Cilostazol for intermittent claudication

Bedenis, Rachel; Stewart, Marlene; Cleanthis, M.; Robless, Peter; Mikhailidis, Dimitri P.; Stansby, Gerard

doi:10.1002/14651858.cd003748.pub4

Cited by 149 publications

(116 citation statements)

References 41 publications

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“…Cilostazol and naftridrofuryl are both eff ective treatments [22,23] (expert consensus). Pentoxifyllin, L-arginine, bufl omedil or ginkgo biloba as well as all other tested substances and procedures have not proven to be effi cient in intermittent claudication.…”

Section: Intermittent Claudicationmentioning

confidence: 99%

German guideline on the diagnosis and treatment of peripheral artery disease – a comprehensive update 2016

Lawall

Huppert

Espinola‐Klein

et al. 2017

Vasa

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Summary:The prevalence of peripheral artery disease (PAD) is increasing worldwide and is strongly age-related, affecting about 20 % of Germans over 70 years of age. Recent advances in endovascular and surgical techniques as well as clinical study results on comparative treatment methods strengthened the need for a comprehensive review of the published evidence for diagnosis, management, and prevention of PAD. The interdisciplinary guideline exclusively covers distal aorta and atherosclerotic lower extremity artery disease. A systematic literature review and formal consensus fi nding process, including delegated members of 22 medical societies and two patient self-support organisations were conducted and supervised by the Association of Scientifi c Medical Societies in Germany, AWMF. Three levels of recommendation were defi ned, A = "is recommended/ indicated", B = "should be considered", C = "may be considered", means agreement of expert opinions due to lack of evidence. Altogether 294 articles, including 34 systematic reviews and 98 RCTs have been analysed. The key diagnostic tools and treatment basics have been defi ned. In patients with intermittent claudication endovascular and/or surgical techniques are treatment options depending on appropriate individual morphology and patient preference. In critical limb ischaemia, revascularisation without delay by means of the most appropriate technique is key. If possible and reasonable, endovascular procedures should be applied fi rst. The TASC classifi cation is no longer recommended as the base of therapeutic decision process due to advances in endovascular techniques and new crural therapeutic options. Limited new data on rehabilitation and follow-up therapies have been integrated. The article summarises major new aspects of PAD treatment from the updated German Guidelines for Diagnosis and Treatment of PAD. Limited scientifi c evidence still calls for randomised clinical trials to close the present gap of evidence.Keywords: Peripheral artery disease, diagnosis, treatment, update, guideline update fi cation [2] has been the basis of the therapeutic decision process for the last decade. Its four types A-B-C-D classify peripheral atherosclerotic vascular lesions of increasing length and complexity. According to TASC, type A and B lesions were recommended to be treated endovascular-fi rst, type C and D lesions were typically fi rst addressed for surgical repair. With increasing experience of intervention and advanced stent technologies, such as drug eluted and covered stent grafts of increasing lengths, bifurcational stents, and covered angioplasty catheters, the endovascular procedures recently have become increasingly successful. Patients request non-surgical procedures as an alternative approach without risk of narcosis and lower invasive character. A renunciation from the TASC guided approach has become the consequence of the scientifi c literature evaluation.

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Section: Intermittent Claudicationmentioning

confidence: 99%

German guideline on the diagnosis and treatment of peripheral artery disease – a comprehensive update 2016

Lawall

Huppert

Espinola‐Klein

et al. 2017

Vasa

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“…Hasonló eredményeket közölt a 2014-ben megjelent Cochrane Database-analízis is, amelyben 15 kettős vak, kontrollált cilostazoltanulmány eredményeit összegez-ték. A vizsgálatokban összesen 3718 beteg vett részt, a cilostazolkezelés időtartama a különböző vizsgálatokban 6-26 hét volt [14]. Vizsgálatunk eredményei igazolták, hogy a cilostazol szignifikánsan növeli a Fontaine II.…”

Section: Megbeszélésunclassified

“…A hat hónapos kezelés során a boka/kar index (BKI) szignifikáns javulását is igazoltuk. A BKI változását kevés tanulmányban vizsgálták, egy vizsgálatban hasonló javulást találtak [15], másik két vizsgálatban a BKI csökkent vagy nem változott [14]. A hat hónapos kezelés során észlelt javulásban a cilostazol ismert vasodilatator és érfa-li pleiotrop hatása szerepet játszhat.…”

Section: Megbeszélésunclassified

A cilostazol hatékony és biztonságos lehetőség a claudicatio intermittens kezelésére. A NOCLAUD vizsgálat eredményei

Farkas

Járai

2017

Orvosi Hetilap

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A perifériás verőérbetegség gyakori megjelenési formája a claudicatio intermittens, amely jelentősen rontja a betegek életminőségét. A cilostazol 2014-ben került Magyarországon forgalomba. A vizsgálat célkitűzése a cilostazol haté-konyságának és biztonságosságának értékelése volt claudicatio intermittensben szenvedő betegekben. A multicentrikus, beavatkozással nem járó vizsgálatba 1405 beteg került beválasztásra, akik hat hónapig cilostazolkezelést kaptak. A vizsgálatot befejező 1331 betegből 674 beteg adatai kerültek hatékonysági elemzésre. A fájdalommentes és abszolút járástávolság, valamint a hatperces sétateszt szignifikánsan nőtt a harmadik hónapra (78,65%, 65,23%, 56,09%; p<0,0001), és további növekedés volt megfigyelhető a hat hónapos kezelést követően (129,74%, 107,2%, 80,38%; p<0,0001). Mellékhatás a betegek 7,26%-ában fordult elő. A leggyakoribb mellékhatások a fejfájás, hasmenés, szédü-lés, tachycardia és palpitatio voltak. A cilostazolkezelés leállítására 24 beteg (1,7%) esetében került sor mellékhatás miatt. A hat hónapos cilostazolkezelés szignifikánsan növelte a claudicatio intermittensben szenvedő betegek járástá-volságát, jelentős biztonságossági probléma nélkül. Orv. Hetil., 2017, 158(4), 123-128.

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“…Cilostazol is commonly used in symptomatic IC due to its ability to decrease platelet function and increase vasodilation. Systematic reviews of the efficacy of cilostazol in IC report an increase in maximal walking distance and improvements in quality of life based upon the Short Form 36 health-related qualityof-life questionnaire, and improvement in ankle-brachial pressure index (ABPI) when compared with placebo [29,30]. No benefit in mortality has consistently been found with cilostazol.…”

Section: Intermittent Claudicationmentioning

confidence: 99%

Clinical Efficacy and Safety of Cilostazol: A Critical Review of the Literature

Rogers

Oliphant

Finks

2015

Drugs

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Cilostazol is a unique antiplatelet agent that has been commercially available for over two decades. As a phosphodiesterase III inhibitor, it reversibly inhibits platelet aggregation yet also possesses vasodilatory and antiproliferative properties. It has been widely studied in a variety of disease states, including peripheral arterial disease, cerebrovascular disease, and coronary artery disease with percutaneous coronary intervention. Overall, cilostazol appears to be a promising agent in the management of these disease states with a bleeding profile comparable to placebo; even when combined with other antiplatelet agents, cilostazol does not appear to increase the rate of bleeding. Despite the possible benefit of cilostazol, its use is limited by tolerability as some patients often report drug discontinuation due to headache, diarrhea, dizziness, or increased heart rate. To date, it has been predominantly studied in the Asian population, making it difficult to extrapolate these results to a more diverse patient population. This paper discusses the evolving role of cilostazol in the treatment of vascular diseases.

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Cilostazol for intermittent claudication

Cited by 149 publications

References 41 publications

German guideline on the diagnosis and treatment of peripheral artery disease – a comprehensive update 2016

German guideline on the diagnosis and treatment of peripheral artery disease – a comprehensive update 2016

A cilostazol hatékony és biztonságos lehetőség a claudicatio intermittens kezelésére. A NOCLAUD vizsgálat eredményei

Clinical Efficacy and Safety of Cilostazol: A Critical Review of the Literature

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