Platelet Reactivity in PAD Undergoing Percutaneous Angioplasty (PAD)

July 13, 2020 updated by: Petar Zlatanovic, Clinical Centre of Serbia

Influence of Platelet Reactivity in Peripheral Arterial Disease Patients Undergoing Percutaneous Angioplasty on Mid-term Outcomes

Dual antiplatelet therapy has a key role in a prevention of thrombosis of treated artery in patients undergoing percutaneous transluminal angioplasty (PTA). Weak therapeutic response and presence of residual platelet activity is related to high risk for stent thrombosis and it is well in known in coronary artery disease (CAD) patients undergoing percutaneous coronary intervention (PCI). However there are few data on the association between a different entity of platelet inhibition on antiplatelet treatment and clinical outcomes in patients with peripheral artery disease (PAD). The aim of this study was to evaluate the degree of on-treatment platelet reactivity, and its association with ischemic and hemorrhagic adverse events at follow up in PAD patients undergoing PTA.

Study Overview

Status

Unknown

Conditions

Intervention / Treatment

Detailed Description

This is a single-center observational cohort study. All together 450 patients undergoing and elective PTA (both with and without stenting) who are going to be refereed to the Clinic for Vascular and Endovascular Surgery (based on the previous experience) during the two year period (January 1st 2020 and January 1st 2022) are planned to be involved in this study. All interventions will be performed according to the current standards and the type of the endovascular procedure will be at the discretion of operator. All patients will receive at the day of treatment 300mg of Aspirin and 300mg of Clopidogrel. The day after the procedure platelet function will be assessed by "point-of-care" impedance aggregometry test using the Multiplate analyzer. According to the manufacturer proposition, resistancy on Aspirin will be defined as arachidonic acid receptor (ASPI) value < 600 and ASPI/thrombin receptor activating peptide (TRAP) < 0.5, and for Clopidogrel adenosine diphosphate (ADP) < 500 and ADP/TRAP < 0.5 . After that patients will receive dual antiplatelet therapy (Aspirin 100mg and Clopidogrel 75mg) in the six months period. Follow-up examinations will be scheduled on 1, 6 and 12 months after the intervention. Adherence to antiplatelet treatment will assessed during scheduled or unscheduled examinations. Statistical analysis will be performed using the software package SPSS 20 (SPSS Inc., Chicago, Il, USA). Categorical data will be represented as numbers and percentages. Chi-square test or Fisher exact test as appropriate will be used to compare categorical data. Continuous variables will be represented as mean ± standard deviation and as median and interquartile range, depending on the normality of data. Student's t test or Mann-Whitney U test as appropriate will be used to compare two population groups. We will then assess the ability of ASPI and ADP values to distinguish between patients with and without clinical event at 6 months follow up by receiver-operating characteristic (ROC) curve analysis and the optimal cut-off ASPI and ADP values will be determined by estimating the value resulting in the maximum sum of sensitivity and specificity (area under the curve - AUC). Kaplan-Meier curves with log-rank test will be used to assess difference in the time-to-event end-points. A multivariable Cox proportional hazard model adjusted for clinical and laboratory variables will be performed to evaluate the independent contribution of platelet hyper- or hypo-reactivity to the outcomes. A P-values <0.05 will be considered statistically significant.

Study Type

Observational

Enrollment (Anticipated)

450

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Serbia
      • Belgrade, Serbia, 11000
        • Recruiting
        • Clinical Center of Serbia
        • Contact:

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years to 85 years (ADULT, OLDER_ADULT)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Sampling Method

Non-Probability Sample

Study Population

All patients treated at the Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade due to PAD (critical limb ischemia {CLI} or intermittent claudication {IC}) with PTA with/without stenting of aorto-iliac, femoro-popliteal and crural disease between January 1st 2020 and January 1st 2022

Description

Inclusion Criteria:

- all patients treated due to PAD with PTA with/without stenting of aorto-iliac, femoro-popliteal and crural disease at the mentioned time period with critical limb ischemia (CLI) or intermittent claudication (IC)

Exclusion Criteria:

  • younger that 18 and older than 85
  • contraindications for Aspirin and Clopidogrel use
  • thrombocytopenia (<100 x 10⁹/l)
  • thrombocytosis (>450 x 10⁹/l)
  • kidney insufficiency (stage 4 and 5)
  • more severe anemia (Hgb < 100 g/l)
  • severe hepatic disorder
  • congestive heart failure
  • known hemorrhagic disorder
  • known malignant disease
  • previous use of drugs with known anti-thrombocyte mechanism of action (dipyridamole, NSAID)
  • use oral anticoagulant therapy
  • use of corticosteroids
  • use of drugs that are metabolized threw CYP3A4 (like erythromycin and rifampicin)

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

Cohorts and Interventions

Group / Cohort
Intervention / Treatment
Aspirin responders
On impedance aggregometry- Multiplate analyzer, if ASPI < 600 or ASPI/TRAP < 0.5
Drug: Aspirin 300mg and Clopidogrel 300mg
Aspirin 300mg and Clopidogrel 300mg on the day of the PTA
Aspirin non-responders
On impedance aggregometry- Multiplate analyzer, if ASPI > 600 or ASPI/TRAP > 0.5
Drug: Aspirin 300mg and Clopidogrel 300mg
Aspirin 300mg and Clopidogrel 300mg on the day of the PTA
Clopidogrel responders
On impedance aggregometry- Multiplate analyzer, if ADP < 500 or ADP/TRAP < 0.5
Drug: Aspirin 300mg and Clopidogrel 300mg
Aspirin 300mg and Clopidogrel 300mg on the day of the PTA
Clopidogrel non-responders
On impedance aggregometry- Multiplate analyzer, if ADP > 500 or ADP/TRAP > 0.5
Drug: Aspirin 300mg and Clopidogrel 300mg
Aspirin 300mg and Clopidogrel 300mg on the day of the PTA

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Mortality
Time Frame: 6 months
All-cause mortality
6 months
Major Adverse Limb Event (MALE)
Time Frame: 6 months
It includes major amputation, reintervention which could be surgical or repeat angioplasty. Major amputation is defined as amputation above the ankle.
6 months

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Major Adverse Cardio- and Cerebrovascular Events (MACCE)
Time Frame: 6 months
Nonfatal stroke, nonfatal myocardial infarction, and cardiovascular death
6 months
Bleeding complications
Time Frame: 6 months
Major and minor bleeding
6 months

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Clinical Centre of Serbia

Investigators

  • Principal Investigator: Petar Zlatanovic, MD, Clinical Center of Serbia

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (ACTUAL)

January 1, 2020

Primary Completion (ANTICIPATED)

January 1, 2022

Study Completion (ANTICIPATED)

July 1, 2022

Study Registration Dates

First Submitted

November 14, 2019

First Submitted That Met QC Criteria

November 14, 2019

First Posted (ACTUAL)

November 18, 2019

Study Record Updates

Last Update Posted (ACTUAL)

July 15, 2020

Last Update Submitted That Met QC Criteria

July 13, 2020

Last Verified

July 1, 2020

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

  • Platelet reactivity in PAD

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

UNDECIDED

IPD Plan Description

to be available on request for now

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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