Effect of Ticlopidine on Graft Patency Following Arterial Reconstructive Surgery in the Lower Extremity: A Multicenter Three-Year Prospective Study

Abstract

A multicenter, randomized, prospective trial was conducted to determine the clinical efficacy of ticlopidine, an antiplatelet agent, in the prevention of graft occlusion following vascular reconstructive surgery of the lower extremity for arteriosclerosis obliterans. Ticlopidine was administered for two years to one group of patients (112 reconstructed arterial segments) while a control group received no antithrombotic therapy (108 segments). There was no significant difference between the treated and control groups in the overall cumulative patency rates for both suprainguinal and infrainguinal reconstructions. In the treated group, however, there was a significant reduction of occlusions in patients with rest pain or ischemic gangrene (p < 0.1) and in those with hyperlipidemia (p < 0.05). Ticlopidine-treated patients with infrainguinal arterial at Purdue University on April 13, 2015 ves.sagepub.com Downloaded from 542 reconstructions developed more occlusions than controls between three and twelve months after surgery, but the controls had more occlusions both immediately after surgery and in the second postoperative year. It appeared, therefore, that ticlopidine reduced graft failure due to neointimal fibrous hyperplasia or progression of the underlying condition but caused an adverse effect by delaying graft healing. The clinical usefulness of antiplatelet therapy is limited, but it may be effective in the prevention of graft occlusion when administered to the selected patient groups above mentioned. Controversy about antiplatelet therapy and future research on adjuvant drug therapy after arterial reconstruction are discussed.

Adjuvant medical therapy in peripheral bypass surgery

“…Two controlled trials of the platelet inhibitor, ticlopidine, in peripheral bypass grafts have been reported ( Table 2). The open, controlled trial 25 showed treatment bene®t only in a subgroup of patients with hyperlipidaemia and not overall or in a number of other subgroups analysed. The second trial published 26 had a multicentre, double-blind, placebocontrolled design and showed a signi®cant treatment bene®t up to 2 years in terms of graft patency, whether analysed by life-table techniques or by ITT analysis of patients alive with primary or secondary graft patency.…”