The current role of anticoagulation in patients with PAD

Dr Sonia Anand is a professor in the Division of Cardiology, associate chair of Equity and Diversity in the Department of Medicine, and director of the Population Genomics Program at McMaster University.

What is the current role of anticoagulation in patients with peripheral artery disease (PAD)?

Sonia Anand, MD, PhD: The year is 2019 and we have a lot of new options. In the past the standard of care was a single antiplatelet agent, like aspirin or clopidogrel, but in a 2017 trial called the COMPASS trial, published in 2018, we showed that a low-dose factor Xa inhibitor called rivaroxaban at one-quarter of the full dose used together with aspirin is superior to aspirin alone at preventing major adverse cardiovascular events (MACE) as well as major adverse limb events (MALE).

Although the guidelines have not been updated to reflect that, we expect that low-dose rivaroxaban and aspirin will become the standard of care to prevent MACE and MALE in patients with PAD.