Project Coversheet

Date of Award


Degree Type

DNP Project

Degree Name

Doctor of Nursing (ND)




Hector R. Morales, DNP, APRN, PHH/CS-BC


Background: Peripheral arterial disease (PAD) affects 10 million adults in the United States and remains a major cause of morbidity, mortality, and disability worldwide despite recent advances in medical, endovascular, and surgical therapies. After lower extremity revascularization (LER), patients are at heightened risk for developing major adverse cardiovascular events (MACE) and major adverse limb events (MALE). Current guidelines for the medical management of these conditions include antiplatelet therapy and aspirin (ASA). Upon reflection on current practice and performing an evidence-based literature review using the ACE Star Model, areas of opportunity for improved management of patients undergoing revascularization for symptomatic PAD became evident and resulted in the development of a quality improvement (QI) project.

Method: The QI project implemented the use of rivaroxaban plus ASA to reduce the primary composite outcomes that include acute limb ischemia, including major amputation, myocardial infarction, ischemic stroke, and/or cardiovascular death. The project was conducted over eight weeks and included 10 patients undergoing LER. Two patients met the inclusion criteria for the implementation of this initiative.

Results: The patients treated with rivaroxaban and ASA reported significant improvement in their symptoms. Ankle-brachial index (ABI) examination also revealed significant improvement in circulation in the lower extremities.

Discussion: The development of MALE is associated with poor prognosis among individuals diagnosed with PAD. Treatment with rivaroxaban along with ASA significantly reduced the incidence of complications and should be considered as an important therapy for this condition.