Antithrombotic Therapy in Peripheral Arterial Occlusive Disease: Peripheral angioplasty
The combined use of aspirin and ticlopidine after coronary angioplasty and stenting appears to result in synergistic platelet inhibition compared to monotherapy with either agent; however, differences in clinical outcome were not shown in a trial that evaluated changes in platelet activation In a randomized clinical trial comparing ticlopidine and aspirin to aspirin alone in 226 patients undergoing PTCA with stenting, the rates of stent thrombosis and composite major clinical adverse events were higher in the group treated with aspirin alone (2.9% and 3.9%, respectively) than with combination therapy (0.8% and 0.8%, respectively), but these differences failed to achieve statistical significance Other investigators have shown a reduction in stent thrombosis using a combination of ticlopidine and aspirin compared with aspirin alone; however, the study was not randomized and few patients were in the aspirin-only group. flovent inhaler
In a retrospective study of 264 patients undergoing PTCA with stenting, no difference in stent thrombosis or major adverse clinical events was observed in those treated with aspirin and ticlopidine vs those treated with aspirin alone A randomized clinical trial (level I) in which the combination of aspirin and ticlopidine was compared with aspirin plus anticoagulation showed a reduction in the rate of cardiac events and bleeding complications in the group treated with aspirin and ticlopidine An aspirin-alone group was not evaluated. Given the heterogeneity in the trials evaluating ticlopidine for PTCA, the addition of ticlopidine to aspirin for routine use in conjunction with peripheral percutaneous transluminal angioplasty (PTA) cannot be recommended.
In patients undergoing peripheral angioplasty, there are limited data from clinical trials available. Whether the results from trials of antithrombotic therapy in patients undergoing PTCA can be extrapolated to this setting is unknown. In a single, nonrandomized study, no correlation was noted between indium-Ill-labeled platelet uptake at peripheral angioplasty sites and subsequent risk of developing recurrent stenosis. A small, randomized trial (level II) compared aspirin plus dipyridamole vs placebo on outcomes up to 1 year after peripheral angioplasty and found no beneficial effect of antiplatelet therapy.