Prospective Randomized Study of Sarpogrelate Versus Clopidogrel-based Dual Antiplatelet Therapies in Patients Undergoing Femoropopliteal Arterial Endovascular Interventions

Abstract

Background:Sarpogrelate is a selective 5-hydroxytryptamine (5-HT) receptor subtype 2A antagonist which blocks 5-HT induced platelet aggregation and proliferation of vascular smooth muscle cells. We compared the efficacy of sarpogrelate-based dual antiplatelet therapies for the prevention of restenosis and target lesion revascularization (TLR) rates comparing with that of clopidogrel after percutaneous endovascular interventions (EVIs) of femoropopliteal (FP) arterial lesions.Methods:This prospective, multicenter, randomized clinical trial recruited a total of 120 patients with successful EVI of FP lesions at seven centers across China between January 2011 and June 2012. Patients were randomized to receive either sarpogrelate (100 mg trice daily for 6 months, n = 63) or clopidogrel (75 mg once daily for 6 months, n = 57). All patients also received oral aspirin (100 mg once daily for 12 months). Clinical follow-up was conducted up to 12 months postprocedure.Results:There was no significant difference between the two groups in basic demographic data. The restenosis rate was higher in the clopidogrel group (22.80%) than in sarpogrelate group (17.50%), but there was no significant difference between these two groups (P = 0.465). The TLR rate, ipsilateral amputation rate, mortality in all-cause and bleeding rate were also similar in the two groups (P > 0.05).Conclusions:Aspirin plus sarpogrelate is a comparable antithrombotic regimen to aspirin plus clopidogrel after EVI of FP arterial lesions. Dual antiplatelet therapies might play an important role in preventing restenosis after successful EVI of FP lesions.

New therapeutic opportunities for 5-HT2 receptor ligands

“…This is now clear for peripheral arterial disease in which sarpogrelate improves outcome of symptomatic patients (Ren, et al, 2013) but it remains to be demonstrated after endovascular therapy. Retrospective studies showed a reduction of major clinical endpoints such as amputation or death from any cause after endovascular therapy for critical hindlimb ischemia (Takahara, et al, 2014) and the first preliminary results of a recent prospective study suggest that sarpogrelate associated to aspirin is as efficacious as sarpogrelate associated to clopidogrel for the prevention of restenosis following femoropopliteal arterial stenting (Chen, et al, 2015).…”

Inhibition of 5‐Hydroxytryptamine Receptor 2B Reduced Vascular Restenosis and Mitigated the β‐Arrestin2–Mammalian Target of Rapamycin/p70S6K Pathway

“…A 5‐HT2R antagonist, sarpogrelate,43 which inhibited platelet aggregation and thrombus formation44, 45, 46, 47 was introduced as a therapeutic agent for the treatment of vascular occlusive disease48, 49, 50, 51 and for patients undergoing percutaneous interventions 52, 53. In a porcine model, sarpogrelate inhibited 5‐HT–induced coronary contraction and spam 54, 55.…”

Związek układu serotoninergicznego i układu sercowo-naczyniowego

“…Podawanie sarpogrelatu po przeprowadzeniu zabiegów endowaskularnych w niedrożnych tętnicach kończyny dolnej redukowało liczbę punktów końcowych, takich jak amputacja kończyny czy zgon. Co więcej, wyniki tego badania wskazują równoważność podawania sarpogrelatu z kwasem acetylosalicylowym (ASA, acetylsalicylic acid), jak i sarpogrelatu z klopidogrelem w zapobieganiu restenozie w odcinku udowo-podkolanowym [31]. Wyniki przedstawionych badań -redukcja hiperplazji neointimy i poprawa funkcji śródbłonka -zachęcają do stosowania sarpogrelatu w miażdżycy kończyn dolnych [32].…”