Rationale and design for the study Apixaban versus ClopidoGRel on a background of aspirin in patient undergoing InfraPoPliteal angioplasty for critical limb ischemia: AGRIPPA trial

Biagioni, Rodrigo Bruno; Lópes, Renato D.; Agati, Leandro Barile; Sacilotto, Roberto; Wolosker, Nelson; Sobreira, Marcone Lima; Soares, Bruno Leonardo de Freitas; Joviliano, Edwaldo Edner; Bernardi, Walkiria Hueb; Castelli, Valter; Caffaro, Roberto Augusto; Fioranelli, Alexandre; Bellen, Bonno van; Casella, Ivan Benaduce; Fidelis, Ronald José Ribeiro; Flumignan, Ronald Luiz Gomes; Comerota, Anthony J.; Ramacciotti, Eduardo

doi:10.1016/j.ahj.2020.06.010

Cited by 19 publications

(8 citation statements)

References 20 publications

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“…Finally, the 'Efficacy and Safety of Apixaban in Reducing Restenosis and Limb Loss in PAD Patients (AGRIPPA)' is an exploratory trial that will evaluate the efficacy and safety of apixaban 2.5 mg twice daily plus ASA compared with DAPT (clopidogrel plus aspirin) in 200 patients with critical limb ischemia undergoing endovascular infrapopliteal revascularization followed for 12 months. The aim of this trial is to prove the concept of an alternative antithrombotic regimen for these patients which allow testing the hypothesis in a future large randomized clinical trial [68].…”

Section: Role Of Other Doacsmentioning

confidence: 99%

Antithrombotic Therapy in Patients with Peripheral Artery Disease: A Focused Review on Oral Anticoagulation

Rivera‐Caravaca

Camelo-Castillo

Ramírez-Macías

et al. 2021

IJMS

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Peripheral artery disease (PAD) is a major cause of morbidity and mortality but it is usually underdiagnosed and undertreated. Patients with PAD present dysregulated procoagulant, anticoagulant, and fibrinolytic pathways leading to arterial and venous thrombosis. The risk of several ischemic-related complications could be mitigated with appropriate antithrombotic therapy, which plays a central role in all types of PAD. For years, antiplatelets have been indicated in patients with symptomatic PAD or those who have undergone revascularization. Unfortunately, a non-negligible proportion of patients with PAD will suffer from adverse events during the follow-up, even despite proper medical therapies for the prevention of PAD complications. Thus, there is room for improving clinical outcomes in these patients. Given the implication of both, primary and secondary hemostasis in arterial thrombosis and the pathophysiology of PAD, the combination of antiplatelets and anticoagulants has emerged as a potential antithrombotic alternative to antiplatelets alone. In this narrative review article, we have highlighted the most recent evidence about antithrombotic therapy in PAD patients, with a special focus on oral anticoagulation. Certainly, COMPASS and VOYAGER PAD trials have shown promising results. Thus, rivaroxaban in combination with aspirin seem to reduce cardiovascular outcomes with a similar bleeding risk compared to aspirin alone. Nevertheless, results from real-world studies are needed to confirm these observations, and other trials will provide novel evidence about the safety and efficacy of emerging anticoagulant agents.

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Section: Role Of Other Doacsmentioning

confidence: 99%

Antithrombotic Therapy in Patients with Peripheral Artery Disease: A Focused Review on Oral Anticoagulation

Rivera‐Caravaca

Camelo-Castillo

Ramírez-Macías

et al. 2021

IJMS

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“…They produce a more predictable anticoagulant response than VKAs since their metabolism is unaffected by genetic polymorphisms or variations in dietary vitamin K intake, with fewer drug–drug interactions. Although other DOACs have been examined in patients with atherosclerotic disease, the majority of trials have been focused on rivaroxaban, an FXa inhibitor [ 192 , 193 ].…”

Section: Rational Therapymentioning

confidence: 99%

The Role of the Coagulation System in Peripheral Arterial Disease: Interactions with the Arterial Wall and Its Vascular Microenvironment and Implications for Rational Therapies

Miceli

Basso

Rizzo

et al. 2022

IJMS

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Peripheral artery disease (PAD) is a clinical manifestation of atherosclerotic disease with a large-scale impact on the economy and global health. Despite the role played by platelets in the process of atherogenesis being well recognized, evidence has been increasing on the contribution of the coagulation system to the atherosclerosis formation and PAD development, with important repercussions for the therapeutic approach. Histopathological analysis and some clinical studies conducted on atherosclerotic plaques testify to the existence of different types of plaques. Likely, the role of coagulation in each specific type of plaque can be an important determinant in the histopathological composition of atherosclerosis and in its future stability. In this review, we analyze the molecular contribution of inflammation and the coagulation system on PAD pathogenesis, focusing on molecular similarities and differences between atherogenesis in PAD and coronary artery disease (CAD) and discussing the possible implications for current therapeutic strategies and future perspectives accounting for molecular inflammatory and coagulation targets. Understanding the role of cross-talking between coagulation and inflammation in atherosclerosis genesis and progression could help in choosing the right patients for future dual pathway inhibition strategies, where an antiplatelet agent is combined with an anticoagulant, whose role, despite pathophysiological premises and trials’ results, is still under debate.

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“…A VOYAGER PAD vizsgálathoz hasonló terápiás megközelítés elemzését tűzte ki célul az AGRIPPA-vizsgálat, amely csökkentett dózisú apixaban (2 × 2,5 mg) hatását fogja összevetni 75 mg klopidogrélterápia hatékonyságával 100 mg ASA-háttérkezelés mellett alsó végtagi endovascularis beavatkozást követően [64].…”

Section: A Thrombocytaaggregáció-gátlás éS Az Antikoaguláns Terápia K...unclassified

Az alsó végtagi endovascularis verőér-beavatkozások során alkalmazott antithromboticus, antikoaguláns terápia szempontjai

Szabó

Dósa

Csobay-Novák

et al. 2022

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Összefoglaló. A népesség öregedése, a meghatározó cardiovascularis rizikótényezők – mint a cukorbetegség – egyre nagyobb arányú előfordulása, a csökkenő akut cardiovascularis halálozás az alsó végtagi verőérszűkület növekvő megjelenésével jár. Ezzel együtt szaporodnak a beavatkozást igénylő, jelentős életminőség-romlást, illetve végtag-veszélyeztetettséget okozó, súlyosabb esetek. Ilyenkor az alsó végtagi revascularisatio szüksége merül fel, ami az utóbbi évtizedben az endovascularis beavatkozások számának növekedéséhez vezetett. A beavatkozások technikai sikere mellett újabb szűkületek, elzáródások veszélyével kell számolni. Ennek hátterében az atherosclerosis progressziója mellett a beavatkozáshoz köthető, kontrollált érfalsérülés indukálta vascularis remodelling (neointima-hyperplasia), valamint thromboticus tényezők állnak. Az ér-nyitvamaradás hosszú távú biztosításának feltétele a fenti folyamatok megelőzésére alkalmazott optimális gyógyszeres kezelés. Ennek biztosítása elengedhetetlen a beavatkozást megelőzően, periprocedurálisan, majd az érintett betegkör hosszú távú gondozása során. A gyógyszeres terápiás lehetőségek közül az antithromboticus, antikoaguláns terápiának kiemelt jelentősége van. Az ezen hatású gyógyszerek alkalmazását igen nehézzé teszi (i) a thromboticus elzáródás kiújulása és a potenciális vérzés közötti dinamikusan változó egyensúly bizonytalansága, (ii) az egyéb társbetegségek kapcsán felmerülő terápiás szempontok egyidejű érvényesítése, valamint (iii) a napi ellátásban támpontot adó tudományos bizonyítékok relatív hiánya. Az összefoglaló tanulmány a fenti gyógyszerterápiás terület legújabb eredményeit kísérli meg elemezni. Orv Hetil. 2022; 163(3): 98–108. Summary. The aging of the population, the increasing prevalence of important risk factors of atherosclerosis, like diabetes, and the declining mortality of acute cardiovascular conditions lead to increased peripheral arterial disease incidence. At the same time, cases showing a severe decline in quality of life or danger of limb loss get more prevalent that demands vascular interventions. In such cases, revascularization is recommended, and consequently, in the last decade, an expansion in endovascular procedures can be seen. Considering these procedures, besides a technical success, the risk of new stenosis or occlusion may be imminent. This may be accounted for the progression of atherosclerosis and the controlled vascular injury caused by the procedure itself that induces vascular remodeling (neointima hyperplasia) and thrombotic hyperactivity. The long-term vascular patency is closely associated with the success of an optimal medical treatment strategy. Its effect is considered essential prior to the endovascular procedure, perioperatively, and in the phase of long-term follow-up of the affected patients. In this scenario, antithrombotic and anticoagulant therapy regimes bear particular relevance. The use of this kind of drugs is challenged by (i) the uncertainty of dynamic changes of balance between the thrombotic reocclusion and the risk of bleeding, (ii) the interplay of treatment strategy related to concomitant diseases, (iii) the relative lack of high-level scientific pieces of evidence guiding daily routine. The narrative review makes an effort to provide new findings and an analysis of this therapeutic field. Orv Hetil. 2022; 163(3): 98–108.

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Rationale and design for the study Apixaban versus ClopidoGRel on a background of aspirin in patient undergoing InfraPoPliteal angioplasty for critical limb ischemia: AGRIPPA trial

Cited by 19 publications

References 20 publications

Antithrombotic Therapy in Patients with Peripheral Artery Disease: A Focused Review on Oral Anticoagulation

Antithrombotic Therapy in Patients with Peripheral Artery Disease: A Focused Review on Oral Anticoagulation

The Role of the Coagulation System in Peripheral Arterial Disease: Interactions with the Arterial Wall and Its Vascular Microenvironment and Implications for Rational Therapies

Az alsó végtagi endovascularis verőér-beavatkozások során alkalmazott antithromboticus, antikoaguláns terápia szempontjai

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