Comparison of efficacy and safety of sarpogrelate-based anti-platelet therapy with clopidogrel-based anti-platelet therapy following arterial endovascular therapy: A systematic review

Abstract

Objective: Sarpogrelate is a selective serotonin/5-hydroxytryptamine 2A receptor antagonist used in the management of peripheral artery disease (PAD). The drug has emerged as a promising choice for medical management post-endovascular therapy (EVT) due to its anti-platelet aggregation, vasoconstriction, and anti-vascular smooth muscle proliferation properties. The aim of the meta-analysis is to evaluate the efficacy and safety of sarpogrelate-based APT following arterial EVTs in PAD. Material and Methods: PubMed, Google Scholar, Scopus, and the Cochrane were systematically searched from inception to December 2023. Any randomized controlled trial studies in English that evaluated the efficacy and safety of sarpogrelate-based APT after EVT in patients with PAD was included. Data on the restenosis rate, target lesion revascularization (TLR), and safety parameters were extracted and studied. The pooled differences in efficacy and safety parameters between sarpogrelate-based APT and non-sarpogrelate-based APT was calculated using the relative risk (RR) with a 95% CI. Results: A total of three randomized controlled trials were included out of 354 articles obtained through a literature search. No significant differences were observed in the risk of restenosis (RR=0.74, 95% C.I.= 0.55- 1.00, P=0.954) and TLR (RR=0.76, 95% C.I.= 0.47- 1.23 , P=0.476) among patients being treated with sarpogrelate and non-sarpogrelate based APT. Likewise, sarpogrelate-based APT had similar safety profile as non-sarpogrelate-based APT. Conclusion: Sarpogrelate-based APT can be considered an effective alternative to clopidogrel-based conventional APT after EVTs. However, there is a huge need for a larger multicenter, multinational, and multiethnic global trial with sufficient participants in order to produce generalizable findings.