Ticagrelor Compared With Clopidogrel in Patients With Prior Lower Extremity Revascularization for Peripheral Artery...

Area of Science:

• Cardiology
• Vascular Medicine
• Pharmacology

Background:

• Optimal antithrombotic therapy remains undetermined for symptomatic peripheral artery disease (PAD) patients with prior limb revascularization.
• The EUCLID trial investigated ticagrelor versus clopidogrel in PAD patients.
• This analysis specifically examined outcomes in patients enrolled due to prior lower extremity revascularization.

Purpose of the Study:

• To compare the efficacy and safety of ticagrelor versus clopidogrel in PAD patients with a history of limb revascularization.
• To assess the risk of cardiovascular events and bleeding in this specific patient subgroup.

Main Methods:

• The EUCLID trial randomized 13,885 PAD patients to ticagrelor or clopidogrel.
• This substudy focused on 7,875 patients enrolled based on prior lower extremity revascularization (ankle-brachial index ≤0.80 excluded).
• Exclusion criteria included recent revascularization (<30 days) and need for dual antiplatelet therapy.

Main Results:

• Patients with prior revascularization had higher rates of myocardial infarction (HR 1.29) and acute limb ischemia (HR 4.23) compared to those enrolled by ABI criteria.
• No significant differences were observed between ticagrelor and clopidogrel for the primary efficacy endpoint (composite of CV death, MI, stroke), all-cause mortality, acute limb ischemia, or major bleeding.
• Median follow-up was approximately 30 months.

Conclusions:

• Peripheral artery disease patients with prior revascularization exhibit increased risks of myocardial infarction and acute limb ischemia.
• Ticagrelor and clopidogrel demonstrated comparable effectiveness and safety profiles in this patient population.
• Further research may be needed to optimize antithrombotic strategies for PAD patients with a history of revascularization.