Peripheral artery disease? Yes
pad-specificNo one has reached this rule yetSupervised exercise therapy and, separately, whether low-dose rivaroxaban belongs alongside aspirin
No clinician has signed off this rule yet. It reflects our reading of the guidelines cited below, which has not been independently checked.
Word for word, as generated for the example person below. Figures in the text are theirs.
Ask specifically about supervised exercise therapy for your legs. It is a guideline-backed treatment in its own right, not just "stay active."
Proven in trialsTrials counted real events, like heart attacks, strokes, or deaths, and this changed them.
Structured, supervised walking programs (typically 3 sessions a week, 30-45 minutes, walking to near-maximal leg pain and resting, repeated) are a Class I, Level A recommendation, the same strength as a statin. A pooled analysis of 25 randomized trials found peak walking time improved by about 180 meters and pain-free walking distance by about 128 meters compared with usual care, improvements on the same order as what a surgical procedure achieves for many people, without the procedural risk. Many insurers, including Medicare, cover a structured program; ask for a referral to one rather than a general instruction to walk more.
ACC/AHA (US)
Supervised exercise therapy is Class 1, Level A in chronic symptomatic PAD, including after revascularization. A structured community-based program with behaviour-change support is also Class 1, Level A. Unstructured exercise advice is Class 2b, B-R: its usefulness is uncertain.
2024 ACC/AHA Multisociety Guideline for the Management of Lower Extr… · Recommendation behind this rule · class and level read from the guideline tables on 2026-09-30
AHA Scientific Statement — Optimal Exercise Programs for Patients With Peripheral Artery Disease · Class 1 · Level A
Ask your doctor whether low-dose rivaroxaban alongside your aspirin is right for you. It is specifically about protecting your legs, not just your heart.
Proven in trialsTrials counted real events, like heart attacks, strokes, or deaths, and this changed them.
In the COMPASS trial's PAD subgroup, adding rivaroxaban 2.5 mg twice daily to aspirin cut major adverse limb events (severe ischemia requiring hospitalization, bypass, angioplasty, or amputation) by 46%, and total amputations by 58%, compared with aspirin alone. In VOYAGER PAD, the same low-dose combination reduced acute limb ischemia by 33% after a leg revascularization procedure specifically. Bleeding was somewhat more common in both trials, though not dramatically so, which is why this is a conversation rather than an automatic add-on: it depends on your own bleeding risk.
ACC/AHA (US)
In symptomatic PAD, rivaroxaban 2.5 mg twice daily with low-dose aspirin is Class 1, Level A to reduce major cardiovascular and major limb events, and the same Class 1, Level A applies after revascularization. Full-dose anticoagulation without another indication is Class 3: Harm, Level A.
2024 ACC/AHA Multisociety Guideline for the Management of Lower Extr… · Recommendation behind this rule · class and level read from the guideline tables on 2026-09-30
COMPASS trial, peripheral artery disease subanalysis — rivaroxaban plus aspirin · Class 1 · Level A
“Peripheral artery disease” — an illustrative profile, not a real user.
Cited by the recommendations above.
For practising clinicians. Endorse it, propose a change, or dispute it. We verify every reviewer before a review is shown, and a review stays attached to the version of the rule you saw — if the rule changes, the page says so. You'll be asked to declare any relevant interests; they're shown with your review.
Log in or create an account to submit a review. An account is how we tie a review to a person we can verify.
Runs in lib/engine/preventionEssentials.ts as pad-specific.