What are the SVS guidelines for the medical treatment of intermittent claudication (IC) in peripheral arterial occlusive disease (PAOD)?

Updated: Sep 12, 2019
  • Author: Josefina A Dominguez, MD; Chief Editor: Vincent Lopez Rowe, MD  more...
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Answer

Recommendations for medical treatment of intermittent claudication (IC) include the following:

  • Multidisciplinary comprehensive smoking cessation interventions are recommended for patients with IC (repeatedly until tobacco use has stopped) (grade 1 recommendation; evidence level A).
  • Statin therapy is recommended for symptomatic PAD (grade 1 recommendation; evidence level A).
  • Optimized diabetes control (hemoglobin A1c goal of < 7.0%) is recommended in patients with IC if this goal can be achieved without hypoglycemia (grade 1 recommendation; evidence level B).
  • Indicated beta blockers (eg, for hypertension, cardiac indications) are recommended in patients with IC; no evidence supports concerns about worsening claudication (grade 1 recommendation; evidence level B).
  • In patients with IC due to atherosclerosis, antiplatelet therapy with aspirin (75-325 mg daily) is recommended (grade 1 recommendation; evidence level A).
  • Clopidogrel 75 mg/day is recommended as an effective alternative to aspirin for antiplatelet therapy in patients with IC (grade 1 recommendation; evidence level B).
  • In patients with IC due to atherosclerosis, it is suggested that warfarin not be used solely to reduce the risk of adverse cardiovascular events or vascular occlusions (grade 1 recommendation; evidence level C).
  • It is suggested that folic acid and vitamin B12 supplements not be used to treat IC (grade 2 recommendation; evidence level C).
  • In patients with IC who do not have congestive heart failure (CHF), a 3-month trial of cilostazol (100 mg bid) is suggested to improve pain-free walking (grade 2 recommendation; evidence level A).
  • In patients with IC who cannot tolerate or have contraindications for cilostazol, a trial of pentoxifylline (400 mg tid) is suggested to improve pain-free walking (grade 2 recommendation; evidence level B).

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