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Article Abstract
Background: Clopidogrel and Ticagrelor are well-known antiplatelet drugs that inhibit P2Y12 receptors. Though Clopidogrel is currently the standard of care for Peripheral Artery Disease (PAD), 25% of patients are known to exhibit drug resistance due to genetic variability. Ticagrelor presents an alternative with reduced susceptibility to genetic variations and has demonstrated superior outcomes in Acute Coronary Syndromes. However, Ticagrelor currently lacks a formal indication for PAD management. This study aims to compare the clot strength and platelet function in PAD patients transitioning from Aspirin-Clopidogrel to Aspirin-Ticagrelor using Thromboelastography with platelet mapping (TEG PM).
Methods: PAD patients undergoing revascularization surgery at a single tertiary center were enrolled from December 2022-2024. TEG-PM analysis was performed at baseline, 1 week, 1, 3, and 6 months. Patients who switched from Clopidogrel to Ticagrelor were included in this study. Consenting patients also underwent VerifyNow testing for Clopidogrel resistance. Statistical analysis employed descriptive statistics and the Wilcoxon matched-pairs test to compare TEG PM parameters.
Results: In our cohort of 35 patients (mean age 66.49±10.74 years, 65.7% male), significant differences were observed in platelet function parameters. Adenosine diphosphate (ADP)-mediated maximum amplitude (MA) that depicts clot strength was significantly lower with ticagrelor compared to clopidogrel (50.8mm vs. 59.5mm, p<0.0001). Ticagrelor also showed superior platelet inhibition (30.90% vs. 13.40%, p=0.0001). One bleeding event (defined as clinically significant hemorrhage that required medical intervention or transfusion) occurred on Ticagrelor while two thrombotic events (defined as arterial graft/stent occlusion or stenosis) were documented on Clopidogrel. VerifyNow testing revealed that 34.6% of the patients (9/26) were resistant to Clopidogrel (P2Y12 reaction units >180).
Conclusion: Ticagrelor demonstrated superior platelet inhibition compared to Clopidogrel in PAD patients following revascularization. The high prevalence of clopidogrel resistance underscores the potential clinical benefit of Ticagrelor for PAD patients post-revascularization.
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| http://dx.doi.org/10.1016/j.jvs.2025.08.022 | DOI Listing |
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