Personalized Antiplatelet Therapy Following Endovascular Revascularization in Peripheral Artery Occlusive Disease: A Novel Concept

Abstract

Case:A 73 year old patient with a longstanding history of peripheral artery occlusive disease (PAOD) presented with an acute on chronic progression of symptoms, based on a long occlusion of the superficial femoral artery (SFA), which was treated by thrombosuction, percutaneous transluminal angioplasty, and SFA stenting. Postprocedural dual antiplatelet therapy was initiated and subsequently adjusted based on platelet reactivity testing. Discussion: Increasingly complex arterial lesions are treated by an endovascular approach; however, long-term patency rates are often disappointing. In order to optimize the patency rates (dual) antiplatelet therapy is initiated. It is known that a substantial proportion of patients have high platelet reactivity despite the use of antiplatelet drugs. Several methods have been published to test the individual response to different antiplatelet drugs. There is evidence that adjusting antiplatelet therapy based on platelet reactivity testing results in a reduction of cardiovascular events and bleeding complications; however, the optimal test and the exact role of personalized antiplatelet therapy in PAOD is currently unknown.

Antiplatelet therapy for tibial balloon angioplasty: A clinical perspective

“…Assuming that a high proportion of CLI patients have a high platelet activity on aspirin and/or clopidogrel, tailoring therapy of antiplatelet drugs based on platelet testing seems appealing. 69 However, two randomized trials (ARTIC 70 and GRAVITAS) 71 totalling 4654 patients undergoing coronary stenting in the setting of stable coronary artery disease (CAD) or non-ST elevation myocardial infarction did not show any benefit of the tailored approach with respect to CV death, ST and non-ST myocardial infarction, and bleeding complications.…”

High On-Treatment Platelet Reactivity in Peripheral Arterial Disease: A Pilot Study to Find the Optimal Test and Cut Off Values

“…13e16 The existence of HCPR has led to the concept of tailored APT, the idea that simply testing platelet reactivity in response to APT and adjusting the regimen based on the results, will lead to improved clinical outcomes. 17 Most research on this concept is performed in cardiac patients undergoing percutaneous coronary intervention. To date, clinical trials on tailored APT have shown diverging results.…”