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Aspirin alone or in combination with dipyridamole significantly reduces the risk of nonfatal stroke in adults with peripheral artery disease (PAD). There was no significant association between aspirin alone or aspirin with dipyridamole in reducing the risk of myocardial infarction, cardiovascular mortality, major bleeding events, or all-cause mortality. (LOE = 1a)
http://www.ncbi.nlm.nih.gov/pubmed/19436018?dopt=Abstract

The 2005 guidelines on managing peripheral arterial disease from the American College of Cardiology and the American Heart Association have been updated. Among the new recommendations:

*Patients who are smokers or former smokers should be asked about their tobacco use at each visit, and smokers should be helped in developing a plan for quitting, including the use of drug therapies.
*Values for the ankle-brachial index (ABI) should be reported as "incompressible" if over 1.40; "normal" if 1.00 to 1.40; "borderline" if 0.91 to 0.99; and "abnormal" if 0.90 or less.
*The utility of antiplatelet therapy to reduce cardiovascular risks in asymptomatic patients with borderline ABIs is characterized as "not well established."
*Adding warfarin to antiplatelet therapy to reduce cardiovascular ischemic risks in patients with lower-extremity disease "is of no benefit and is potentially harmful," owing to increased risks for bleeding
*Limited evidence suggests that antiplatelet therapy can reduce cardiovascular risks in asymptomatic patients with ABIs less than or equal to 0.90.

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