Analysis Of The Efficacy And Safety Of Alternative Therapy After Superficial Femoral Artery Stent Implantation In Patients With Aspirin Resistance

BackgroundLower limb arteriosclerosis obliterans(LEASO)is a common and frequently-occurring disease in vascular surgery.It is estimated that more than 200 million people worldwide suffer from LEASO,and the incidence is increasing year by year.After suffering from LEASO,the mild patients show intermittent claudication that affects the quality of life,and the severe patients have ischemic ulcers and gangrene in the affected limbs,leading to amputation or even death.In recent years,endovascular treatment has become the first choice for LEASO because of its high success rate,strong maneuverability,minimally invasive and other advantages.In order to maintain the long-term patency of the target vessel after endovascular treatment,aspirin and clopidogrel were routinely given for dual anti-platelet therapy(DAPT),but aspirin resistance(AR)caused some patients to revascularize the target vessel restenosis or thrombosis occurred in a short period of time,leading to recurrence or even aggravation of symptoms,which seriously affected the prognosis of patients and increased the economic burden of patients.At present,there is no unified treatment plan for AR.When patients are found to have AR,clinicians often switch to other antiplatelet drugs based on their own experience to continue DAPT or switch to anticoagulant drugs for dual anticoagulation and antiplatelet therapy,but there are few studies on its effectiveness and safety.ObjectiveBy analyzing and comparing the efficacy and safety of indobufen or low-dose rivaroxaban in patients with AR after superficial femoral artery stenting,to provide a safe and effective alternative to aspirin for AR patients.MethodsA retrospective analysis was conducted on 158 patients with unilateral superficial femoral artery stent implantation in the first affiliated Hospital of Zhengzhou University from September 2018 to December 2019.All patients were treated with aspirin and clopidogrel after admission.According to the maximum platelet aggregation rate(MAR)induced by arachidonic acid(AA)one day before operation,patients with MARAA<55%were included in the non-AR group,namely aspirin group.Patients with MARAA≥ 55%were included in the AR group and divided into indobufen group and rivaroxaban group according to different replacement schemes.The aspirin group continued the aspirin combined clopidogrel regimen,the indobufen group switched to the indobufen combined clopidogrel regimen,and the rivaroxaban group switched to the rivaroxaban combined clopidogrel regimen.Give the same drugs for expanding blood vessels and lowering lipids.The treatment course of the three groups was 12 months.Blood routine examination,thromboelastogram(TEG),ankle-brachial index(ABI),color ultrasound or computed tomography angiography(CTA)were performed at 1 month,3 months,6 months and 12 months after operation.In-stent restenosis(ISR)events were recorded.The improvement of symptoms was observed before and after treatment,and the symptom scores were recorded to evaluate the curative effect.Adverse events such as gastrointestinal discomfort and bleeding were recorded.Results1.In this study,there was no significant difference in sex,age,high risk factors and intraoperative stent implantation among the three groups(P>0.05).2.There was no significant difference in platelet count,coagulation reaction time(R value),clot strength(MA value)and coagulation comprehensive index(CI)among the three groups at 1 month,3 months,6 months and 12 months after operation.There was no significant difference in ABI between the three groups before operation and 1 month,3 months,6 months and 12 months after operation.At 1 month,3 months,6 months and 12 months after operation,the incidence of ISR in-indobufen group was 2.0%,3.9%,5.9%and 11.8%respectively,while that in rivaroxaban group was 0%,2.2%,4.4%and 8.9%,respectively.The incidence of ISR in aspirin group was 0%,1.6%,6.5%and 11.3%,respectively.There was no significant difference in the incidence of ISR among the three groups at different time after operation.There was no significant difference in curative effect and total effective rate among the three groups(P>0.05).3.During the treatment,gastrointestinal discomfort occurred in 2 cases(3.9%),mild hemorrhage in 4 cases(7.8%)and severe hemorrhage in 2 cases(3.9%)in indobufen group.Gastrointestinal discomfort occurred in 2 cases(4.4%),mild hemorrhage in 2 cases(4.4%)and severe hemorrhage in 1 case(2.0%)in rivaroxaban group.In the aspirin group,gastrointestinal discomfort occurred in 12 cases(19.4%),mild bleeding in 5 cases(8.1%),and severe bleeding in 3 cases(4.8%).In terms of gastrointestinal discomfort,the incidence of gastrointestinal discomfort in indobufen group and rivaroxaban group was lower than that in aspirin group(P<0.05),but there was no significant difference between indobufen group and rivaroxaban group(P>0.05).There was no significant difference in mild and severe bleeding events among the three groups(P>0.05).Conclusion1.The efficacy of indobufen or low dose rivaroxaban in preventing ISR after superficial femoral artery stent implantation in AR patients is similar to that of aspirin in non-AR patients,and their safety is better than aspirin2.Indobufen or low-dose rivaroxaban can be used as an alternative to aspirin after superficial femoral artery stent implantation in AR patients.