About Peripheral Artery Disease (PAD)

What is PAD?

Peripheral artery disease, or PAD, is a progressive disease that is the result of plaque buildup in the arteries of the limbs—usually the legs. PAD also has similar risk factors and the same underlying cause as coronary artery disease, or CAD, which increases a person’s risk for a blood clot–related event like a heart attack or stroke.

How common is PAD?

PAD affects up to 8.5 million people in the US alone. But studies showed only about 25% of adults age 50 and older have any awareness of PAD.*

*According to the Centers for Disease Control and Prevention (CDC).

PAD and atherosclerosis

PAD is the end result of atherosclerosis, or hardening of the arteries. This is the process by which the arteries become damaged and inflamed as a result of certain health conditions or risk factors, including:

High blood pressure
High cholesterol
Being overweight
Family history

Then, like sludge on the inside of pipes, cholesterol, white blood cells, and other substances build up inside the damaged walls, forming plaque. Plaque can start forming as early as childhood and builds up slowly, over many years.

As the plaques grow larger, less blood can get through the artery to supply your muscles with the oxygen they need to function. This reduced blood flow may cause symptoms such as:

  • Pain or cramps in one or both hips, thighs, or calf muscles after walking or being physically active
  • Leg numbness or weakness
  • Lower leg or foot are cool to the touch, especially when compared to the other side
  • Sores that won’t heal on legs, feet, or toes
  • A change in the skin color on the legs
  • Hair loss or slower hair growth on feet or legs
  • Slower growth of toenails
  • Shiny skin on legs
  • No pulse or a weak pulse in legs or feet
  • Erectile dysfunction in men

The risk with PAD is that some plaques can rupture. This triggers your body’s blood clotting response. A clot forms around the ruptured plaque, creating a blockage and cutting off blood flow to your legs which can cause pain. When your tissue doesn’t get enough oxygen, it can start to die. In the most serious cases, an amputation may be required.

PAD and coronary artery disease (CAD)

Another thing to be aware of is that because PAD and coronary artery disease, or CAD, share similar risk factors and are both caused by the buildup of plaque inside arteries, people with PAD also have a high chance of having CAD. CAD is the buildup of plaque inside the arteries that supply blood to the heart. A blood clot in these arteries is what can cause a heart attack or, if the blood clot travels to the brain, a stroke—both of which can be life threatening.

PAD treatment options

Surgical and nonsurgical procedures may be performed to restore blood flow in a blocked artery. Examples include:

  • Angioplasty opens a blocked artery by inflating a tiny balloon inside the blockage
  • Stent implantation permanently props open a blocked artery with a tiny wire mesh tube that is placed during an angioplasty
  • Atherectomy uses a sharp blade and a catheter to collect and remove plaque from inside a blocked artery
  • Peripheral artery bypass graft surgery reroutes blood around a completely blocked artery using a man-made blood vessel or a blood vessel from another part of your body

While the above procedures may be life-saving, they do not fix you for good.

Prescription and nonprescription antiplatelet blood thinners may be prescribed immediately following diagnosis or an event to help prevent blood clots. Antiplatelets are one type of blood thinner that work by helping to keep platelets (which are pieces of blood cells) from sticking together. Examples include:

  • Dual antiplatelet therapy (DAPT): aspirin plus one other antiplatelet medicine, such as clopidogrel, are typically prescribed temporarily to help prevent blood clots after stent implantation, peripheral artery bypass graft surgery, or after a heart attack
  • Clopidogrel (Plavix®)
  • Aspirin

XARELTO® plus low-dose aspirin for chronic PAD

The medicines just discussed, including aspirin, have been recommended to reduce the risk of blood clots in people with chronic PAD. Now, a new medication is available for healthcare professionals to prescribe for people with chronic PAD. XARELTO® is an FDA-approved treatment that can be added to low-dose aspirin to help further reduce the risk of blood clots that may cause a serious cardiovascular event like a heart attack, stroke, or cardiovascular death.

US Food and Drug Administration.

Aspirin alone may not be enough

Even when you’re following your healthcare professional’s instructions to take aspirin every day and to eat right and stay active, you may still have an underlying risk for blood clots that can cause another unexpected cardiovascular event like a severe blockage in your leg, a heart attack, or a stroke.




While aspirin alone can help reduce your risk for these events, a large study of almost 40,000 people, including those with PAD or CAD, showed that even though more than half were taking aspirin, the number of heart attacks, strokes, and cardiovascular deaths more than doubled over a two-year period.

According to data from the REACH Registry.

Adding XARELTO® to your low-dose aspirin

XARELTO® 2.5 mg twice daily in combination with low-dose aspirin (75 mg–100 mg) once daily is proven to help further reduce the risk of heart attack, stroke, and cardiovascular death in people with chronic PAD versus aspirin alone.

In fact, in a clinical trial, almost 96% of people with chronic PAD or CAD taking XARELTO® 2.5 mg twice daily in combination with low-dose aspirin once daily did not have a heart attack, stroke, or die from a cardiovascular event.§

§Patients were followed for an average length of treatment of 23 months.

How XARELTO® works with aspirin

XARELTO® works together with aspirin to help protect you from blood clots that may cause a heart attack, a stroke, or cardiovascular death. Think of XARELTO® and aspirin like two members of the same team whose job it is to prevent serious blood clots from forming and growing. But they each play different positions—aspirin, an antiplatelet blood thinner, helps keep platelets (which are pieces of blood cells) from sticking together, and XARELTO®, an anticoagulant blood thinner, helps slow down the blood's clotting process.

Until recently, aspirin had to play defense on its own, but a study showed that adding XARELTO® to the team helps further reduce the risk of a heart attack, stroke, and cardiovascular death compared to aspirin alone.

Bleeding risk with XARELTO® plus low-dose aspirin

While all blood thinners come with a risk of bleeding, around 3% of people taking XARELTO® 2.5 mg with their low-dose aspirin experienced a major bleeding event, such as bleeding into the brain. That represents about a 1% increase in bleeding versus people taking only low-dose aspirin.

But remember, if you and your doctor chose to add XARELTO® to your low-dose aspirin, it’s likely because your doctor believes the benefit of helping to protect you from life-threatening blood clots outweighs your risk of bleeding.

Managing your overall health

It’s important to quit smoking, keep trying to eat right and stay active, and take any other medicines your doctor has prescribed, like medicines for high blood pressure or high cholesterol. Because while no drug or procedure can completely rid your arteries of plaque, managing your overall health can help slow the progression of your PAD.

Start the Conversation

If you have PAD and are taking aspirin, talk to your healthcare professional about your risk for blood clots that may cause a cardiovascular event such as a heart attack or a stroke, and whether adding XARELTO® to your care plan may be right for you.