CARDIOVASCULAR JOURNAL OF AFRICA • Volume 35, No 2, May – August 2024 102 AFRICA The effects on clinical outcomes of administering medications together or separately in prolonged dual antiplatelet therapy after peripheral revascularisation Ozgur Akkaya, Oguz Karahan Abstract Background: In the current guidelines, dual antiplatelet therapy [acetylsalicylic acid (ASA) + clopidogrel] is recommended for at least three months after peripheral iliac stenting. In this study, we investigated the effect on clinical outcomes of adding ASA in different doses and at different times after peripheral revascularisation. Methods: Seventy-one patients were administered dual antiplatelet therapy after successful iliac stenting. Group 1, consisting of 40 patients, was given 75 mg of clopidogrel plus 75 mg of ASA in a single dose in the morning. In group 2, separate doses of 75 mg of clopidogrel (in the morning) and 81 mg of 1 × 1 ASA (in the evening) were started in 31 patients. The demographic data and bleeding rates of the patients after the procedure were recorded. Results: The groups were found to be similar in terms of age, gender and accompanying co-morbid factors (p > 0.05). The patency rate was 100% in the first month in both groups, and it was above 90% at the sixth month. When one-year patency rates were compared, although the first group had higher rates (85.3%), no significant difference was found (p < 0.05). However, there were 10 (24.4%) bleeding events in group 1, and five (12.2%) of these were in the gastrointestinal system, resulting in reduced haemoglobin levels (p = 0.038). Conclusion: ASA doses of 75 mg or 81 mg did not affect one-year patency rates. However, higher bleeding rates were observed in the group that received both clopidogrel and ASA treatment simultaneously (in the morning) despite the lower dose of ASA. Keywords: peripheral arterial revascularisation, dual antiplatelet therapy, acetylsalicylic acid dosing, outcome, bleeding Submitted 22/12/22; accepted 15/3/23 Published online 19/6/23 Cardiovasc J Afr 2024; 35: 102–105 www.cvja.co.za DOI: 10.5830/CVJA-2023-013 Peripheral arterial disease (PAD) involving the extremity arteries is defined as narrowing and occlusion of the antegrade flow of the main arteries. Although PAD has various causes, such as underlying vasculitis, dysplastic events, thrombosis, embolism and trauma, the most common is atherosclerotic vascular occlusion.1 This condition, which is not symptomatic at first, starts with intermittent claudication and is accompanied by other findings related to extremity ischaemia as it progresses. PADmay be a precursor marker for systemic atherosclerosis, so timely diagnosis and treatment are important. Following diagnosis with imaging methods, treatment covers a wide spectrum, ranging from simple lifestyle changes to medical treatment and surgery.1,2 Balloon angioplasty and stenting have produced very successful results before surgery in cases that do not respond to medical therapy, especially for PAD involving aorto-iliac disease and femoral occlusion.3 However, medical treatment is important, especially after the procedure.3,4 In the Turkish Peripheral Artery and Vein Diseases 2021 guidelines, single anti-aggregant therapy was recommended, especially after aortoiliac and femoral endovascular procedures, and after standard combination therapy with acetylsalicylic acid (ASA) (75–100 mg/ day) and clopidogrel (75 mg/day) for at least four weeks.5 There are different views on how long dual antiplatelet therapy (DAPT) should last. Although it has been argued that there is no difference between high and low ASA doses, there is a consensus that the ideal dose range is generally 75–100 mg for ASA and 75 mg for clopidogrel.5,6 In this study, the clinical outcomes were investigated of administering prolonged dual antiplatelet therapy, APA and clopidogrel, either together in one tablet or separately in two tablets to patients who underwent endovascular treatment for PAD. The aim was to reveal the results of prolonged treatment, and specifically, the effects of taking ASA in combination with clopidogrel as a single tablet or as two separate tablets at different times. Methods Patients admitted to our clinic between January 2021 and July 2022 due to PAD were evaluated prospectively. Based on the Trans-Atlantic Inter-Society Consensus Document II classification, 112 patients with primary stenting TASC II A & B iliac lesions were identified.7 Seventy-one of these patients who were treated with dual antiplatelet therapy and followed up for one year were included in the study. Patients who did not agree to participate in the study, whose records and controls could not be reached during the follow-up period, who did not complete the one-year follow-up period or for whom vascular patency was not provided were excluded from the study. In addition, patients were excluded if they had contraindications for dual antiplatelet therapy or the presence of distal type occlusive peripheral artery disease, took additional bleeding agents (such as anticoagulant agents), or required continuous chemotherapy. Alanya Training and Research Hospital, Antalya, Turkey Ozgur Akkaya, MD, oakkaya369@gmail.com Alanya Alaaddin Keykubat University, Antalya, Turkey Oguz Karahan, MD
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