Assessing Confidence and Competence of Student Pharmacists in a Virtual Medication Adherence Training Program.

OBJECTIVE: To assess the impact of a virtual medication adherence training (VMAT) program on students' perceived confidence and perceived competency in delivering medication adherence services via telehealth. METHODS: This pilot pre-/post-observational study consisted of 2 subsequent sections: (1) 4 asynchronous self-study modules via Canvas (Instructure, Inc.) learning management system, and (2) 2 live application-based sessions involving virtual and telephonic standardized patients. A pre-/post-survey was given to first-, second-, and third-year Doctor of Pharmacy students to assess perceived confidence and perceived competence. Participants completed a 5-question multiple-choice quiz before and after each module to assess knowledge. RESULTS: Students' overall perceived confidence and perceived competency significantly increased upon completing VMAT. Knowledge in each module assessment also significantly improved. During the assessment of performance throughout the live sessions, most participants lost points when resolving issues within the interaction, addressing the need for patient follow-up, and assessing patient knowledge of medication adherence. CONCLUSION: This novel VMAT suggests that this or similar programs would be beneficial to improve pharmacy students' perceived confidence, perceived competence, and knowledge in delivering virtual medication adherence services in the telehealth setting. The incorporation of such training within the didactic curriculum of doctoral pharmacy programs should be considered to improve patient care skills for future medication experts.

Impact of Pharmacist Transitions of Care on 30-Day Readmissions Within a Primary Care-Based Accountable Care Organization.

Previous studies in the ambulatory care setting have shown inconsistent results in regard to, or with respect to pharmacist telephonic transitions of care (TOC) encounters and reduction in 30-day readmission rates. No studies that have been completed within an accountable care organization (ACO) evaluating the impact of telephonic TOC encounters performed by a pharmacist have been identified. The objective of this study was to analyze the impact of clinical pharmacy telephonic TOC encounters on readmission rates within a primary care-based ACO. In this retrospective chart review, data for those who had a pharmacist telephonic TOC encounter and those who had an attempt were collected. The primary outcome of this study was all-cause 30-day readmission rate. Secondary outcomes included 30-day readmission rate for targeted disease states, time to readmission, and readmission reason the same as previous discharge reason. For subjects who received a telephonic TOC encounter, pharmacist intervention type and provider acceptance of intervention(s) were described. For the final analysis, 154 encounters were included, 83 encounters in the telephonic TOC encounter group, and 71 did not receive a telephonic TOC encounter. The 30-day readmission rates were similar among those who received a telephonic TOC encounter and those who did not: the difference was not significant (15.7% vs. 28.2%; P = 0.059). There was also no statistical difference in the secondary outcomes. Even so, the results of this study suggest that performing a pharmacist telephonic TOC encounter in a primary care-based ACO setting has the potential to reduce 30-day readmission rates and further research appears to be warranted in this important area of practice.

Investigating the place of sodium-glucose cotransporter-2 inhibitors and dual sodium-glucose cotransporter-1 and dual sodium-glucose cotransporter-2 inhibitors in heart failure therapy: a systematic review of the literature.

Sodium-glucose cotransporter-2 inhibitors have been shown to have significant metabolic, renal, and atherosclerotic cardiovascular disease benefits. Recent randomized controlled trials have extended these benefits to patients with heart failure. In fact, the robust findings from these studies in patients with any type of heart failure have led to the incorporation of this drug class in currently updated evidence-based guidelines for this condition. However, given the novelty in utilizing these agents in heart failure, there is uncertainty regarding place in therapy and sequencing in treatment. As such, this review aims to summarize existing literature to guide practitioners regarding the use of these agents in the management of heart failure.

Earthquakes, Hurricanes, Pandemics: Pharmacy Students Impacting Pharmacy Practice in Puerto Rico Through Medication Therapy Management Services During Disasters.

BACKGROUND: Community-based medication therapy management advanced pharmacy practice experiences (MTM APPE) can engage pharmacy students in public health initiatives, including emergency response preparedness, to successfully impact patient care. This study aimed to evaluate pharmacy students' perceptions of their experience on an MTM APPE during disasters in Puerto Rico. METHODS: After completing the MTM APPE during times of hurricanes, earthquake or pandemic, pharmacy students were asked to voluntarily participate in a questionnaire about their perception of assisting during a disaster. The survey consisted of 5 questions. Four questions were based on a Likert scale with answers choices ranging from Agree, Not Sure, Disagree, or Not Applicable. One question requested free text comments from participants. RESULTS: Sixteen students completed the survey. Pharmacy students agreed that the MTM APPE taught them the clinical skills needed to assist and educate individual patients and the community that suffered from a disaster, and that the role of the pharmacist is vital when a disaster disrupts a community's health-care system. CONCLUSIONS: Training in emergency response to disasters should be a considered component of MTM APPE.

Use trends of chlorthalidone and hydrochlorothiazide among United States adults with hypertension: National Health and Nutrition Examination Survey 2009-2018.

OBJECTIVES: To estimate the national prevalence of chlorthalidone and hydrochlorothiazide use among adults diagnosed with hypertension by sociodemographic subgroup, healthcare access status, and clinical factors. METHODS: Data was extracted from the National Health and Nutrition Examination Survey for 2009-2010 through 2017-2018 survey waves. Patients at least 20 years old, diagnosed with hypertension, and on hydrochlorothiazide or chlorthalidone were included. Uni-variable logistic regression models estimated the odds of being on chlorthalidone compared with hydrochlorothiazide use by sociodemographic and clinical factors. Analyses were adjusted for multi-stage complex survey design and are nationally representative. RESULTS: Two thousand five hundred and eighty-five participants were included with 95.2% participants using hydrochlorothiazide and 4.8% using chlorthalidone. Participants over 65 years were more likely to be on chlorthalidone compared with younger counterparts [odds ratio (OR) 1.8; 95% confidence interval (CI) 1.12-2.88]. Participants with hypokalemia (OR 2.62; 95% CI 1.56-4.42) or hyponatremia [OR 2.298; 95% CI 1.23-4.30) were more likely to be using chlorthalidone compared with patients with normal levels. CONCLUSION: Chlorthalidone, a potent and effective first-line antihypertensive agent and thoroughly studied thiazide diuretic with substantial cardiovascular benefits, continues to be underutilized in patients with hypertension. Findings demonstrated that individuals receiving chlorthalidone were more likely to be 65 years or older and to experience hyponatremia or hypokalemia. Sociodemographic factors, healthcare access and use, clinical factors, and medical conditions did not appear to sway the choice in thiazide diuretic use.

Real-World Analysis of Long-Acting and NPH-Containing Insulins on Glycemic Control.

Introduction Affordability of insulin products has become a concern in the past several years as the average price of various insulin products has increased. While awaiting legislation at the federal level that would address issues leading to high insulin costs, providers may have shifted prescribing practices to prescribe the lowest-priced insulin products to achieve patients' treatment goals. Objective To compare the prevalence of hypoglycemic events between patients receiving lower-cost neutral protamine Hagedorn (NPH)-containing human insulins and higher-cost long-acting insulin analogs in Medicare Part D enrollees within a management services organization, as well as assessing glycemic control and changes in body mass index. Methods This was a multicenter, retrospective study conducted at three primary care clinics. The co-primary outcomes were percent difference of documented mild and severe hypoglycemic events between individuals receiving NPH-containing human insulin and long-acting insulin. Results A total of 72 patients met inclusion criteria and were receiving NPH-containing human insulins or the long-acting insulin analogs, 15 and 57 patients, respectively. Severe hypoglycemic events occurred in 3.5% vs 0% of the long-acting insulin analog and NPH-containing human insulin group, respectively (P = 0.999). Mild hypoglycemic episodes were experienced by 31.6% versus 33.3% of long-acting insulin analog and NPH, respectively (P = 0.539). For secondary outcomes, no difference was observed in glycemic control outcomes across insulin groups. Conclusion Among Medicare Part D patients with type 2 diabetes mellitus, the use of NPH-containing human insulins was not associated with an increased risk of mild or severe hypoglycemia-related episodes or reduced glycemic control compared with long-acting insulin. Study findings suggest that lower-cost, NPH-containing human insulins may be an alternative to higher-cost, long-acting insulin analogs.

Utilizing Pharmacist-Led Telehealth Services in Ambulatory Patients with Heart Failure.

Background: Heart failure is one of the leading causes of hospital admissions. Non-adherence to medications and poor dietary management for patients who suffer from this condition can lead to worsening of symptoms and hospitalization. Pharmacist interventions via telehealth have demonstrated a beneficial impact on disease management and adherence outcomes in patients with chronic conditions. Methods: This retrospective, descriptive cohort study reviewed subjects from a single-centered primary care office. Data was collected via electronic chart review between January and December 2021. Subjects eligible for inclusion were adults who were diagnosed with heart failure by their primary care provider and referred to a pharmacist for a telehealth visit. The primary outcome was the number of heart failure-related hospitalizations post-pharmacist intervention via telehealth. The secondary outcome was the number of cardiovascular-related hospitalizations post-pharmacist intervention via telehealth. Results: 37 patients were included for analysis. Only two patients were admitted for heart failure post-pharmacist intervention. Fifteen patients were admitted post-pharmacist intervention for a cardiovascular-related hospitalization. Conclusion: This report illustrates the employment of pharmacist-led telehealth services in the chronic heart failure population. This study encourages pharmacist-based interventions via telehealth in the ambulatory setting as few HF-related hospitalizations occurred in this cohort.

Impact of Student Pharmacist-Led Transition-of-Care Services on 30-Day Hospital Readmissions at a University Call Center.

Background: Transition of care (TOC) refers to the movement of patients between different health care settings due to changes in medical conditions and needs. Pharmacists can play an important role in TOC services as polypharmacy is a common reason for hospital readmission that costs the US taxpayers an average of $17 billion annually. Objective: The purpose of this study is to evaluate the impact of TOC telehealth services provided by pharmacy students at a university-based call center on 30-day hospital readmission. Methods: In this retrospective observational study, an electronic chart review was conducted for patients who were discharged from the hospital and received a telephone call from pharmacy students. Patients were referred to the pharmacy team from a primary care provider office. The co-primary endpoints were the number of 30-day all-cause hospital readmissions (including emergency department visits) and 30-day readmission due to initial admission diagnosis in patients who received a telephonic TOC call from a pharmacy student compared with patients who declined or were unable to be reached. Types of pharmacy-related TOC interventions provided by students were also collected. Results: A total of 84 patients were included in this study. All-cause 30-day readmission was similar between groups (13% vs 15.8%), whereas 30-day readmission due to initial admission diagnosis was much lower in the intervention group (5.9% vs 11.1%). Although a positive trend was observed in favor of the intervention group, a statistically significant difference was not observed for both 30-day all-cause readmission and 30-day readmission due to initial admission diagnosis. Medication reconciliation, adherence counseling, and lifestyle education (diet, exercise) are the most common topics discussed with the patients during TOC interventions. Conclusion: Using student pharmacists to provide postdischarge TOC calls can be a benefit to the patient and the health care team while offering pharmacy students valuable learning experience prior to graduation.

Is now our time? History to provider status for allied health professions and the path for pharmacists.

The designation of health care providers is limited to physicians, physician assistants, nurse practitioners, certified nurse midwives, nurse anesthetists, clinical psychologists, dietitians, and social workers. Pharmacists are not federally recognized health care providers and, therefore, are not eligible for cognitive service reimbursements. This commentary explains the intentions of adding pharmacists as Medicare Part B providers, evaluates current state pharmacist provider status, and calls pharmacists, technicians, and other key stakeholders to advocate on behalf of the profession of pharmacy. If federal provider status is granted to pharmacists, patients will gain better access to care, health spending will decline, and physician lead care teams will have an expert in medications readily available for consultation or other medication-related needs. Reimbursement would provide more resources to administer these needed services to more patients in areas with limited access to health care resources.

The Impact of Pharmacists on Telehealth During Transitions of Care: A Literature Review.

Purpose: To provide a review of pharmacists' impact during transitions of care (TOC) visits utilizing telehealth. Methods: An electronic literature review was conducted on studies that addressed pharmacists' impact on telehealth during TOC. Articles included in the review were randomized or observational studies, cohort studies, case series or case reports, literature reviews, or pilot studies conducted on adults. Articles investigating children were excluded from the review. Results: Of the articles identified, 14 studies met the eligibility criteria and were selected for the literature review. All of the studies were published in English between 2013 and 2021. Most were conducted in the United States of America (n = 12) with 1 conducted in Ireland (n = 1) and 1 in Australia (n = 1). The majority of telehealth monitoring was conducted via phone (n = 8), video conferencing (n = 3), or both (n = 2) in patients' homes by pharmacists alone (n = 8) while the remaining studies involved telemonitoring by a combination of pharmacy fellows, residents, and/or students. These findings showed that pharmacist intervention in patient care showed improved patient outcomes and goal markers for a variety of health conditions as well as lower rates of 30 day, 60 day, and 90 day hospital readmissions. Conclusion: Pharmacist involvement in telehealth monitoring had a positive impact on TOC interventions and overall patient outcomes including decreased hospital readmissions and increased patient medication adherence.

Considerations of management and marketing courses within pharmacy curricula in the United States.

INTRODUCTION: To assess the extent pharmacy programs are offering courses in management and marketing. METHODS: We sampled the extent of management and marketing coursework in the doctor of pharmacy (PharmD) curricula in the United States (US) by examining website descriptions of the best pharmacy schools in 2020 (N = 134) as ranked by the US News and World report. Links to curriculum descriptions and catalogs were reviewed for coursework having the words, marketing, management, entrepreneurship, or business plan in the title. RESULTS: Of the 134 PharmD curricula reviewed, 36 (27%) had no required or elective management courses, and 101 (75%) had no required or elective marketing courses in their curriculum. Most schools did offer a core (n = 89) or elective (n = 9) management course. However, of those, about half (n = 46) provided only a single management course over the entire curriculum. Only 33 (25%) schools offered a marketing course, of which most (n = 27) were elective. CONCLUSIONS: Many pharmacy schools in the US are not providing pharmacy graduates with the business management and marketing education required for the role of a pharmacist. Pharmacy education should consider curriculum changes that equip pharmacy students with sufficient business knowledge and skills to be innovative and entrepreneurial in all practice settings.

Controlling Blood Pressure During a Pandemic: The Impact of Telepharmacy for Primary Care Patients.

INTRODUCTION: Studies have shown positive clinical outcomes in chronic conditions, such as hypertension, through pharmacist-delivered medication therapy management and medication adherence services. Given the need for social distancing during the COVID-19 pandemic, increased utilization of telepharmacy strategies has been employed for managing blood pressure control. METHODS: A retrospective single-center cohort study that compared in-person pharmacist visits and telepharmacy visits in primary care patients with hypertension via electronic chart review from January 2018 to July 2022. Subjects were included who were at least 18 years of age with hypertension. Comparator groups were patients who underwent an in-person pharmacy (pre-COVID-19) visit vs a telepharmacy visit (post-COVID-19). The primary outcome was the number of patients with controlled blood pressure based on a blood pressure goal of less than or equal to 130/80 following telepharmacy visit vs in-person visit. Medication adherence, pharmacist intervention, incidence of antihypertensive side-effects, and blood pressure maintenance based on a goal of ≤140/90 were also evaluated. RESULTS: A total of 77 patients were included. There was no difference in the primary outcome following in person pharmacy visits compared to telepharmacy visits (P = .690). There was also no difference found for the secondary endpoints of blood pressure goal less than or equal to 140/90 mmHg (P = .481), medication adherence (P = 1.00), or antihypertensive adverse events (P = .344). CONCLUSION: Telepharmacy visits had a nonsignificant change in blood pressure control when compared to in-person visits. Results suggest that the utilization of either in-person or telepharmacy strategies benefit the management of hypertension.

Evaluating Pharmacist-Driven Interventions in a Primary Care Setting to Improve Proportion of Days Covered and Medication Adherence.

BACKGROUND: Medication nonadherence is the leading cause of poor health outcomes and increased risk of hospitalizations. Previous studies have shown that pharmacist interventions can help improve medication adherence and CMS quality measures. OBJECTIVE: The purpose of this study was to examine the impact of clinical pharmacists' interventions on medication adherence and PDC scores for ACEi/ARBs, statins, and noninsulin antidiabetic medications in the primary care setting. METHODS: This observational study was conducted at four primary care clinics to evaluate PDC scores pre- and post-pharmacist interventions from April 2020 to December 2020. Eligible patients were Humana Part D beneficiaries with a baseline PDC score <85%. The primary outcome of this study was to evaluate the average change in final PDC scores, and 1-month change in PDC scores following a pharmacist intervention. Secondary outcomes were number and types of adherence barriers identified, interventions provided by the pharmacist, and barriers and interventions category (pharmacy, patient or physician-related). RESULTS: A total of 89 barriers were identified and 208 interventions were completed. A statistically significant difference in the average change of final PDC score from baseline was seen among those on ACEi/ARBs (72.5 to 78.0, p = 0.004) and statins (73.3 to 76.6, p < 0.001). Similarly, a statistically significant change was observed from baseline to 1-month PDC among those on ACEi/ARBS (72.5 to 75.4, p = 0.001) and statins (73.3 to 74.9, p < 0.001). Conclusion: Pharmacists located in a primary care setting improved medication adherence and PDC score for patients on ACEIs/ARBs and statins.

Improving medication adherence in patients with hypertension through pharmacist-led telehealth services.

BACKGROUND: Pharmacist-led telehealth services have resulted in improvements in several disease states, including diabetes and conditions requiring anticoagulation. Pharmacists who used telehealth methods to follow up with their patient have noticed an increase in medication adherence. METHODS: Using PubMed and EBSCO secondary databases, inclusion criteria were any peer-reviewed study design such as randomized controlled trials, literature reviews, systematic reviews, and cohort studies published within the last 10 years. Search terms included pharmacist, telemedicine, telehealth, cardiovascular disease, and medication adherence. RESULTS: Seventeen articles were reviewed. Most pharmacist interventions for patients with hypertension involving telemedicine, E-Health, or remote monitoring were performed in the outpatient setting. The primary target of most studies consisted of improving medication adherence. CONCLUSION: Pharmacist services play an integral role in maintaining medication adherence among the hypertensive population. Telehealth is an effective method of communication with patients to ensure their health is maintained, minimizing barriers of access to care.

Development of a combination didactic-experiential elective course within a college-based pharmacy call center.

BACKGROUND: Pharmacy graduates should be prepared to provide patient care in a variety of healthcare settings as members of an interprofessional collaborative team. College-based pharmacy call centers can serve as settings to promote interprofessional practice through didactic and experiential coursework. An elective course, Team-Based Medication Management Practices, was developed to provide student pharmacists the opportunity to learn about pharmacy-led services within value-based care models and to prepare them for interprofessional care by incorporating experiential activities within a college-based call center. EDUCATIONAL ACTIVITY: A two-credit elective course was offered to third-year pharmacy students. The course was delivered through a combination of didactic lectures and experiential activities within a college-based pharmacy call center, with modules focused on medication adherence, medication therapy management, and transitions of care. A survey was administered to students at the end of the course to evaluate perceptions. FINDINGS: Six students enrolled in the elective and completed the survey. Most students "strongly agreed" or "agreed" that they gained a better understanding of interprofessional care within value-based care models and pharmacy services that can be provided within a college-based call center while acquiring patient care skills. The role of telehealth in the delivery of pharmacist-led patient care services is likely to continue expanding as a result of the COVID-19 pandemic and it will become increasingly important to train students to provide these services.

Evaluating a Pharmacist-Led Intervention on Cardiovascular- and Diabetes-Related Quality Measures in a Primary Care-Based Accountable Care Organization.

BACKGROUND: The Centers for Medicare and Medicaid Services (CMS) publishes quality measures to gauge performance in Accountable Care Organizations (ACOs). ACO-27 (Diabetes Mellitus: Hemoglobin A1c Poor Control) and ACO-41 (Diabetes: Eye Exam), are 2 components for the Diabetes Composite measure. ACO-42 focuses on Statin Therapy for the Prevention and Treatment of Cardiovascular (CV) Disease. There are limited studies regarding the pharmacist role in CV and Diabetes Management in the ACO primary care setting. OBJECTIVE: To evaluate the impact of pharmacist-led interventions on CV- and diabetes-related CMS quality measures within a primary care-based ACO. METHODS: This retrospective pre-post intervention study included 3 primary care-based ACO offices. Patients who met eligibility criteria for CMS quality measures ACO-27, -41 and -42 were included. Pharmacist interventions occurred in December 2018. The study co-primary outcomes were the percentage of patient meeting ACO-27/-41 (composite diabetes-related) and -42 (statin-related) CMS quality measures in the pre-intervention compared to the post-intervention phases. RESULTS: Of 105 patients meeting study inclusion criteria, 77.1% were on statin therapy prior to intervention. After pharmacist intervention, the prevalence of patients on statin therapy increased to 80.0% (p = 0.083). All patients had a HbA1c less than 9% pre-intervention. Sixty-one (58.1%) patients had a documented dilated eye exam prior to intervention. Post-intervention, the prevalence of exams increased to 73.3% (p < 0.0005). CONCLUSIONS: Pharmacists can assist primary care providers in the ACO setting meet CV- and diabetes-related CMS quality measures, demonstrating the value of the pharmacist in value-based health care settings.

Effects of a Therapeutic Interchange Between Branded and Generic Inhaled Therapy on Chronic Obstructive Pulmonary Disease.

Objective To evaluate the difference in the occurrence of chronic obstructive pulmonary disease (COPD) exacerbations six months preconversion compared with six months postconversion from the branded inhaled corticosteroid/long-acting beta 2-agonist inhalers to the generic fluticasone/salmeterol inhalers. Design Retrospective cohort study using a six-month pre-/post-test design Setting Three primary care offices within a Management Service Organization (MSO) in South Florida. Patients, Participants Patients were included in the study if they had a diagnosis of COPD (in electronic medical record [EMR]), were at least 18 years of age, were under the care of a provider at one of the three primary care clinics within an MSO, and were switched from a branded ICS/LABA inhaler to a generic ICS/LABA inhaler between May 2019 and February 2020. This study included a total of 22 patients. Interventions Not applicable; this was a retrospective chart review. Main Outcome Measure The prevalence of COPD exacerbations leading to hospitalizations, emergency room visits, urgent care visits, or clinic visits. Results In this study, 10 (45.5%) patients experienced at least one exacerbation while on generic inhaler therapy compared with four (18.2%) patients while on branded inhaler therapy (P = 0.05). Those on a generic inhaler were 3.8 times more likely to have a COPD exacerbation. Conclusion While changing patients from branded to generic inhalers may be appealing because of the potential benefits in cost-reduction, the results of this study conclude that the inhaler switch may lead to increased exacerbations. Prescribers need to be aware of potential complications that may be related to a therapeutic interchange.

Destigmatizing public health concerns and supply of COVID-19 vaccines.

The end of the global pandemic caused by COVID-19 and a future without masks and restrictions are promising with the discovery of a vaccine. Still, there is much worry about the vaccine itself. Fears about what is inside the vaccine, how quickly it was created and plans for distribution are major concerns. This article aims to address these concerns to relieve vaccine hesitancy. Methods for distribution within the United States as well as different strategies to ensure proper and equitable allocation of COVID-19 vaccine worldwide is also described.

impact of a Pharmacy-Led Transitions of Care Program Within a Primary Care-Based Accountable Care Organization.

OBJECTIVE: To assess the impact of pharmacist-led transitions of care program on 30-day readmission rates in the accountable care organization (ACO) primary care setting. DESIGN: Retrospective cohort study. SETTING: Two primary care provider (PCP) offices with an ACO in South Florida. PATIENTS, PARTICIPANTS: Adult Medicare patients who completed a post-discharge follow-up visit at two primary care offices within an ACO from July to December 2017. INTERVENTIONS: To supplement postdischarge visits with a PCP, the pharmacy services were also provided two days per week with a PCP. The comparator groups were patients who only saw a PCP or those who saw a PCP and pharmacist. MAIN OUTCOME MEASUREMENTS: The primary outcome was hospital readmission or emergency department visit within 30 days. RESULTS: A total of 190 subjects were included. There were 113 patients in the PCP group and 77 patients in the PCP/pharmacist group. There was a reduction in the primary outcome when comparing the PCP-only versus PCP/pharmacist groups (6.2% versus 3.9%; P = 0.74). CONCLUSION: Involving pharmacists in patient transitions of care in the primary care setting may be beneficial as previous studies have demonstrated. Further studies evaluating pharmacy services in emerging health care models are needed in order to most effectively utilize the expertise of the pharmacy team.

Antithrombotic Therapy in Peripheral Artery Disease: Stepping in the Right Direction.

We reviewed the various antithrombotic therapies available to treat peripheral artery disease (PAD). A literature review using the PubMed and MEDLINE databases used the following keywords: antithrombotic therapy, anticoagulation, peripheral artery disease, and peripheral vascular disease. Randomized studies written in English that assessed the use of antithrombotic therapy in patients with PAD were evaluated. PAD is a worldwide condition that limits blood flow in the lower extremities, leading to a risk of major adverse cardiovascular events and major adverse limb events. Antithrombotic therapy is necessary to prevent these complications, and the choice of therapy depends upon the stage of disease progression. For symptomatic patients in the beginning stage, single antiplatelet therapy (SAPT) is the preferred therapy, specifically, aspirin. For patients undergoing endovascular revascularization, the preferred therapy is dual antiplatelet therapy using aspirin and clopidogrel combined for at least the first month followed by long-term SAPT. For patients undergoing surgical revascularization, the preferred choice of therapy depends upon the type of graft used, with better results obtained with antiplatelet therapy for prosthetic grafts and anticoagulation for venous grafts. New studies have shown that therapy using both antiplatelets and anticoagulation in the form of aspirin plus low-dose rivaroxaban can reduce complications in all three patient populations, which has paved the way for future studies featuring direct oral anticoagulants with the potential to change current guideline recommendations.