Aspirin Monotherapy Should Not Be Recommended for Cardioprotection in Patients With Symptomatic Peripheral Artery Disease

Patients with peripheral artery disease (PAD), regardless of disease stage, are at a marked increased risk for systemic cardiovascular events. Therefore, cardiovascular risk reduction is central to the management of these patients. Treatment of hypertension, use of statins, and strategies for smoking cessation are all well-established, evidence-based interventions in the patient with PAD. In contrast, the rationale for use of antiplatelet agents has been more controversial.The 2016 American Heart Association/American College of Cardiology guideline for management of the patient with PAD indicates, “Antiplatelet therapy with aspirin alone (range, 75–325 mg per day) or clopidogrel alone (75 mg per day) is recommended to reduce MI [myocardial infarction], stroke and vascular death in patients with symptomatic PAD.”1 Per the guideline, this class I recommendation (strong) was supported by level A evidence (high quality from more than 1 randomized controlled trial or meta-analyses of randomized controlled trials).The primary evidence supporting the recommendation was the work of the Antiplatelet Trialists’ Collaboration (ATC).2 The ATC found a 22% reduction in vascular events associated with antiplatelet therapy compared with …