Inadequate response to antiplatelet therapy in patients with peripheral artery disease: a prospective cohort study

Thrombosis Journal

Research

H. M. H. Spronk¹  B. M. M. Kremers¹  A. J. ten Cate-Hoek²  H. ten Cate³  B. M. E. Mees⁴  J. H. C. Daemen⁴ 

[1] Department of Biochemistry, Laboratory for Clinical Thrombosis and Hemostasis, Maastricht University, Maastricht, The Netherlands;Department of Biochemistry, Laboratory for Clinical Thrombosis and Hemostasis, Maastricht University, Maastricht, The Netherlands;Thrombosis Expertise Center, Maastricht University Medical Center, Maastricht, The Netherlands;Department of Biochemistry, Laboratory for Clinical Thrombosis and Hemostasis, Maastricht University, Maastricht, The Netherlands;Thrombosis Expertise Center, Maastricht University Medical Center, Maastricht, The Netherlands;Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands;Center for Thrombosis and Hemostasis, Gutenberg University Medical Center, Mainz, Germany;Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, The Netherlands;

关键词: Atherosclerosis;    Atherothrombosis;    Peripheral artery disease;    Cardiovascular risk;    Antiplatelet therapy;    High on-treatment platelet reactivity;   

DOI  :  10.1186/s12959-022-00445-4

 received in 2022-03-07, accepted in 2022-12-22,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundPatients with peripheral artery disease (PAD) are treated with preventive strategies to improve the cardiovascular risk. The incidence of cardiovascular events and mortality however remains high in PAD populations. We therefore aimed to better characterize PAD patients suffering from cardiovascular events and mortality in order to tailor preventive treatment.MethodsBetween 2018 and 2020, 246 PAD outpatients (17 newly diagnosed, 229 with known PAD) were prospectively enrolled in this observational cohort study. Patient data and blood samples were collected after inclusion, and the primary composite endpoint (myocardial infarction, elective coronary revascularization, ischemic stroke, acute limb ischemia, mortality) was evaluated after one year. Secondary outcomes included platelet reactivity, measured using the VerifyNow assay, and medication adherence, assessed using the Morisky Medication Adherence Scale-8 (MMAS-8). Logistic regression models were used to identify associations between characteristics and the occurrence of events.ResultsThe cohort comprised 207 patients with claudication and 39 with chronic limb threatening ischemia. Twenty-six (10.6%) patients suffered from an event during follow-up. Prior myocardial infarction (OR 3.3 [1.4–7.7]), prior ischemic stroke (OR 4.5 [1.8–10.9]), higher levels of creatinine (OR 5.2 [2.2–12.6]), lower levels of high-density lipoprotein (OR 4.2 [1.5–10.6]) and lower haemoglobin levels (OR 3.1 [1.3–7.1]) were associated with events. Patients with events had more often high on-treatment platelet reactivity (HTPR) on aspirin (OR 5.9 [1.4–25.1]) or clopidogrel (OR 4.3 [1–19.3]). High adherence to medication was associated with the occurrence of events (OR 4.1 [1–18]).ConclusionsPatients suffering from cardiovascular events and mortality were characterized by prior cardiovascular events as compared to patients who did not experience any events. Antiplatelet therapy was not optimally protective despite high medication adherence, and HTPR was independently associated with the occurrence of events. More research is needed on alternative treatment strategies such as dual antiplatelet therapy or combinations with anticoagulant drugs.Trial registrationThe Medical Ethics Committee (METC) of the MUMC+ approved the study (NL63235.068.17) and the study was registered in the Netherlands Trial Register (NTR7250).

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

41116_2022_35_Article_IEq105.gif

41116_2022_35_Article_IEq103.gif

Fig. 1