Single versus dual antiplatelet therapy impact on coagulation/thrombosis post PAD revascularization

Objective: To evaluate and compare the impact of single- versus dual-antiplatelet (SAPT vs DAPT) therapy on coagulation profiles and postoperative outcomes in patients with peripheral arterial disease (PAD). Methods: Patients with PAD undergoing lower extremity revascularization from December 2020 to August 2023 were prospectively enrolled in this cohort study and followed for one year to record the incidence of thrombotic events (TEs). These events include arterial graft/stent occlusion or stenosis, as identified through Doppler ultrasonography or angiography. Patients were categorized by type of intervention (open vs. endovascular) and further stratified by thromboprophylaxis regimen (SAPT vs DAPT). Descriptive statistics were conducted to characterize each group. Differences in continuous variables were analyzed using Student's t-test, while categorical variables were evaluated using Fisher's exact test. Kaplan–Meier survival curves and cox proportional hazard assessed the thrombosis probability between groups. Results: A total of 157 patients were analyzed, of which 56 were open and 101 were endovascular. In the endovascular group, the majority of patients were on DAPT (61.4%), whereas in the open procedure, most individuals were on SAPT (78.6%). DAPT recipients exhibited a lower prothrombotic profile than SAPT recipients in either operative cohort ( p < .05). However, the incidence of index TEs was similar between medication groups within each cohort over the one-year follow-up period. DAPT was associated with a decreased incidence of recurrent TEs in the open intervention group ( p < .001), indicating its potential for reducing subsequent thrombotic complications following an index TE. Additionally, there was no significant difference in thrombosis probability between endovascular and open procedures ( p = .73), nor between DAPT and SAPT groups across both procedure modalities ( p = .98). Conclusion: While DAPT demonstrated lower prothrombotic thromboelastography with platelet mapping profiles compared to SAPT, this did not translate into differences in index TEs across surgical modalities.