外周动脉疾病抗栓治疗进展

Advances in Antithrombotic Therapy for Peripheral Artery Diseases

摘要: 随着全世界老龄化的进展，外周动脉疾病(peripheral arterial diseases, PAD)的患病率逐渐上升，PAD与糖尿病、高血脂、高血压、吸烟等危险因素密切相关；PAD患者通常有广泛的动脉粥样硬化，PAD进展与其他心血管事件和心血管死亡风险增加相关。因此，外周动脉疾病患者应同时接受非药物和药物二级预防，以降低心血管事件以及其他并发症的风险。目前PAD的治疗方式主要包括生活方式干预、药物治疗与手术治疗，而药物治疗主要包括他汀类药物、血管紧张素转化酶抑制剂以及抗栓治疗等，其中抗栓治疗受到越来越多的关注，本篇综述的重点是介绍PAD的抗血小板和抗凝治疗。无症状PAD不需要抗凝或抗血小板治疗，而对于有缺血性下肢症状(如动脉粥样硬化引起的间歇性跛行或严重肢体缺血)的患者，应使用小剂量阿司匹林或氯吡格雷抗血小板治疗。对于复发性缺血事件风险高、有症状的PAD患者，以及因PAD接受过血管内或开放手术干预的患者，应考虑阿司匹林联合小剂量口服直接抗凝剂(direct oral anticoagulants, NOACs)利伐沙班治疗，并权衡出血风险。

Abstract: With the progress of aging in the world, the prevalence of peripheral artery diseases has gradually increased. PAD is closely related to diabetes, hyperlipidemia, hypertension, smoking and other risk factors. Patients with PAD usually have extensive atherosclerosis. Progression of PAD is associated with an increased risk of other cardiovascular events and cardiovascular death. Therefore, patients with PAD should receive both nonpharmacologic and pharmacologic secondary prevention to re-duce the risk of cardiovascular and other complications. At present, the treatment of PAD mainly includes lifestyle intervention, drug therapy and surgical treatment, and drug therapy mainly in-cludes statins, angiotensin-converting enzyme inhibitors and antithrombotic therapy, among which antithrombotic therapy has received more and more attention. The focus of this review is on an-tiplatelet and anticoagulant therapy for PAD. Asymptomatic PAD does not require anticoagulant or antiplatelet therapy, whereas antiplatelet therapy with low-dose aspirin or clopidogrel should be used in patients with ischemic lower-extremity symptoms, such as intermittent claudication or critical limb ischemia due to atherosclerosis. Aspirin combined with low dose of rivaroxaban should be considered for symptomatic PAD patients with a high risk of recurrent ischemic events, and for those who have received endovascular or open surgical intervention for PAD, and the risk of bleed-ing should be weighed.