Medical Management

American Limb Preservation Society
Introduction
In addition to the preventative benefits of appropriate medication in high-risk patients with diabetes and/or vascular compromise, working with a patient’s primary care provider to ensure medical optimization of comorbid conditions is a cornerstone of preoperative management to help reduce the risk of postoperative complications. Accordingly, we have a compiled a brief reference resource list ranging from recent studies on antithrombotic medications and lipid-lowering therapies to the latest meta-analyses and literature on hypertension and diabetes management.
Antithrombotic therapy
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Rivaroxaban with or without aspirin in patients with stable peripheral or carotid artery disease: an international, randomized, double-blind, placebo-controlled trial.

Anand SS, Bosch J, Eikelboom JW, et al.Lancet. 2018;391(10117):219-229.
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Major adverse limb events and mortality in patients with peripheral artery disease: the COMPASS trial.

Anand SS, Caron F, Eikelboom JW, et al.J Am Coll Cardiol. 2018;71(20):2306-2315.
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Safety and efficacy of vorapaxar in secondary prevention of atherosclerotic disease: a meta-analysis of randomized control trials.

Sharma A, Helft G, Garg A, et al.Int J Cardiol. 2017;227:617-624.
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Ticagrelor for prevention of ischemic events after myocardial infarction in patients with peripheral artery disease.

Bonaca MP, Bhatt DL, Storey RF, et al.J Am Coll Cardiol. 2016;67(23):2719-2728.
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Peripheral revascularization in patients with peripheral artery disease with vorapaxar: insights from the TRA 2oP-TIMI 50 trial.

Bonaca MP, Creager MA, Olin J, et al.JACC Cardiovasc Interv. 2016;9(20):2157-2164.
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Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomized trials.

Antithrombotic Trialists’ (ATT) Collaboration; Baigent C, Blackwell L, Collins R, et al. Lancet. 2009;373(9678):1849-60.
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Prevention of serious vascular events by aspirin amongst patients with peripheral arterial disease: randomized, double-blind trial.

Critical Leg Ischaemia Prevention Study (CLIPS) Group; Catalano M, Born G, Peto R. J Intern Med. 2007;261(3):276-84.
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Lipid-Lowering Therapy
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2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.

Grundy SM, Stone NJ, Bailey AL, et al.Circulation. 2019;139(25):e1082-e1143.
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Association of statin dose with amputation and survival in patients with peripheral artery disease.

Arya S, Khakharia A, Binney ZO, et al.Circulation. 2018;137(14):1435-1446.
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Association between intensity of statin therapy and mortality in patients with atherosclerotic cardiovascular disease.

Rodriguez F, Maron DJ, Knowles JW, Virani SS, Lin S, Heidenrejch PA.JAMA Cardiol. 2017;2(1):47-54.
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High-intensity statin therapy is associated with improved survival in patients with peripheral artery disease.

Foley TR, Singh GD, Kokkinidis DG, et al.J Am Heart Assoc. 2017;6(7):e005699.
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Use of angiotensin-converting enzyme inhibitors and freedom from amputation after lower extremity revascularization

Kray JE, Dombrovskiy VY, Vogel TR.Vasc Health Risk Manag. 2017;13:269-274.
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Intensive vs. standard blood pressure control and cardiovascular disease outcomes in adults aged > 75 years: a randomized clinical trial.

Williamson JD, Supiano MA, Applegate WB, et al.JAMA. 2016;315(24):2673-82.
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Relation of baseline high-sensitivity C-reactive protein level to cardiovascular outcomes with rosuvastatin in the justification for use of statins in prevention: an intervention trial evaluating rosuvastatin (JUPITER).

Ridker PM, MacFadyen J, Libby P, Glynn RJ.Am J Cardiol. 2010;106(2):204-9.
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Lipid-lowering for peripheral arterial disease of the lower limb.

Aung PP, Maxwell HG, Jepson RG, Price JF, Leng GC.Cochrane Database Syst Rev. 2007;2007(4):CD000123. doi: 10:1002/14651858.CD000123.pub2
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Hypertension
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Effect of blood pressure lowering medications on leg ischemia in peripheral artery disease patients: a meta-analysis of randomized controlled trials.

Manapurathe DT, Krishna SM, Dewdney B, Moxon JV, Biros E, Golledge J.PLoS One. 2017;12(6):e0178713. doi: 10.1371/journal.pone.0178713. eCollection 2017.
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Diabetes
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6. Glycemic targets: Standards of Medical Care in Diabetes-2021.

American Diabetes Association.Diabetes Care. 2021;44(Suppl 1):S73-S84.
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Risks of diabetic foot syndrome and amputation associated with sodium glucose co-transporter 2 inhibitors: a meta-analysis of randomized controlled trials.

Li D, Yang JY, Wang T, Shen S, Tang H.Diabetes Metab. 2018;44(5):410-414.
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CANVAS Program Collaborative Group. Canagliflozin and cardiovascular and renal events in type 2 diabetes.

Neal B, Perkovic V, Mahaffey KW, et al;N Engl J Med. 2017;377(7):644-57.
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Pain Management
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Estimating the effect of intravenous acetaminophen for postoperative pain management on length of stay and inpatient hospital costs.

Shaffer EE, Pham A, Woldman RL, et al.Adv Ther. 2017;33(12):2211-2228.
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Multimodal analgesia, current concepts, and acute pain considerations.

Helander EM, Menard BL, Harmon CM, et al.Curr Pain Headache Rep. 2017;21(1):3.
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