Emphasis on Dual Antithrombotic Therapy
In the prospective randomized double blind and placebo controlled MIRROR study, peri- and postinterventional dual antithrombotic therapy using acetylsalicylic acid (ASA) and clopidogrel was compared with treatment consisting of ASA and placebo, in patients with infrainguinal peripheral arterial vascular disease treated by endovascular intervention (percutaneous transluminal angioplasty (PTA) or stent. Patients who received dual antithrombotic therapy peri-interventionally as well as for six months after the intervention had a significantly lower repeat intervention rate at the treated vascular section after 6 months (1). The groups were not different regarding complications; in particular, no higher rate in bleeding complications was seen in the clopidogrel arm.
After the study medication was stopped after 6 months as planned, no difference in intervention rates was seen between the groups at 12 months (2).
Even though the number of cases was small (n=80), the trial provided initial evidence in support of dual antithrombotic peri-interventional and postinterventional therapy after interventional treatment of peripheral arterial vascular disease. In our opinion, dual antithrombotic therapy seems worth recommending for 6 months after intervention for peripheral arterial vascular disease (PTA or stent). It remains to be seen if a longer duration of dual therapy—for example, for 12 months—would make sense (as is usual in interventions involving the coronary arteries) or whether new antithrombotic substances may yield a further positive effect.
Dr. med. Frederik Strobl
Institut für Klinische Radiologie
Prof. Dr. med. Gunnar Tepe
Diagnostische und Interventionelle Radiologie
RoMed Klinikum Rosenheim
Conflict of interest statement
The authors declare that no conflict of interest exists.
|1.||Tepe G, Bantleon R, Brechtel K, et al.: Management of peripheral arterial interventions with mono or dual antiplatelet therapy—the MIRROR study: a randomised and double-blinded clinical trial. Eur Radiol 2012; 22: 1998–2006 CrossRef MEDLINE|
|2.||Strobl FF, Brechtel K, Schmehl J, et al.: Twelve-month results of a randomized trial comparing mono with dual antiplatelet therapy in endovascularly treated patients with peripheral artery disease. J Endovasc Ther 2013; 20: 699–706 CrossRef MEDLINE|
|3.||Lawall H, Huppert P, Espinola-Klein C, Rümenapf G: Clinical practice guideline: The diagnosis and treatment of peripheral arterial vascular disease. Dtsch Arztebl Int 2016; 113: 729–36 VOLLTEXT|