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CardioVascular and Interventional Radiology

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01-12-2014 | Clinical Investigation

Initial Experience With Ticagrelor in Patients With Critical Limb Ischemia and High On-Clopidogrel Platelet Reactivity Undergoing Complex Peripheral Endovascular Procedures

Authors: Stavros Spiliopoulos, Konstantinos Katsanos, Georgios Pastromas, Athanasios Diamantopoulos, Panagiotis Kitrou, Dimitris Siablis, Dimitris Karnabatidis

Published in: CardioVascular and Interventional Radiology | Issue 6/2014

Abstract

Purpose

To investigate the safety and efficacy of ticagrelor in patients with critical limb ischemia (CLI) and high on-clopidogrel platelet reactivity (HCPR) undergoing complex, limb-salvage, peripheral endovascular procedures (PEP).

Materials and Methods

The study included consecutive patients with HCPR undergoing PEP for CLI. HCPR was defined as platelet reaction units (PRU) >234 as assessed by the VerifyNow P2Y12 assay. Patients with HCPR were prescribed ticagrelor, 180/90 mg twice daily, and aspirin, 100 mg daily, for 6 months and ticagrelor, 180/90 mg twice daily, thereafter. Primary safety outcome was total major bleeding, and primary efficacy outcome was the composite of cardiovascular death and major amputation. Secondary outcomes included the level of platelet inhibition achieved and target limb revascularization (TLR)-free survival rate.

Results

In total, 37 CLI patients with 40 limbs were investigated. Mean follow-up period was 11.3 ± 5.0 months (range 6–21). The mean treated lesion length was 229.2 ± 71.4 mm in the femoropopliteal axis and 179.3 ± 83.9 mm in the infrapopliteal arteries. No major or minor bleeding was detected. There were four periprocedural minor adverse events (10.8 %), and in two cases (5.6 %) ticagrelor was discontinued. In all patients, ticagrelor achieved platelet inhibition lower than the cut-off value. Mean PRU during clopidogrel therapy was 308.4 ± 41.8 (range 257–422) versus 67.0 ± 52.8 (range 2–189) when switched to ticagrelor; p < 0.0001. Kaplan–Meier estimated primary efficacy outcome and TLR-free survival rates were 92.0 and 67.3 % at 12 months, respectively.

Conclusion

In this series of CLI patients with HCPR undergoing complex PEP, initial experience with ticagrelor was proven safe and efficient because it resulted in sufficient platelet inhibition and satisfactory clinical results without major complications.

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Title: Initial Experience With Ticagrelor in Patients With Critical Limb Ischemia and High On-Clopidogrel Platelet Reactivity Undergoing Complex Peripheral Endovascular Procedures
Authors: Stavros Spiliopoulos
Konstantinos Katsanos
Georgios Pastromas
Athanasios Diamantopoulos
Panagiotis Kitrou
Dimitris Siablis
Dimitris Karnabatidis
Publication date: 01-12-2014
Publisher: Springer US
Published in: CardioVascular and Interventional Radiology / Issue 6/2014
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI: https://doi.org/10.1007/s00270-014-0852-y

2024 ASCO Annual Meeting

Springer Medicine

Initial Experience With Ticagrelor in Patients With Critical Limb Ischemia and High On-Clopidogrel Platelet Reactivity Undergoing Complex Peripheral Endovascular Procedures

Abstract

Purpose

Materials and Methods

Results

Conclusion

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Purpose

Materials and Methods

Results

Conclusion

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