Ticagrelor Versus Clopidogrel in Symptomatic Peripheral Vascular Disease

Peripheral vascular disease is considered as a manifestation of systemic atherosclerosis associated with adverse events, both cardiovascular and related to the lower limbs.

Previous studies showed that clopidogrel monotherapy is associated with lower risk of events when compared to low doses of aspirin. Such is the rationale behind this article comparing clopidogrel and ticagrelor in patients with peripheral vascular disease.

This double-blind study randomized 13,885 patients with symptomatic peripheral vascular disease to receive monotherapy with ticagrelor (90 mg twice daily) or clopidogrel (75 mg once daily). Patients were eligible if they had an ankle-brachial index of 0.8 or less, or had undergone previous revascularization of the lower limbs.

The primary efficacy endpoint was a composite of cardiovascular death, acute myocardial infarction, or ischemic stroke. The primary safety endpoint was major bleeding. The mean follow-up was 30 months.

The mean age of patients was 66 years; 43% were enrolled on the basis of the ankle-brachial index and 57% on the basis of previous revascularization.

The baseline ankle-brachial index in all patients was 0.71; 76.6% of patients were symptomatic due to intermittent claudication, and 4.6% had critical ischemia.

The primary efficacy endpoint occurred in 751 of 6930 patients (10.8%) receiving ticagrelor and in 740 of 6955 (10.6%) receiving clopidogrel (hazard ratio [HR]: 1.02; p = 0.65).

The rate of acute lower limb ischemia was 1.7% and turned out to be identical in both groups (p = 0.85); the same was observed for the rate of major bleeding, which was 1.6% (p = 0.49).

Conclusion

In patients with symptomatic peripheral vascular disease, ticagrelor was not shown to be superior to clopidogrel for the reduction of cardiovascular adverse events. Major bleeding occurred at identical rates among both trial groups.

Original title: Ticagrelor Versus Clopidogrel in Symptomatic Peripheral Artery Disease. The EUCLID Trial.

Reference: Hiatt WR et al. N Engl J Med. 2016 Nov 13. [Epub ahead of print].

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