Abstract
Objective
Adenosine diphosphate (ADP) receptor inhibitors such as clopidogrel are known to be less effective at reducing platelet function for some patients because of a phenomenon called high on-treatment platelet reactivity (HTPR). However, the clinical effect of this for patients undergoing endovascular intervention for peripheral arterial disease is unclear. The aim of this study was to assess the impact of ADP receptor inhibitor HTPR on clinical outcomes following lower limb arterial endovascular intervention for peripheral arterial disease.
Methods
A systematic review and meta-analysis was performed. Primary outcomes included all cause mortality and major bleeding. Secondary outcomes were major adverse cardiovascular events, major adverse limb events, restenosis, and target lesion revascularisation. Outcome quality was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool.
Results
There were 10 eligible studies including 1 444 patients included in the meta-analysis. The most commonly tested ADP receptor inhibitor was clopidogrel (seven studies). The pooled rate of ADP receptor inhibitor HTPR was 29% (95% CI 27 – 32). The meta-analysis showed that ADP receptor inhibitor HTPR was associated with a greater risk of major adverse limb events (OR 6.25, 95% CI 2.09 – 18.68, p = .001) and a trend towards a higher all cause mortality (OR 1.71, 95% CI 0.99 – 2.94, p = .050) and more major adverse cardiovascular events (OR 4.23, 95% CI 0.46 – 38.92, p = .20) after endovascular intervention. Overall strength of evidence was very low for all outcomes.
Conclusion
ADP receptor inhibitor HTPR was associated with worse clinical outcomes after lower limb endovascular intervention for peripheral arterial disease. Prospective studies are required to determine the impact of modifying the antithrombotic regimen on clinical outcomes.
Adenosine diphosphate (ADP) receptor inhibitors such as clopidogrel are known to be less effective at reducing platelet function for some patients because of a phenomenon called high on-treatment platelet reactivity (HTPR). However, the clinical effect of this for patients undergoing endovascular intervention for peripheral arterial disease is unclear. The aim of this study was to assess the impact of ADP receptor inhibitor HTPR on clinical outcomes following lower limb arterial endovascular intervention for peripheral arterial disease.
Methods
A systematic review and meta-analysis was performed. Primary outcomes included all cause mortality and major bleeding. Secondary outcomes were major adverse cardiovascular events, major adverse limb events, restenosis, and target lesion revascularisation. Outcome quality was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool.
Results
There were 10 eligible studies including 1 444 patients included in the meta-analysis. The most commonly tested ADP receptor inhibitor was clopidogrel (seven studies). The pooled rate of ADP receptor inhibitor HTPR was 29% (95% CI 27 – 32). The meta-analysis showed that ADP receptor inhibitor HTPR was associated with a greater risk of major adverse limb events (OR 6.25, 95% CI 2.09 – 18.68, p = .001) and a trend towards a higher all cause mortality (OR 1.71, 95% CI 0.99 – 2.94, p = .050) and more major adverse cardiovascular events (OR 4.23, 95% CI 0.46 – 38.92, p = .20) after endovascular intervention. Overall strength of evidence was very low for all outcomes.
Conclusion
ADP receptor inhibitor HTPR was associated with worse clinical outcomes after lower limb endovascular intervention for peripheral arterial disease. Prospective studies are required to determine the impact of modifying the antithrombotic regimen on clinical outcomes.
| Original language | English |
|---|---|
| Pages (from-to) | 91-101 |
| Number of pages | 11 |
| Journal | European Journal of Vascular and Endovascular Surgery |
| Volume | 63 |
| Issue number | 1 |
| Early online date | 26 Nov 2021 |
| DOIs | |
| Publication status | Published - 20 Jan 2022 |
Bibliographical note
Publisher Copyright:© 2021 European Society for Vascular Surgery
Keywords
- ADP receptor inhibitors
- Endovascular intervention
- Peripheral arterial disease
- Platelet function test
- Platelet reactivity