BACKGROUND: Peripheral arterial disease (PAD) is a condition whereby the peripheral arteries of the body, and particularly the lower limbs, experience atherosclerosis resulting in narrowing of the peripheral arteries. This largely preventable condition is a major cause of cardiovascular morbidity and mortality, affecting over 230 million people worldwide.

METHODOLOGY: We conducted a systematic search for randomized control trials on four databases: Medline, CINAHL, PubMed, and Embase. We compared the outcomes of anticoagulation therapy with standard care following PRISMA standards.

RESULTS: 10,051 studies were identified, and through titles and abstract screening followed by full text screening, five studies involving 14,463 individuals were included. One study compared rivaroxaban with dose adjusted warfarin. Two studies compared a combination of rivaroxaban and low dose aspirin with antiplatelet therapy. These three demonstrated a reduction in major adverse cardiovascular events (MACE) and Major adverse limb events (MALE) when combined with Aspirin. However, they noted increased bleeding risk.

CONCLUSION: Newer-generation direct oral anticoagulants in combination with antiplatelet therapy, may improve cardiovascular outcomes and reduce limb-related complications in patients with PAD. Further randomized controlled trials (RCTs) are needed to determine optimal dosing before guideline implementation.