Peripheral interventions and antiplatelet therapy: Role in current practice

Table 1 Results of clinical trials initially designed for patients with coronary artery disease, with subgroup analysis in peripheral arterial disease

Clinical trial	No. of patients	Patient population	Drugs studied	Primary end point	Outcomes
PEGASUS TIMI-54 subgroup analysis[40] (2016)	1143	CAD and concomitant PAD	Ticagrelor 90 mg BID + aspirin vs Ticagrelor 60 mg BID + aspirin vs Placebo + aspirin	Cardiovascular death, MI and stroke Acute limb ischemia and peripheral revascularization for ischemia	15.2% in ticagrelor (pooled group) and 19.3% in placebo. ARR 4.1% in ticagrelor (pooled group) 60 mg dose more beneficial (ARR of 5.2%) 0.46% in ticagrelor (pooled group) and 0.71% in placebo (HR 0.65; 95%CI: 0.44-0.95; P = 0.026)
PLATO-subgroup analysis[32] (2015)	1144	CAD and concomitant PAD	Ticagrelor vs clopidogrel	Cardiovascular death, MI and stroke	18% in ticagrelor group and 20.6% in clopidogrel group (HR: 0.85; 95%CI: 0.64–1.11; P =0.99)
TRA 2P-TIMI 50[35] (2012)	26449	Previous history of MI or ischemic stroke within the previous 2 wk-12 mo or PAD	Vorapaxar vs placebo	Cardiovascular death, MI, and stroke	9.3% in vorapaxar group and 10.5% in placebo (P < 0.001) Subgroup analysis in PAD patients showed no difference between groups for the primary endpoint Rate of intracranial hemorrhage (1% vorapaxar vs 0.5% placebo; P < 0.001)
CHARISMA[38] (2006)	15603	Patients with either clinically documented vascular disease or risk factors for atherothrombotic disease	Aspirin plus clopidogrel vs aspirin monotherapy	MI, stroke or cardiovascular death	6.8% in clopidogrel plus aspirin group and 7.3% in aspirin group (P = 0.22) Subgroup analysis in PAD patients: no benefit was derived from dual antiplatelet therapy
CAPRIE[15] (1996)	19185	Recent MI, recent ischemic stroke or symptomatic PAD	Aspirin vs clopidogrel	MI, stroke and vascular death	RRR of 8.7% clopidogrel group (P = 0.043; 95%CI: 0.3-16.5) Subgroup analysis in PAD patients: 23.8% RRR in clopidogrel over aspirin (P = 0.0028; 95%CI: 8.9-36.2)

MI: Myocardial infarction; PAD: Peripheral arterial disease; ARR: Absolute risk reduction; RRR: Relative risk reduction.