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Combination Antiplatelet Therapy in Patients with Peripheral Vascular Bypass Grafts

Lookup NU author(s): Dr Jonathan Smout, Dr Brian Shenton, Professor Gerard Stansby

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Abstract

Peripheral bypass graft occlusion occurs in approximately 25% of cases in the 5 years following surgery; hence, therapies directed at reducing the tendency toward thrombotic occlusion are of clinical importance. This trial was conducted to determine if the addition of clopidogrel to aspirin enhances antiplatelet therapy in patients with infrainguinal bypass grafts. A randomized placebo-controlled study was performed on 20 patients over 3 months following infrainguinal bypass surgery. In addition to their regular aspirin therapy, patients were randomized to receive either clopidogrel (group 1) or placebo (group 2) for 1 week. Platelet activation was measured ex vivo by platelet aggregometry and flow cytometry. In group 1, there was a significant reduction in spontaneous (SP), adenosine diphosphate (ADP), and arachidonic acid (AA)-induced platelet aggregation compared with group 2; SP -17% (CI -33, -0.2 p = 0.048), ADP -39%, (CI -56, -22 p = 0.001), AA -21% (CI -39, -4 p = 0.023). Flow cytometry demonstrated a significant reduction in ADP-induced platelet P-selectin expression and GPIIb/IIIa activation following treatment with clopidogrel but not with placebo. This study demonstrated that the addition of clopidogrel to aspirin reduces platelet activation measured by platelet aggregation and flow cytometry, supporting a long-term trial with clinical endpoints.


Publication metadata

Author(s): Smout JD, Mikhailidis DP, Shenton BK, Stansby G

Publication type: Article

Publication status: Published

Journal: Clinical and Applied Thrombosis/Hemostasis

Year: 2004

Volume: 10

Issue: 1

Pages: 9-18

Print publication date: 01/01/2004

ISSN (print): 1076-0296

ISSN (electronic): 1938-2723

Publisher: Sage

URL: http://dx.doi.org/10.1177/107602960401000103

DOI: 10.1177/107602960401000103

PubMed id: 14979400


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