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Randomized clinical trial of the antiplatelet effects of aspirin–clopidogrel combination versus aspirin alone after lower limb angioplasty. BJS 2005; 92: 159-165.

Published: 17th December 2004

Authors: K. Cassar, I. Ford, M. Greaves, P. Bachoo, J. Brittenden

Background

There is a high risk of reocclusion after successful lower limb angioplasty. Platelets play a central role in this process. The aim of this study was to investigate the antiplatelet effect of a combination of aspirin and clopidogrel compared with aspirin alone in patients with claudication undergoing endovascular revascularization.

Method

This was a double‐blind randomized placebo‐controlled trial. Some 132 patients were randomized to clopidogrel and aspirin or placebo and aspirin, with a loading dose 12 h before endovascular intervention. Flow cytometric measurements of platelet fibrinogen binding and P‐selectin expression were taken as measures of platelet function at baseline, 12 h after the loading dose, and 1 h, 24 h and 30 days after intervention.

Results

Within 12 h of the loading dose, platelet activation in the clopidogrel group had decreased (P‐selectin by 27·3 per cent, P = 0·017; fibrinogen binding by 34·7 per cent, P = 0·024; stimulated fibrinogen binding by 49·2 per cent, P < 0·001). No change was observed in the placebo group. Platelet function in the clopidogrel group was significantly suppressed compared with baseline at 1 h, 24 h and 30 days after endovascular intervention (stimulated fibrinogen binding by 53·9, 51·7 and 57·2 per cent respectively; all P < 0·001).

Conclusion

A combination of clopidogrel and aspirin inhibited platelet function more than aspirin alone in patients with claudication before and after angioplasty. Copyright © 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

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