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

Abstract

OBJECTIVES:

To investigate the influence of dual antiplatelet therapy vs. aspirin alone on local platelet activation and clinical endpoints in patients with PAD treated with endovascular therapy.

METHODS:

Patients received either 500 mg aspirin and 300 mg clopidogrel before intervention followed by a daily dose of 100 mg aspirin and 75 mg clopidogrel for 6 months, or the same doses of aspirin plus placebo instead of clopidogrel. Primary endpoints were local concentrations of platelet activation markers β-thromboglobulin and CD40L, and the rate of patient's resistant to clopidogrel. Secondary endpoints included the clinical development 6 months after the intervention.

RESULTS:

Eighty patients, 40 in each group, were enrolled. The median peri-interventional concentration of β-TG was 224.5 vs. 365.5 (P = 0.03) in the clopidogrel and placebo group. The concentration of CD40L was 127 and 206.5 (P = 0.05). Thirty per cent of patients who had received clopidogrel were resistant. Two clopidogrel and eight placebo patients required TLR (P = 0.04). The clopidogrel patients who needed revascularisation were both resistant to clopidogrel. Minor bleeding complications occurred in one clopidogrel and two placebo patients.

CONCLUSION:

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.

• Authors: Gunnar Tepe, Rüdiger Bantleon, Klaus Brechtel, Jörg Schmehl, Thomas Zeller, Claus D Claussen, Frederik F Strobl
• Journal: European radiology (Eur Radiol) Vol. 22 Issue 9 Pg. 1998-2006 (Sep 2012) ISSN: 1432-1084 [Electronic] Germany
• PMID: 22569995 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Platelet Aggregation Inhibitors
• Aspirin

Topics

• Aged
• Angioplasty (adverse effects)
• Aspirin (therapeutic use)
• Double-Blind Method
• Female
• Humans
• Male
• Peripheral Arterial Disease (complications, surgery)
• Platelet Aggregation Inhibitors (therapeutic use)
• Thrombosis (drug therapy, etiology)
• Treatment Outcome