Critical Limb Ischemia Clinical Trial
Official title:
Prevalence of High On-Treatment (Aspirin and Clopidogrel) Platelet Reactivity in Patients With Critical Limb Ischemia
Critical Limb Ischemia (CLI) is defined as limb pain that occurs at rest, or impending limb
loss that is caused by severe compromise of blood flow to the affected extremity. CLI is a
major cause of death and disability (secondary to myocardial infarction, stroke and
amputation). The mortality in patients with CLI approaches 25% and 50% at one and five years
respectively. High on-treatment platelet reactivity (HPR) in patients treated with aspirin
and clopidogrel (previously referred to as "resistance") is associated with an increased risk
of recurrent cardiovascular events after percutaneous coronary interventions and acute
coronary syndromes. The prevalence and significance of High on-treatment Platelet Reactivity
(HPR) in patients with critical limb ischemia treated with aspirin and/or clopidogrel is not
known.
The investigators project aims to investigate the prevalence of HPR (to aspirin and
clopidogrel) in one hundred patients with diagnosis of critical limb ischemia encountered at
University of Southern California (USC) affiliated hospitals (Los Angeles County Hospital and
Keck Hospital of University of Southern California).
This prospective clinical study will investigate the prevalence of high on- treatment platelet reactivity (HPR) in one hundred patients with critical limb ischemia (CLI), at the Keck Hospital of USC and Los Angeles County Medical Center (LAC+USC). Platelet inhibition to aspirin will be evaluated with the VerifyNow® aspirin (ASA) test. Clopidogrel platelet inhibition will be evaluated with two different tests: the vasodilator-stimulated phosphoprotein (VASP) and the VerifyNow® purigenic receptor P2Y12 (VN-P2Y12) assays. All platelet function analyses will be performed once after a minimum of one week of uninterrupted dual antiplatelet therapy with aspirin and clopidogrel. High on-treatment Platelet Reactivity on aspirin treatment (HPRA) group will be defined as aspirin reaction units (ARU) ≥550 by the VerifyNow® ASA assay. High on-treatment Platelet Reactivity on clopidogrel (HPRC) group will be defined as P2Y12 reaction units (PRU) ≥208 by the VerifyNow® assay and Vasodilator-stimulated phosphoprotein-platelet reactivity index (VASP-PRI) ≥50% by the vasodilator-stimulated phosphoprotein (VASP) assay. All other patients will be assigned to the adequate platelet reactivity on therapy (APR) group. Prevalence of high on-treatment platelet reactivity will then be calculated for aspirin and/or clopidogrel ;
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