title: Management of peripheral arterial interventions with mono or dual antiplatelet therapy--the MIRROR study: a randomised and double-blinded clinical trial.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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 β-thromboglobulin and CD40L, and the rate of patient's resistant to clopidogrel. Secondary endpoints included the clinical development 6 months after the intervention.
  
  
  RESULTS
  Eighty patients, 40 in each group, were enrolled. The median peri-interventional concentration of β-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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Radiologische Klinik, Diagnostische und Interventionelle Radiologie, Eberhard-Karls-Universität, Tübingen, Germany. gunnar.tepe@ro-med.de
authors.forename: Gunnar
authors.initials: G
authors.lastname: Tepe
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Bantleon
authors.forename: Klaus
authors.initials: K
authors.lastname: Brechtel
authors.forename: Jörg
authors.initials: J
authors.lastname: Schmehl
authors.forename: Thomas
authors.initials: T
authors.lastname: Zeller
authors.forename: Claus D
authors.initials: CD
authors.lastname: Claussen
authors.forename: Frederik F
authors.initials: FF
authors.lastname: Strobl
mesh_terms: D000368:Aged; D017130:Angioplasty / Q000009:adverse effects*; D001241:Aspirin / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D058729:Peripheral Arterial Disease / Q000150:complications / Q000601:surgery*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D013927:Thrombosis / Q000188:drug therapy* / Q000209:etiology*; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D001241:Aspirin