On-Treatment Platelet Reactivity is a Predictor of Adverse Events in Peripheral Artery Disease Patients Undergoing Percutaneous Angioplasty.

Abstract

OBJECTIVES:

Few data are available on the association between a different entity of platelet inhibition on antiplatelet treatment and clinical outcomes in patients with peripheral artery disease (PAD). The aim of this study was to evaluate the degree of on-treatment platelet reactivity, and its association with ischaemic and haemorrhagic adverse events at follow up in PAD patients undergoing percutaneous transluminal angioplasty (PTA).

METHODS:

In this observational, prospective, single centre study, 177 consecutive patients with PAD undergoing PTA were enrolled, and treated with dual antiplatelet therapy with aspirin and a P2Y12 inhibitor. Platelet function was assessed on blood samples obtained within 24 h from PTA by light transmission aggregometry (LTA) using arachidonic acid (AA) and adenosine diphosphate (ADP) as agonists of platelet aggregation. High on-treatment platelet reactivity (HPR) was defined by LTA ≥ 20% if induced by AA, and LTA ≥ 70% if induced by ADP. Follow up was performed to record outcomes (death, major amputation, target vessel re-intervention, acute myocardial infarction and/or myocardial revascularisation, stroke/TIA, and bleeding).

RESULTS:

HPR by AA and HPR by ADP were found in 45% and 32% of patients, respectively. During follow up (median duration 23 months) 23 deaths (13%) were recorded; 27 patients (17.5%) underwent target limb revascularisation (TLR), two (1.3%) amputation, and six (3.9%) myocardial revascularisation. Twenty-four patients (15.6%) experienced minor bleeding. On multivariable analysis, HPR by AA and HPR by ADP were independent predictors of death [HR 3.8 (1.2-11.7), p = .023 and HR 4.8 (1.6-14.5), p = .006, respectively]. The median value of LTA by ADP was significantly lower in patients with bleeding complications than in those without [26.5% (22-39.2) vs. 62% (44.5-74), p < .001). LTA by ADP ≤ 41% was independently associated with bleeding HR 14.6 (2.6-24.0), p = .001] on multivariable analysis.

CONCLUSIONS:

In this study a high prevalence of on-clopidogrel and aspirin high platelet reactivity was found, which was significantly associated with the risk of death. Conversely, a low on-clopidogrel platelet reactivity was associated with a higher risk of bleeding. These results document that the entity of platelet inhibition is associated with both thrombotic and bleeding complications in PAD patients.

• Authors: Elisa Grifoni, Anna Maria Gori, Betti Giusti, Renato Valenti, Angela Migliorini, Stefania Basili, Rita Paniccia, Mahmoud Farouk Elmahdy, Raffaele Pulli, Carlo Pratesi, David Antoniucci, Francesco Violi, Rossella Marcucci
• Journal: European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery (Eur J Vasc Endovasc Surg) Vol. 56 Issue 4 Pg. 545-552 (Oct 2018) ISSN: 1532-2165 [Electronic] England
• PMID: 30025662 (Publication Type: Journal Article)
• Copyright: Copyright © 2018 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.

Chemical References

• Platelet Aggregation Inhibitors
• Clopidogrel

Topics

• Aged
• Aged, 80 and over
• Angioplasty (methods)
• Blood Platelets
• Clopidogrel (therapeutic use)
• Female
• Humans
• Male
• Middle Aged
• Myocardial Infarction (drug therapy)
• Peripheral Arterial Disease (drug therapy)
• Platelet Aggregation Inhibitors (therapeutic use)
• Platelet Function Tests