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

in Atherosclerosis and Risk Factors

Applied

Type

Modification

Confidence

92%

Created

Apr 26, 2026

Evidence

1 source

Rationale

The stale guideline citation acc 2025 e was replaced with the superseding 2026 ACC/AHA Lower Extremity PAD guideline ACC/AHA (PMID 41252847) for both claims in the section, as instructed. The newer guideline covers the same recommendations regarding elevated MACE/MALE risk in diabetic PAD patients and the use of dual pathway inhibition post-LER. No content was removed or added beyond the citation update, preserving the existing structure and tone.

Evidence

ACC/AHA. Management of Lower Extremity Peripheral Artery Disease: Guidelines From the ACC/AHA. 2026. PMID: 41252847.
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].[@acc2026-g]. 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].[@acc2026-g].

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