Platelet reactivity still high after clopidogrel therapy in symptomatic femoropopliteal disease

Platelet reactivity remains high in patients with symptomatic femoropopliteal disease treated with clopidogrel vs ticagrelor after implantation of drug-eluting stents (DESs), a new study has found.

Researchers randomly assigned 40 eligible patients who had undergone DES implantation to receive ticagrelor (mean age, 73±9 years; 70 percent male) or clopidogrel (mean age, 71±9 years; 60 percent male) with aspirin for the first 3 months and alone for the succeeding 9 months. Platelet reactivity was the outcome of interest and was assessed before the intervention and at the 3-month follow-up, after aspirin discontinuation.

Mean platelet reactive units (PRUs) were significantly higher at 3 months in patients who had been treated with clopidogrel (200±61 vs 81±72; p<0.001). Baseline PRU values were comparable between groups (242±60 vs 261±60). The decrease from baseline in the ticagrelor arm was also significant (p<0.0001).

In contrast, frequency-domain optical coherence tomography (FD-OCT) showed that ticagrelor and clopidogrel were similarly effective in terms of percentage volume obstruction at follow-up (29.7±17.6 percent vs 31.2±10.7 percent; p=0.78).

Similarly, the percentage of uncovered stent struts was comparable between the treatment arms (24.2±32.8 percent vs 15.3±15.8 percent; p=0.4).

Both interventions also had comparable clinical efficacy. Target limb vascularization was reported in five patients in the ticagrelor group and in six in the clopidogrel arm. Three deaths were reported, two of which were from the clopidogrel group.