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Impact of high on-treatment platelet reactivity after angioplasty in patients with peripheral arterial disease

机译：高治疗血小板反应性血管成形术后血管成形术后的影响

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Objective: High on-treatment platelet reactivity (HTPR) to dual antiplatelet therapy (DAPT) predicts adverse events in coronary artery disease patients. In peripheral artery disease (PAD) patients, data concerning the clinical impact of HTPR are limited. Therefore, we evaluated the incidence of (i) HTPR to DAPT and (ii) its impact on 6 months outcome after angioplasty. Methods and results: In this prospective single center analysis, we investigated 102 consecutive patients with PAD from 2016 to 2017. All patients underwent peripheral endovascular treatment due to intermittent claudication (Fontaine IIb). Clopidogrel effects were measured using vasodilator-stimulated protein phosphorylation (VASP) assay, aspirin effects by light-transmission aggregometry (LTA). Major adverse limb events (MALE), major adverse cardiac and cerebrovascular events (MACCE) and BARC bleeding (bleeding academic research consortium classification) within 6 months were assessed. HTPR to clopidogrel (n = 37, 36%), to aspirin (n = 11, 11%) and to both (n = 11, 11%) were frequent. Compared to sufficient platelet inhibition by aspirin and clopidogrel (n = 43, 42%), patients with dual HTPR showed a higher risk of MALE at 6 months (27% vs. 7%; hazard ratio [HR]: 4.45; 95% confidence interval [CI]: 1.1 to 67.8;p= .03). This was independent of diabetes, creatinine, body mass index, and age as well as of procedural details in a multivariate logistic regression analysis. MACCE (n = 2) and BARC bleeding rates (n = 2) were low. Conclusion: In this small exploratory study, HTPR was frequent in PAD patients. Furthermore, the results are suggestive that MALE might be associated with dual HTPR. This leads to the hypothesis that optimized antithrombotic regimens post percutaneous transluminal angioplasty should be tested in clinical trials.
机译：目的：双重抗血小板治疗（DAPT）的高治疗期血小板反应性（HTPR）预测冠心病患者的不良事件。在外周动脉疾病（PAD）患者中，有关HTPR临床影响的数据有限。因此，我们评估了（i）HTPR对DAPT的发生率，以及（ii）其对血管成形术后6个月预后的影响。方法和结果：在这项前瞻性单中心分析中，我们调查了2016年至2017年连续102例PAD患者。所有患者均因间歇性跛行（Fontaine IIb）接受了外周血管内治疗。氯吡格雷效应通过血管扩张剂刺激蛋白磷酸化（VASP）测定，阿司匹林效应通过光透射聚集测定（LTA）测定。评估6个月内的主要不良肢体事件（男性）、主要不良心脑血管事件（MACCE）和BARC出血（出血学术研究联盟分类）。HTPR对氯吡格雷（n=37,36%）、阿司匹林（n=11,11%）和两者（n=11,11%）的疗效比较常见。与阿司匹林和氯吡格雷充分抑制血小板（n=43,42%）相比，双重HTPR患者在6个月时表现出更高的男性风险（27%对7%；危险比[HR]：4.45；95%可信区间[CI]：1.1至67.8；p=0.03）。在多元逻辑回归分析中，这与糖尿病、肌酐、体重指数、年龄以及手术细节无关。MACCE（n=2）和BARC出血率（n=2）较低。结论：在这项小型探索性研究中，PAD患者常发生HTPR。此外，研究结果提示男性可能与双重HTPR有关。这导致了一个假设，即经皮腔内血管成形术后的最佳抗血栓治疗方案应在临床试验中进行测试。

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