Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Dr. Kulick received his undergraduate and medical degrees from the University of Southern California, School of Medicine. He performed his residency in internal medicine at the Harbor-University of California Los Angeles Medical Center and a fellowship in the section of cardiology at the Los Angeles County-University of Southern California Medical Center. He is board certified in Internal Medicine and Cardiology.
While lifestyle changes may be enough treatment for some
people with peripheral artery disease, others may require medication. Examples of medications used
to treat peripheral artery disease include antiplatelet or anticlotting agents, cholesterol-lowering
drugs such as statins, medications that increase blood supply to the extremities such as
cilostazol (Pletal) and pentoxifylline
(Trental), and medications that control
high blood pressure.
(such as aspirin and clopidogrel
make the blood platelets less likely to stick to one another to form blood
clots. Low dose aspirin (81 to 325 mg/day) is usually prescribed indefinitely
because it is also helpful in preventing strokes and heart attacks in
patients with peripheral artery disease. Clopidogrel (Plavix) is an
alternative to aspirin for those who are allergic or cannot tolerate
aspirin. Antiplatelet medications also help prevent occlusion of blood
vessels after angioplasty or bypass surgery.
medications act to prevent blood clotting. Both heparin and
(Coumadin) are anticoagulant medications. Anticoagulants are sometimes
prescribed for people with peripheral artery disease if they are at increased risk for formation of
blood clots; these agents are used much less frequently than anti platelet agents in patients with
peripheral artery disease.
of the statin family
have been shown in numerous large clinical trials to help prevent heart attacks
and strokes and prolong survival among patients with atherosclerosis. Statins
have also been shown to slow the progression of peripheral artery disease,
decrease arthrosclerosis in the arteries, and improve claudication symptoms.
Cilostazol (Pletal) is a
mediation that can help increase physical activity (enabling one to walk a
greater distance without the pain of claudication).
Cilostazol works by
causing dilation of the arteries and an increased supply of oxygenated blood
to be delivered to the arms and legs. Cilostazol is recommended for some patients
with claudication when lifestyle modifications and exercise are ineffective.
Cilostazol should be taken on an empty stomach either a half an hour before or two
hours after meals. High fat meals, grapefruit juice, and certain medications
such as omeprazole (Prilosec) and
diltiazem (Cardizem) can increase the absorption, and hence, the blood
levels of cilostazol. Side effects are generally mild that include
diarrhea, and dizziness. Cilostazol should not be used in patients with heart
failure because of concern over increased
mortality in heart failure
patients using medications similar to cilostazol.
Pentoxifylline (Pentoxyl, Trental) improves blood flow to the extremities by decreasing the viscosity ("stickiness") of blood, enabling more efficient blood flow. Side effects are fewer than with cilostazol, but its benefits are weaker and have not been conclusively proven by all studies.
Drugs to control hypertension may also be prescribed. Current recommendations are to treat hypertension in patients with peripheral artery disease to prevent strokes and heart attacks.
Reviewed by Daniel Lee Kulick, MD, FACC, FSCAI on 6/28/2012