Research Activities, July 2013
More research needed on effective treatments for peripheral artery disease
Comparative Effectiveness Research
Available evidence for treatment of patients with peripheral artery disease (PAD) is limited by the few studies that provide direct comparisons of treatment options, according to a research review from AHRQ. A limited number of studies on antiplatelet therapy for the prevention of cardiovascular events in patients with PAD found that aspirin has no benefit over placebo in asymptomatic PAD patients. Dual antiplatelet therapy is not significantly better than aspirin at reducing cardiovascular events in patients with intermittent claudication (IC, leg muscle or lower extremity discomfort), or critical limb ischemia (CLI, ischemic rest pain for more than 14 days), ulceration, or tissue loss/gangrene.
Exercise therapy, medical therapy such as cilostazol, and endovascular or surgical revascularization interventions all had an effect on improving functional status and quality of life for IC patients. However, the comparative effectiveness of different treatments or combinations of treatments is uncertain. Roughly 20 to 50 percent of patients diagnosed with PAD are asymptomatic, though they usually have functional impairment when tested. More studies of asymptomatic and symptomatic patients with PAD are needed to firmly conclude whether antiplatelet monotherapy or dual antiplatelet therapy is necessary in this high-risk cardiovascular population. Additionally, further research is needed to better understand the comparative effectiveness of different treatment options for IC and CLI for different outcomes and in different populations.
These findings can be found in the research review, Treatment Strategies for Patients With Peripheral Artery Disease at http://go.usa.gov/bdPY.