The objective of this study was to explore prescribing patterns of single vs dual antiplatelet therapy (DAPT) after lower extremity bypass surgery and to investigate the effects of antiplatelet therapy on bypass graft patency. A retrospective review of nonemergent infrainguinal lower extremity bypass operations entered in the national Vascular Quality Initiative (2003-2018) was performed. Patients discharged on aspirin monotherapy or DAPT were identified. Multivariable Cox regression investigated predictors of primary, primary assisted, and secondary patency.

Of the 13,020 patients investigated, 52.2% were discharged on aspirin monotherapy and 47.8% on DAPT. The proportion of patients discharged on DAPT increased from 10.6% in 2003 to 60.6% in 2018 (P < .001). The DAPT cohort was younger, had higher rates of medical (hypertension, diabetes, congestive heart failure, chronic obstructive pulmonary disease) and atherosclerotic (coronary artery disease, prior coronary artery bypass graft, prior lower extremity intervention) comorbidities, and had higher risk bypass procedures (more distal targets, prior inflow bypass procedure, prosthetic conduit use). Multivariable Cox regression analysis did not show any difference between the DAPT and aspirin cohorts in primary patency (hazard ratio [HR], 0.98; 95% confidence interval.

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