Antithrombotic Drugs in the Primary Medical Management of Intermittent Claudication: A Meta-analysis

Bruno Girolami; Enrico Bernardi; Martin H. Prins; Jan Wouter ten Cate; Paolo Prandoni; Rohan Hettiarachchi; Elena Marras; Piero Maria Stefani; Antonio Girolami; Harry R. Büller

doi:10.1055/s-0037-1614560

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 1999; 81(05): 715-722
DOI: 10.1055/s-0037-1614560

Rapid Communication

Schattauer GmbH

Antithrombotic Drugs in the Primary Medical Management of Intermittent Claudication: A Meta-analysis

Bruno Girolami

,

Enrico Bernardi

,

Martin H. Prins

¹From the Institute of Medical Semeiotics, University Hospital of Padua, Italy the Department of Clinical Epidemiology, Atherosclerosis and Inflammation Research, Academic Medical Centre, University of Amsterdam, The Netherlands

,

Jan Wouter ten Cate

²Centre for Haemostasis, Thrombosis, Atherosclerosis and Inflammation Research, Academic Medical Centre, University of Amsterdam, The Netherlands

,

Paolo Prandoni

,

Rohan Hettiarachchi

¹From the Institute of Medical Semeiotics, University Hospital of Padua, Italy the Department of Clinical Epidemiology, Atherosclerosis and Inflammation Research, Academic Medical Centre, University of Amsterdam, The Netherlands

,

Elena Marras

,

Piero Maria Stefani

,

Antonio Girolami

,

Harry R. Büller

²Centre for Haemostasis, Thrombosis, Atherosclerosis and Inflammation Research, Academic Medical Centre, University of Amsterdam, The Netherlands

› Author Affiliations

Abstract

Summary

Background. There is no consensus on the efficacy of the antithrombotic drugs available for patients with intermittent claudication. Methods. A Medline and manual search was used to identify relevant publications. Uncontrolled or retrospective studies, double reports or trials without clinical outcomes were excluded. Included studies were graded as level 1 (randomised and double- or assessor-blind), level 2 (open randomised), or level 3 (non-randomised comparative). Mortality, cerebro- or cardiovascular events, amputations, arterial occlusions or number of revascularization procedures performed in the lower limbs, pain-free and total walking distance, ankle brachial index and calf blood flow, were the main outcomes considered. When feasible, end of treatment results, either continuous or binary, were combined with appropriate statistical methods. Results. Mortality was significantly decreased by ticlopidine compared to placebo (common odds ratio 0.68, 95% C.I., 0.49 - 0.95); clopidogrel decreased vascular events in comparison to aspirin (odds ratio 0.76, 95% C.I., 0.63 - 0.92) in level 1 studies. Arterial occlusions and the number of revascularization procedures performed were statistically significantly decreased by aspirin and ticlopidine, respectively. A small but statistically significant improvement in pain-free walking distance was determined by picotamide, indobufen, low molecular weight heparins, sulodexide and defibrotide, in small studies. Conclusions. Clopidogrel and ticlopidine do reduce clinically important events in patients with intermittent claudication and could be added to the primary medical treatment of these patients. The use of aspirin in these patients cannot be based on direct evidence, but only on analogy with coronary and cerebral atherosclerosis, where it has documented efficacy. Other antithrombotic drugs were not properly evaluated in patients with intermittent claudication.

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References

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