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Peripheral artery disease due to atherosclerosis is associated with considerable morbidity and mortality. Atheromatous plaques impair blood flow, and thrombi that adhere to ruptured plaques result in tissue ischemia and necrosis. The thrombi are platelet-rich but are interlaced with fibrin, which suggests a role for both platelets and clotting factors in their genesis. Given this observation, combining antiplatelet agents with anticoagulants might be more effective than treatment with either agent alone.
A university consortium conducted an international, randomized, open-label clinical trial to compare the combination of oral anticoagulation (warfarin or acenocoumarol, to achieve an international normalized ratio [INR] of 2–3) plus an antip…