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Antiplatelet therapy is one of the cornerstones of peripheral arterial disease management, but its role extends beyond simply prescribing aspirin or clopidogrel. This clinical reference reviews the vascular-surgery decision points around aspirin, clopidogrel, cilostazol, dual antiplatelet therapy, dual-pathway inhibition, peri-revascularization management, dialysis access, and aneurysm disease — with practical emphasis on when to continue, stop, restart, escalate, or avoid therapy.