Cardiovascular Research Institute Düsseldorf (CARID), Division of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Duesseldorf, Germany.
Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK.
Platelets. 2021 Apr 3;32(3):391-397. doi: 10.1080/09537104.2020.1742314. Epub 2020 Apr 7.
: 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.: 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; = .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.: 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.
: 治疗中血小板反应性（HTPR）对双联抗血小板治疗（DAPT）高预测冠心病患者的不良事件。在周围动脉疾病（PAD）患者中，关于 HTPR 的临床影响的数据有限。因此，我们评估了（i）HTPR 对 DAPT 的发生率和（ii）它对血管成形术后 6 个月结果的影响：在这项前瞻性单中心分析中，我们研究了 2016 年至 2017 年间的 102 例连续 PAD 患者。所有患者因间歇性跛行（Fontaine IIb）而行外周血管腔内治疗。使用血管扩张刺激蛋白磷酸化（VASP）测定法测量氯吡格雷的作用，使用光传输聚集测定法（LTA）测量阿司匹林的作用。在 6 个月内评估主要不良肢体事件（MALE）、主要不良心脏和脑血管事件（MACCE）和 BARC 出血（出血学术研究联合会分类）。氯吡格雷（n=37，36%）、阿司匹林（n=11，11%）和两者均有 HTPR（n=11，11%）的患者较为常见。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 MALE 的风险更高（27%比 7%；风险比[HR]：4.45；95%置信区间[CI]：1.1 至 67.8； =.03）。这在多变量逻辑回归分析中独立于糖尿病、肌酐、体重指数和年龄以及程序细节。MACCE（n=2）和 BARC 出血率（n=2）较低：在这项小型探索性研究中，PAD 患者中 HTPR 较为常见。此外，结果表明 MALE 可能与双重 HTPR 相关。这导致假设经皮腔内血管成形术后优化的抗血栓形成方案应在临床试验中进行测试。
