CardioVascular and Interventional Radiology

, Volume 36, Issue 6, pp 1493–1499

Clopidogrel Responsiveness in Patients Undergoing Peripheral Angioplasty

  • Georgios Pastromas
  • Stavros Spiliopoulos
  • Konstantinos Katsanos
  • Athanasios Diamantopoulos
  • Panagiotis Kitrou
  • Dimitrios Karnabatidis
  • Dimitrios Siablis
Clinical Investigation

DOI: 10.1007/s00270-013-0577-3

Cite this article as:
Pastromas, G., Spiliopoulos, S., Katsanos, K. et al. Cardiovasc Intervent Radiol (2013) 36: 1493. doi:10.1007/s00270-013-0577-3
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Abstract

Purpose

To investigate the incidence and clinical significance of platelet responsiveness in patients receiving clopidogrel after peripheral angioplasty procedures.

Materials and Methods

This prospective study included patients receiving antiplatelet therapy with clopidogrel 75 mg after infrainguinal angioplasty or stenting and who presented to our department during routine follow-up. Clopidogrel responsiveness was tested using the VerifyNow P2Y12 Assay. Patients with residual platelet reactivity units (PRU) ≥ 235 were considered as nonresponders (NR group NR), whereas patients with PRU < 235 were considered as normal (responders [group R]). Primary end points were incidence of resistance to clopidogrel and target limb reintervention (TLR)-free survival, whereas secondary end points included limb salvage rates and the identification of any independent predictors influencing clinical outcomes.

Results

In total, 113 consecutive patients (mean age 69 ± 8 years) with 139 limbs were enrolled. After clopidogrel responsiveness analysis, 61 patients (53.9 %) with 73 limbs (52.5 %) were assigned to group R and 52 patients (46.1 %) with 66 limbs (47.5 %) to group NR. Mean follow-up interval was 27.7 ± 22.9 months (range 3–95). Diabetes mellitus, critical limb ischemia, and renal disease were associated with clopidogrel resistance (Fisher’s exact test; p < 0.05). According to Kaplan–Meier analysis, TLR-free survival was significantly superior in group R compared with group NR (20.7 vs. 1.9 %, respectively, at 7-year follow-up; p = 0.001), whereas resistance to clopidogrel was identified as the only independent predictor of decreased TLR-free survival (hazard rate 0.536, 95 % confidence interval 0.31–0.90; p = 0.01). Cumulative TLR rate was significantly increased in group NR compared with group R (71.2 % [52 of 73] vs. 31.8 % [21 of 66], respectively; p < 0.001). Limb salvage was similar in both groups.

Conclusion

Clopidogrel resistance was related with significantly more repeat interventions after peripheral angioplasty procedures.

Keywords

Clopidogrel resistancePeripheral arterial diseaseInfrainguinal angioplastyStenting

Copyright information

© Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2013

Authors and Affiliations

  • Georgios Pastromas
    • 1
  • Stavros Spiliopoulos
    • 1
  • Konstantinos Katsanos
    • 1
  • Athanasios Diamantopoulos
    • 1
  • Panagiotis Kitrou
    • 1
  • Dimitrios Karnabatidis
    • 1
  • Dimitrios Siablis
    • 1
  1. 1.Department of Interventional RadiologyPatras University HospitalPatrasGreece