Antiplatelet agents have a beneficial effect in reducing all cause mortality and fatal cardiovascular events in patients with IC .
BACKGROUND Peripheral arterial disease ( PAD ) is common and is a marker of systemic atherosclerosis .
Patients with symptoms of intermittent claudication ( IC ) are at increased risk of cardiovascular events ( myocardial infa rct ion ( MI ) and stroke ) and of both cardiovascular and all cause mortality .
OBJECTIVES To determine the effectiveness of antiplatelet agents in reducing mortality ( all cause and cardiovascular ) and cardiovascular events in patients with intermittent claudication .
Variability in responsiveness to clopidogrel in patients with intermittent claudication.
OBJECTIVE The concept of clopidogrel resistance is frequently evoked in the cardiac literature . The variability of antiplatelet response in patients with intermittent claudication has not been investigated . The aim of this study was to describe the effect of the addition of clopidogrel to aspirin using ex vivo measures of platelet activation in patients with life-style limiting intermittent claudication . DESIGN OF STUDY Data from r and omised controlled trial . MATERIAL S Data from 67 patients with intermittent claudication taking part in a r and omised controlled trial and who received clopidogrel in addition to aspirin was analysed . METHODS Platelet activation was measured using whole-blood flow cytometric measurement of ADP-stimulated fibrinogen binding at baseline and 12h after administration of a loading dose of 300 mg clopidogrel . Patients continued to receive 75 mg clopidogrel daily for 30 days and platelet activation was again measured at day 30 . Compliance with treatment was assessed by counting returned tablets  . RESULTS Six patients were excluded from analysis because of incomplete compliance with treatment . Six of the sixty-one patients ( 9.8 % ) showed no reduction in platelet activation 12h after administration of the loading dose of clopidogrel . At 30 days these six patients still showed no response to clopidogrel . Amongst the remaining 55 patients , the mean reduction in fibrinogen binding after clopidogrel administration was 51.5 % ( 95 % CI : 43.8 - 59.2 ) . Amongst responders there was a wide variability in reduction of fibrinogen binding in response to clopidogrel ( range 8.11 - 97.7 % ) . Four of these patients ( 6.6 % ) showed a reduction of more than 95 % in fibrinogen binding . CONCLUSIONS Patients with intermittent claudication show a wide variability in their response to clopidogrel . While a small proportion of these patients shows no response at all , another small group appears to respond excessively to clopidogrel . Clinical studies are required to identify whether hyper-responders are at increased risk of bleeding complications and whether hyporesponders are at a higher risk of thrombotic events
Antiplatelet agents have a beneficial effect in reducing all cause mortality and fatal cardiovascular events in patients with IC .
BACKGROUND Peripheral arterial disease ( PAD ) is common and is a marker of systemic atherosclerosis .
Patients with symptoms of intermittent claudication ( IC ) are at increased risk of cardiovascular events ( myocardial infa rct ion ( MI ) and stroke ) and of both cardiovascular and all cause mortality .
OBJECTIVES To determine the effectiveness of antiplatelet agents in reducing mortality ( all cause and cardiovascular ) and cardiovascular events in patients with intermittent claudication .