Management of peripheral arterial interventions with mono or dual antiplatelet therapy—the MIRROR study: a randomised and double-blinded clinical trial

Abstract

Dual antiplatetet therapy reduces peri-interventional platelet activation and improves functional outcome without higher bleeding complications. An individual tailored dual antiplatelet therapy seems desirable for endovascularly treated patients with PAD.

Association of dual-antiplatelet therapy with reduced major adverse cardiovascular events in patients with symptomatic peripheral arterial disease

“…35 Insufficient inhibition of platelet activation is a risk factor for future atherothrombotic events because platelets mediate many of the early steps in thrombosis. 36 In patients with PAD, incomplete platelet inhibition has also been shown to be associated with greater circulating levels of platelet activation markers, including b-thromboglobulin and CD40 L. 37 Whether adjusting the dose of clopidogrel to achieve greater platelet inhibition among patients with PAD could reduce cardiovascular events remains uncertain, because recent studies in patients undergoing percutaneous coronary intervention have failed to show an effect of tailored antiplatelet dosing on subsequent outcomes. 38,39 One study of platelet responsiveness monitored 100 patients for 1 year after femoropopliteal angioplasty and stenting.…”

Standards of Practice for Superficial Femoral and Popliteal Artery Angioplasty and Stenting

“…Dual antiplatelet therapy is used empirically and on an individual basis following stent placement of complex femoropopliteal stenosis or after drug-coated devices because of the presumed increased risk of acute stent thrombosis [26,68]. There is however emerging evidence that for tailored antiplatelet therapy following screening for clopidogrel high on treatment platelet reactivity (HTPR) (by doubling the dose or switching to alternative antiplatelet agents) may be the next step in antiplatelet management of PAD patients [69,70]. Regular outpatient visits at 6 weeks, 6 months, and yearly thereafter are recommended for routine clinical assessment and early identification of any recurrent symptoms suggesting target vessel failure.…”

The role of antiplatelet therapy in patients with peripheral artery disease and lower extremity peripheral artery revascularization

“…The Management of Peripheral Arterial Interventions with Mono or Dual Antiplatelet Therapy RCT randomized 80 patients to receive aspirin þ clopidogrel vs. aspirin þ placebo for 6 months following PTA and/or stenting [39]. The primary endpoint measured platelet activation markers to a loading dose of clopidogrel and aspirin and a secondary endpoint measured 6-month need for target lesion revascularization (TLR).Ultimately, 30% of patients showed clopidogrel resistance, while 6-month TLR rates were significantly reduced using DAPT (20 vs. 5%; P ¼ 0.040).…”