Abstract
The strategy of treatment and prophylaxis of atherothrombotic accidents is based on three "pillars" - stopping the progression atherogenesis (mostly by managing risk factors, i. e. lifestyle and pharmacotherapy, preventing thrombotic complications (antithrombotic treatment) and managing any applicable circulating disorders causing ischemia (i. e. revascularisation or administering vasoactive drugs). When preventing aterothrombotic complications in lower limbs, the therapy is based on antiplatelet treatment.
Only in cases of very high risk of thrombosis (for example after blockage of a vascular connection) or after a peripheral artery embolism, the therapy consists of inhibition of both primary and secondary haemostasis, i. e. a combination of antiplatelet drugs with anticoagulants. In prophylaxis of thrombotic accidents in patients suffering from lower limb ischemia, or generally in cases of atherosclerotic damage to peripheral parts of the circulatory system, acetylsalicylic acid is used, in doses of 75-100 mg (equivalency grade 2B).
In symptomatic patients or patients after revascularisation, clopidogrel is an alternative to acetylsalicylic acid; both the drugs have their efficacy verified to the highest degree (evidence 1A). In comparison to acetylsalicylic acid, clopidogrel has a more significant effect on decrease of thrombotic complications, with a comparable risk of bleeding-related complications (evidence 1B).
In near future, it is possible to expect introduction of new drugs, especially cilostasol (not yet available in CR) with vasodilatory and antiplatelet effects and confirmation of efficacy of new ADP