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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
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Efficacy of clopidogrel treatment and platelet responsiveness in peripheral arterial procedures

Stavros Spiliopoulos1, George Pastromas, Athanasios Diamantopoulos

  • 1Patras University Hospital, Interventional Radiology , Patras, 26504 , Greece.

Expert Opinion on Pharmacotherapy
|August 28, 2014
PubMed

Insights

High on-clopidogrel platelet reactivity (HCPR) affects over 50% of peripheral artery disease patients, increasing re-intervention risks. Personalized antiplatelet therapy using platelet function testing shows promise for optimizing treatment and identifying high-risk individuals.

Area of Science:

  • Cardiology
  • Vascular Medicine
  • Pharmacology

Background:

  • Long-term antiplatelet therapy with clopidogrel is standard for peripheral artery procedures.
  • High on-clopidogrel platelet reactivity (HCPR) is a recognized issue in peripheral artery disease (PAD) patients.
  • HCPR may compromise treatment efficacy in PAD.

Purpose of the Study:

  • To review clopidogrel use and HCPR in PAD patients with intermittent claudication or critical limb ischemia (CLI).
  • To summarize guidelines, explore HCPR prevalence and impact in PAD.
  • To analyze HCPR mechanisms, clinical/genetic factors, and point-of-care testing (PFT) utility.

Main Methods:

  • Literature review of clopidogrel and HCPR in PAD.
  • Analysis of current guidelines and recommendations.
  • Examination of prevalence, clinical impact, mechanisms, and PFT.

Main Results:

  • Clopidogrel is safe and effective post-peripheral arterial revascularization; dual-antiplatelet therapy may benefit complex cases.
  • HCPR affects over 50% of PAD patients on clopidogrel, linked to higher re-intervention rates.
  • HCPR incidence is elevated in CLI, diabetes mellitus, and chronic renal disease patients.

Conclusions:

  • Personalized antiplatelet therapy guided by PFT is an emerging strategy.
  • PFT may optimize platelet inhibition and identify patients at risk of bleeding.
  • Further large-scale trials are warranted to investigate PFT-guided therapy.
Abstract

Keywords:
clopidogrelhigh-on-clopidogrel platelet reactivityperipheral arterial diseaseplateletsresistance

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