Efficacy of Aspirin and Low-Dose Rivaroxaban in Chronic Limb-Threatening Ischemia Under Different Comorbid Conditions
DOI:
https://doi.org/10.52340/spectri.2025.12.02.09Keywords:
Chronic limb-threatening ischemia, diabetes mellitus, atherosclerosis, adual pathway inhibition, peripheral arterial disease, infra-popliteal interventionAbstract
Background: Chronic limb-threatening ischemia (CLTI) in patients with diabetic angiopathy and peripheral atherosclerotic disease is associated with severe thrombotic burden, endothelial dysfunction, impaired distal perfusion, and high risk of restenosis after infra-popliteal revascularization. The coexistence of diabetes mellitus and atherosclerosis further increases vascular complications and negatively affects long-term limb outcomes.
Aim: The aim of the study was to evaluate the effectiveness of aspirin combined with low-dose rivaroxaban in comparison with other antithrombotic regimens in patients with chronic limb-threatening ischemia under different comorbid conditions.
Materials and Methods: A total of 120 patients with infra-popliteal peripheral arterial disease and chronic limb-threatening ischemia were included in the study.
Patients were divided into four treatment groups (30 patients each) according to postprocedural antithrombotic regimen:
- Group I: aspirin + clopidogrel
- Group II: aspirin + rivaroxaban 20 mg once daily
- Group III: aspirin + rivaroxaban 2.5 mg twice daily
- Group IV: aspirin + clopidogrel + rivaroxaban 2.5 mg twice daily
Additional subgroup analysis was performed according to comorbid background:
- isolated diabetes mellitus
- combined diabetes mellitus and atherosclerosis
- isolated atherosclerosis
Outcomes included thrombotic events, reocclusion, repeated intervention, ABI, primary patency, and restenosis.
Results
In patients with isolated diabetes mellitus or isolated atherosclerosis, differences between treatment groups were relatively modest.
The most pronounced differences were observed in patients with combined diabetes mellitus and atherosclerosis.
In this subgroup, Group III demonstrated the best results:
- ABI: 0.80 ± 0.13
- Primary patency: 86.7%
- Restenosis: 10.0%
- Thrombotic events: 6.7%
In contrast, Group IV showed the highest thrombotic burden (50.0%), while Group I demonstrated the lowest ABI and primary patency.
Conclusion
The combination of aspirin and low-dose rivaroxaban demonstrated the most favorable vascular outcomes, particularly in patients with coexistence of diabetes mellitus and atherosclerosis, where thrombotic burden is highest.
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