Cilostazol for intermittent claudication

Brown, Tamara; Forster, Rachel; Cleanthis, M.; Mikhailidis, Dimitri P.; Stansby, Gerard; Stewart, Marlene

doi:10.1002/14651858.cd003748.pub5

Cited by 30 publications

(24 citation statements)

References 60 publications

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“…This positive change could be attributed to the increased walking distance achieved through medication therapies. According to our expectations, the greatest improvements were measured with patients taking cilostazol-containing medications, which is consistent with the results of other previous studies in the literature [26,[56][57][58][59].…”

Section: Changes In Ic Symptoms and Fontaine Classificationsupporting

confidence: 92%

One-year follow-up of patients screened for lower extremity arterial disease

Tóth-Vajna

Vajna

et al. 2022

ELECTRON J GEN MED

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Background:We tested a screening algorithm of lower extremity arterial disease (LEAD) for general practitioners (GPs) with a 1-year follow-up examination. Besides, patients were referred for vascular specialists to verify the presence of LEAD with specific tools.Method: 327 patients were followed-up. We recorded the differences in the anamnesis. Ankle brachial index was re-measured. Patients repeated walking-test. We compared our results to the specialist control.Results: Specialists confirmed LEAD in 73.7%. 63.1% reported IC symptoms. Our screening algorithm had a sensitivity of 92%, and a specificity of 96%, positive and negative predictive values were 91% and 96%. Most LEADpositive patients received LEAD-specific medications (94.2%) and antiplatelet therapy (91.7%). Improvement in walking test were shown in 96 cases (29.3%). Conclusion:Our screening algorithm combined with specialist control has proven to be an easy-to-apply, and efficient methodology for GPs with excellent sensitivity and specificity in identifying individuals at risk of LEAD.

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Section: Changes In Ic Symptoms and Fontaine Classificationsupporting

confidence: 92%

One-year follow-up of patients screened for lower extremity arterial disease

Tóth-Vajna

Vajna

et al. 2022

ELECTRON J GEN MED

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“…The studies by Broderick C et al [ 42 ] and Brown T et al [ 43 ] had shown that cilostazol and pentoxifylline might be effective drugs to improve walking distance. Ma Bo and co-workers [ 44 ] recently published a meta-analysis of five medications (beraprost, aspirin, etc.)…”

Section: Discussionmentioning

confidence: 99%

Systematic review the efficacy and safety of cilostazol, pentoxifylline, beraprost in the treatment of intermittent claudication: A network meta-analysis

et al. 2022

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Objective To evaluate the efficacy and safety of cilostazol, pentoxifylline, beraprost for intermittent claudication due to lower extremity arterial occlusive disease. Methods Randomized controlled clinical trials were identified from PubMed, Scopus, EMbase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, SinoMed, Wanfang and Chongqing VIP databases, from the database inception to 31/12/2021. The outcome measures were walking distance measured by treadmill (maximum and pain-free walking distance), ankle-brachial index and adverse events. The quality of included studies was assessed by the Cochrane bias risk assessment tool. A network meta-analysis was carried out with Stata 16.0 software. Results There were 29 RCTs included in the study, covering total 5352 patients. Cilostazol was ranked first for both maximum and pain-free walking distance, followed by beraprost and pentoxifylline. For cilostazol, pentoxifylline and beraprost, maximum walking distance increased by 62.93 95%CI(44.06, 81.79), 32.72 95%CI(13.51, 55.79) and 43.90 95%CI(2.10, 85.71) meters, respectively relative to placebo, and pain-free walking distance increased by 23.92 95%CI(11.24, 36.61), 15.16 95%CI(2.33, 27.99) and 19.78 95%CI(-3.07, 42.62) meters. For cilostazol, pentoxifylline, beraprost and cilostazol combined with beraprost, ankle-brachial index increased by 0.06 95%CI(0.04, 0.07), -0.01 95%CI(-0.08, 0.05), 0.18 95%CI(0.12, 0.23) and 0.23 95%CI(0.18, 0.27), respectively relative to placebo. The pentoxifylline and cilostazol was associated with a lower ratio of adverse events than beraprost and cilostazol combined with beraprost. Conclusion Cilostazol, pentoxifylline and beraprost were all effective treatments for intermittent claudication; cilostazol with good tolerance was likely to be the most effective in walking distance, while beraprost and cilostazol combined with beraprost were more prominent in the ankle-brachial index.

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“…Finally, another recent review of 16 RCTs (N = 3972) comparing cilostazol with placebo, of which 5 studies also compared cilostazol with pentoxifylline, showed that participants taking cilostazol had a higher initial claudication distance compared with those taking placebo (mean difference, 26.49 m), and a higher absolute claudication distance (39.57 m) with a likely indication for improved quality of life in the cilostazol groups. 251 The most frequently reported adverse events were headache, diarrhea, dizziness, pain, and palpitations. Patients receiving cilostazol had higher odds of developing headache compared to placebo (OR, 2.83) or pentoxifylline at 24 weeks (OR, 2.20).…”

Section: Meta-analyses/reviewsmentioning

confidence: 99%

“…Cilostazol ameliorates intermittent claudication by increasing the walking distance in these people (Figure 2). 2,3,[249][250][251] The higher dose of 100 mg twice daily, if tolerated, seems to be more effective. 250,252 Cilostazol is a safe and efficacious therapy for claudication in both diabetic and nondiabetic populations.…”

Section: Peripheral Artery Diseasementioning

confidence: 99%

Update on Cilostazol: A Critical Review of Its Antithrombotic and Cardiovascular Actions and Its Clinical Applications

Manolis

Manolis²,

Melita

et al. 2021

The Journal of Clinical Pharma

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Cilostazol, a phosphodiesterase III inhibitor, has vasodilating and antiplatelet properties with a low rate of bleeding complications. It has been used over the past 25 years for improving intermittent claudication in patients with peripheral artery disease (PAD). Cilostazol also has demonstrated efficacy in patients undergoing percutaneous revascularization procedures for both PAD and coronary artery disease. In addition to its antithrombotic and vasodilating actions, cilostazol also inhibits vascular smooth muscle cell proliferation via phosphodiesterase III inhibition, thus mitigating restenosis. Accumulated evidence has shown that cilostazol, due to its "pleiotropic" effects, is a useful, albeit underutilized, agent for both coronary artery disease and PAD. It is also potentially useful after ischemic stroke and is an alternative in those who are allergic or intolerant to classical antithrombotic agents (eg, aspirin or clopidogrel). These issues are herein reviewed together with the pharmacology and pharmacodynamics of cilostazol. Large studies and meta-analyses are presented and evaluated. Current guidelines are also discussed, and the spectrum of cilostazol's actions and therapeutic applications are illustrated.

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Cilostazol for intermittent claudication

Cited by 30 publications

References 60 publications

One-year follow-up of patients screened for lower extremity arterial disease

One-year follow-up of patients screened for lower extremity arterial disease

Systematic review the efficacy and safety of cilostazol, pentoxifylline, beraprost in the treatment of intermittent claudication: A network meta-analysis

Update on Cilostazol: A Critical Review of Its Antithrombotic and Cardiovascular Actions and Its Clinical Applications

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