2024-03-28T19:13:06Zhttp://uvadoc.uva.es/oai/requestoai:uvadoc.uva.es:10324/29252021-11-04T09:20:35Zcom_10324_1138com_10324_931com_10324_894col_10324_1226
Belch, Jill J.F.
797de039-4614-426e-a28e-5c5a60e47356
500
Dormandy, John
dfe756cb-8735-4671-b824-66d1b9c89e98
500
Caspar Writing Committee
b5915284-61a0-460c-b4aa-13cbaf4b64a3
500
2013-06-06T07:15:17Z
2013-06-06T07:15:17Z
2010
Journal of Vascular Surgery, October 2010, vol. 52, n.4. p.825-833
0741-5214
http://uvadoc.uva.es/handle/10324/2925
825
4
833
Journal of Vascular Surgery
52
Producción Científica
Objective: Dual antiplatelet therapy with clopidogrel plus acetylsalicylic acid (ASA) is superior to ASA alone in patients
with acute coronary syndromes and in those undergoing percutaneous coronary intervention. We sought to determine
whether clopidogrel plus ASA conferred benefit on limb outcomes over ASA alone in patients undergoing below-knee
bypass grafting.
Methods: Patients undergoing unilateral, below-knee bypass graft for atherosclerotic peripheral arterial disease (PAD)
were enrolled 2 to 4 days after surgery and were randomly assigned to clopidogrel 75 mg/day plus ASA 75 to 100
mg/day or placebo plus ASA 75 to 100 mg/day for 6 to 24 months. The primary efficacy endpoint was a composite of
index-graft occlusion or revascularization, above-ankle amputation of the affected limb, or death. The primary safety
endpoint was severe bleeding (Global Utilization of Streptokinase and Tissue plasminogen activator for Occluded
coronary arteries [GUSTO] classification).
Results: In the overall population, the primary endpoint occurred in 149 of 425 patients in the clopidogrel group vs 151
of 426 patients in the placebo (plus ASA) group (hazard ratio [HR], 0.98; 95% confidence interval [CI], 0.78-1.23). In
a prespecified subgroup analysis, the primary endpoint was significantly reduced by clopidogrel in prosthetic graft
patients (HR, 0.65; 95% CI, 0.45-0.95; P .025) but not in venous graft patients (HR, 1.25; 95% CI, 0.94-1.67, not
significant [NS]). A significant statistical interaction between treatment effect and graft type was observed (Pinteraction
.008). Although total bleeds were more frequent with clopidogrel, there was no significant difference between the rates
of severe bleeding in the clopidogrel and placebo (plus ASA) groups (2.1% vs 1.2%).
Conclusion: The combination of clopidogrel plus ASA did not improve limb or systemic outcomes in the overall
population of PAD patients requiring below-knee bypass grafting. Subgroup analysis suggests that clopidogrel plus ASA
confers benefit in patients receiving prosthetic grafts without significantly increasing major bleeding risk.
application/pdf
spa
Universidad de Valladolid. Facultad de Medicina
info:eu-repo/semantics/openAccess
http://creativecommons.org/licenses/by-nc-nd/3.0/es/
Attribution-NonCommercial-NoDerivs 3.0 Unported
Cardiovascular, Aparato, Efectos de los medicamentos sobre el
Cirugía cardiovascular
Results of the randomized, placebo controlled clopidogrel and acetylsalicylic acid in bypass surgery for peripheal arterial disease (CASPAR) trial
info:eu-repo/semantics/article
SI
ORIGINAL
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2021-11-04 10:20:35.832
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