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DAPT may reduce MACE, mortality in patients with symptomatic PAD
Dual antiplatelet therapy with aspirin and clopidogrel was associated with reduced rates of major adverse cardiac events and mortality at 3 years compared with aspirin monotherapy in patients with claudication or critical limb ischemia.
Researchers conducted an observational cohort study to compare DAPT with aspirin and clopidogrel (n = 348) vs. aspirin monotherapy (n = 281) in 629 patients. The mean age of the cohort was 67 years and 44% were women. Endovascular intervention was performed in 80% of patients.
At 3 years, the rate of MACE was 20% in the DAPT group vs. 28% in the monotherapy group (P = .03). Results of a propensity-matched analysis indicated that DAPT decreased the risk for MACE (adjusted HR = 0.65; 95% CI, 0.44-0.96) and overall mortality (adjusted HR = 0.55; 95% CI, 0.35-0.89) compared with monotherapy. DAPT failed to reduce risk for major amputation (adjusted HR = 0.69; 95% CI, 0.37-1.29). The researchers found no link between DAPT and target vessel revascularization during follow-up.
The researchers also conducted a subgroup analysis of 94 patients who had point-of-care platelet function testing. Of those, 55% exhibited decreased response to clopidogrel and 21% exhibited decreased response to aspirin. The researchers reported no association between reduced response to clopidogrel or aspirin and 1-year adverse event rates.
“These results suggest that DAPT may provide an additional long-term reduction in cardiovascular events among patients with lifestyle-limiting claudication or [critical limb ischemia],” the researchers concluded. “Additional randomized studies are warranted to assess the additive benefit of more intensive and DAPT among patients with advanced PAD.” – by Rob Volansky
Disclosure: One researcher reports consulting for Abbott, Bard, Boston Scientific, Covidien and Medtronic; another researcher reports consulting for Abbott, Medtronic and Spectranetics; and the other researchers report no relevant financial disclosures.