have any episode topics that you'd like to hear, reach out to us. |
| 1:26.7 | You can get our contact |
| 1:27.5 | information at helixtalk.com. We're also on Twitter at Helix Talk. We love the suggestions, |
| 1:33.2 | and we do try to favor those topics when possible. All right, Dr. Kane, so laying out the |
| 1:39.0 | land a little bit, let's get started with the case. So we have a 67-year-old white male past medical history |
| 1:46.5 | is significant for hypertension, dysopidemia, and obesity. The current BMI is 41.8. Also has |
| 1:55.1 | two pack per day smoking or tobacco use history over the course of last 10 years. And patient also has obstructive sleep apnea and uses CPAP. |
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