Significant variation in P2Y₁₂ inhibitor use after peripheral vascular intervention in Medicare beneficiaries

There is no consensus regarding whether to use antithrombotic medications in patients with peripheral artery disease after lower-extremity peripheral vascular intervention. Objectives The main hypothesis is that significant variation exists regarding use of antithrombotic medications after lower-extremity peripheral vascular intervention. We sought to examine the patterns of postprocedural antithrombotic medication use and associated factors in Medicare patients. Methods We measured rates of P2Y₁₂ inhibitor use after peripheral vascular intervention in a 100% national sample of Medicare beneficiaries with Part D prescription drug coverage. We used logistic regression modeling to examine associations between patient and clinical factors and P2Y₁₂ inhibitor use. Results Between 2010 and 2012, a total of 85,830 patients underwent peripheral vascular intervention and had prescription drug claims. Overall, 18.3% of patients were treated with an oral anticoagulant, 19.1% received no P2Y₁₂ inhibitor, 30.8% received a P2Y₁₂ inhibitor before and after the procedure, 6.2% received a P2Y₁₂ inhibitor for up to 30 days after the procedure, and 25.6% received a P2Y₁₂ inhibitor for more than 30 days after the procedure. After adjustment, factors associated with P2Y₁₂ inhibitor use included male sex; black race; history of renal disease, dementia, or heart failure; physician specialty; and clinical setting of the procedure. We observed a strong interaction effect between clinical setting and physician specialty (P < .001). Conclusions One-fifth of patients who underwent lower-extremity peripheral vascular intervention did not fill a prescription for a P2Y₁₂ inhibitor. Patients whose operators were surgeons or radiologists had lower odds of P2Y₁₂ inhibitor use. More research to determine the optimal use and duration of antithrombotic medications after the procedure is warranted.