• Impact of ticagrelor and aspirin versus clopidogrel and aspirin in symptomatic patients with peripheral arterial disease: Thrombus burden assessed by optical coherence tomography

    Abstract

    Purpose

    To compare OCT identified white thrombus decline, neointimal hyperplasia and clinical outcomes of patients treated with ticagrelor plus aspirin with those patients treated with clopidogrel plus aspirin after peripheral interventions.

    Background

    Ticagrelor is a potent platelet inhibitor. In patients with coronary artery disease, ticagrelor and aspirin demonstrated reduced rates of stent thrombosis, compared to aspirin and clopidogrel. The clinical importance of potent antiplatelet inhibition after peripheral endovascular interventions is unknown.

    Methods

    We enrolled 18 patients with superficial femoral artery disease and the presence of OCT-detected clot post-stent placement. Patients were randomized to 75 mg clopidogrel once daily for 1 month vs. 90 mg ticagrelor twice daily for 6 months, both in addition to 81 mg aspirin for 6 months. Clot volumes, ankle-brachial index (ABI), 6-minute walk test, and Rutherford classification were measured at baseline and 6-month follow-up. Neointimal hyperplasia and neovascularization were calculated at 6-month follow-up.

    Results

    N = 11 patients were enrolled in the clopidogrel group and N = 7 in the ticagrelor group. There was a significantly greater decrease in white thrombus in the ticagrelor group (median volume/stent length (0.067 vs 0.014 mm 3/mm, p = 0.05)). No differences were found in % neointima (0.412 vs 0.536 mm /mm, p = 0.44) and neovascularization (28 vs 44, p = 0.16). ABI and Rutherford classification were improved significantly after 6 months in the clopidogrel group, with no difference between groups at 6 months in ABI or Rutherford.

    Conclusion

    In symptomatic patients with PAD, ticagrelor showed significant improvement relative to clopidogrel with respect to white thrombus burden decline.

    Highlights

     

    • The impact of Ticagrelor and Clopidogrel to thrombus burden is compared with using OCT in peripheral arterial disease.
    • The ticagrelor group underwent a significantly greater decrease in white thrombus than clopidogrel.
    • No significant decline was observed in red thrombus.
    • Ticagrelor was not superior in respect of neointimal hyperplasia and neovascularization, and clinical outcomes.

    Source:

    Cardiovascular Revascularization Medicine, 2018-10-01, Volume 19, Issue 7, Pages 778-784, Copyright © 2018 Elsevier Inc.

     

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