Platelet antiaggregation therapy and subinguinal endovascular revascularization.
Anne Lejay1, Fabien Thaveau, Boris Aleil
1Service de Chirurgie Vasculaire, Nouvel Hôpital Civil, Strasbourg, France. anne.lejay@chru-strasbourg.fr
Annals of Vascular Surgery
|February 14, 2013
Summary
Patient adherence to long-term clopidogrel therapy after infrainguinal endovascular procedures significantly improves limb salvage and primary patency. Non-compliance negatively impacts outcomes, highlighting the need for reinforced medical follow-up.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Pharmacology
Background:
- Platelet antiaggregation therapy (PAT) is crucial post-revascularization.
- This study assesses infrainguinal endovascular procedures for critical ischemia based on clopidogrel compliance.
Purpose of the Study:
- To evaluate the impact of patient compliance with long-term clopidogrel therapy on outcomes after infrainguinal endovascular procedures.
- To compare survival, primary patency (PP), and limb salvage (LS) between compliant and non-compliant patient groups.
Main Methods:
- Retrospective analysis of 153 infrainguinal endovascular procedures in 150 patients (2003-2009).
- Postoperative PAT protocol: aspirin + clopidogrel for 1 month, then clopidogrel long-term.
- Patients divided into compliant (Group 1) and non-compliant (Group 2) groups for long-term clopidogrel therapy.
Main Results:
- Survival rates were comparable between compliant and non-compliant groups (P=0.46).
- Primary patency (PP) and limb salvage (LS) rates were significantly higher in the compliant group (Group 1) versus the non-compliant group (Group 2).
- At 4 years, PP was 60% vs. 18% (P=0.02) and LS was 77% vs. 36% (P=0.04) in Group 1 vs. Group 2, respectively.
Conclusions:
- Approximately 31% of patients discontinue clopidogrel therapy, negatively impacting PP and LS.
- Reinforced medical follow-up is essential to improve patient adherence and outcomes after endovascular surgery.
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