Antithrombotic therapy optimization across scenarios (symptomatic PAD, post-LER, post-bypass)

in Atherosclerosis and Risk Factors

Applied

Type

Addition

Confidence

90%

Created

Mar 19, 2026

Evidence

1 source

Rationale

The 2025 ACC Scientific Statement provides critical, updated guidance for the management of PAD in patients with diabetes, a high-risk subgroup. Integrating this evidence ensures the textbook reflects current standards for dual pathway inhibition in this population.

Evidence

Das SR et al. Management of Peripheral Artery Disease in Adults With Diabetes: 2025 ACC Scientific Statement: A Report of the American College of Cardiology. J Am Coll Cardiol. 2025. PMID: 41405527.
Verified source
PubMedDOI

Content Changes

Antithrombotic therapy in peripheral arterial disease (PAD) requires individualized risk–benefit assessment based on clinical scenario (stable PAD, post-revascularization, after bypass) and bleeding risk profile. 

In patients with concomitant diabetes mellitus, the risk of major adverse cardiovascular events (MACE) and major adverse limb events (MALE) is significantly elevated [@acc2025-e]. For these high-risk individuals, dual pathway inhibition (DPI) consisting of low-dose rivaroxaban (2.5 mg twice daily) plus aspirin is recommended to reduce ischemic risk, particularly following lower extremity revascularization (LER) [@acc2025-e].

For detailed trial evidence (COMPASS, VOYAGER-PAD, EUCLID, CASPAR, BOA) and dosing recommendations, see [[Peripheral Artery Disease|Ch. 10]].
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