What is the clinical evidence from this study?

Study design: Observational. Population: Peripheral arterial disease (PAD) (n=72). Intervention: Percutaneous transluminal angioplasty (PTA) vs. Pre-procedure baseline. Primary outcome: Aspirin resistance measured by PFA-200 before surgery in patients permanently taking ASA.

March 22, 2021Open Access

Assessment of platelet function and resistance to aspirin and clopidogrel in patients with peripheral arterial disease undergoing percutaneous transluminal angioplasty

GBGrzegorz BorowskiMedical University of Lublin ANAleksandra NowaczyńskaMedical University of Lublin

Key Result

Percutaneous transluminal angioplasty increased platelet activation in patients with peripheral arterial disease, with approximately 40% of patients demonstrating resistance to aspirin.

Study Design

Type

Observational (n=72)

Multicenter

Structured PICO

Does percutaneous transluminal angioplasty increase platelet activation and resistance to aspirin and clopidogrel in patients with peripheral arterial disease?

Population

72 patients aged 44 to 89 with peripheral arterial disease undergoing percutaneous transluminal angioplasty, assessed for platelet function and resistance to aspirin and clopidogrel.

Exposure

Percutaneous transluminal angioplasty (PTA) with either balloon angioplasty followed by aspirin 75 mg monotherapy, or stent implantation followed by dual antiplatelet therapy (aspirin 75 mg + clopidogrel 75 mg).

Comparator

Pre-procedure baseline vs post-procedure, and aspirin monotherapy vs dual antiplatelet therapy.

Outcome

Platelet function and resistance to aspirin and clopidogrel measured by PFA-200, IVY bleeding time, and cytometric evaluation of CD62p and CD63 expression on the first day after the procedure.surrogate

Percutaneous transluminal angioplasty increases platelet activation and resistance to aspirin and clopidogrel in patients with PAD, which is better mitigated by dual antiplatelet therapy than aspirin monotherapy.

Limitations

Resistance to aspirin and platelet function were assessed only before the PTA procedure and in the first 24 hours after.
The possible long-term dynamics of the response to antiplatelet drugs was not assessed.
Small sample size of 72 patients.

Abstract

Introduction: Analysis of platelet function, acetylsalicylic acid (ASA) and clopidogrel resistance in patients with peripheral arterial disease (PAD) undergoing percutaneous transluminal angioplasty (PTA), the impact of procedure on this phenomenon, connection with diabetes, hypertension, smoking. Material and methods: The study included 72 patients, with a group of patients taking ASA on a permanent basis and a group of patients in whom treatment was implemented after the procedure. Patients were also divided according to the antiplatelet therapy applied, either double-therapy, or ASA monotherapy. Daily doses were 75 mg. Three methods were used for the evaluation of the platelet function: IVY bleeding time, cytometric evaluation of platelet surface antigen (CD62p and CD63) expression and hemostasis measurement by PFA-200®. Results: In the PFA-200 analysis, ASA resistance was found in 37.8% (64.7% were tobacco smokers) before surgery. Patients not taking ASA before, after PTA and first dose of ASA presented resistance in 63%. The first dose of clopidogrel after surgery was associated with resistance in 73.7%. Significant differences in the expression of CD62p and CD63 markers before and after PTA were observed. According to IVY method, aspirin resistance was found in 40% of patients permanently receiving ASA. Conclusions: Patients with PAD who undergo PTA are resistant to ASA in 40%, smoking is associated with this phenomenon. PTA increases the expression of CD62P and CD63, and thus the platelet activation, which is not adequately prevented by antiplatelet drugs at a dose of 75 mg. Dual antiplatelet therapy reduces the activation of thrombocytes more than the monotherapy of ASA.

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