Management of peripheral arterial interventions with mono or dual antiplatelet therapy-the MIRROR study: a randomised and double-blinded clinical trial

To investigate the influence of dual antiplatelet therapy vs. aspirin alone on local platelet activation and clinical endpoints in patients with PAD treated with endovascular therapy. Patients received either 500 mg aspirin and 300 mg clopidogrel before intervention followed by a daily dose of 100 mg aspirin and 75 mg clopidogrel for 6 months, or the same doses of aspirin plus placebo instead of clopidogrel. Primary endpoints were local concentrations of platelet activation markers beta-thromboglobulin and CD40L, and the rate of patient's resistant to clopidogrel. Secondary endpoints included the clinical development 6 months after the intervention. Eighty patients, 40 in each group, were enrolled. The median peri-interventional concentration of beta-TG was 224.5 vs. 365.5 (P = 0.03) in the clopidogrel and placebo group. The concentration of CD40L was 127 and 206.5 (P = 0.05). Thirty per cent of patients who had received clopidogrel were resistant. Two clopidogrel and eight placebo patients required TLR (P = 0.04). The clopidogrel patients who needed revascularisation were both resistant to clopidogrel. Minor bleeding complications occurred in one clopidogrel and two placebo patients. Dual antiplatetet therapy reduces peri-interventional platelet activation and improves functional outcome without higher bleeding complications. An individual tailored dual antiplatelet therapy seems desirable for endovascularly treated patients with PAD. aEuro cent The role of clopidogrel and aspirin following endovascular therapy was investigated. aEuro cent Dual antiplatelet therapy reduces peri-interventional platelet activation more than aspirin alone. aEuro cent Dual antiplatelet therapy improves the outcome of endovascularly treated patients. aEuro cent Clopidogrel resistance is important when treating peripheral arterial disease endovascularly.