Comparison of On-Treatment Platelet Reactivity Between Triple Antiplatelet Therapy With Cilostazol and Standard Dual Antiplatelet Therapy in Patients Undergoing Coronary Interventions

Panchal, Hemang B.; Shah, Tejaskumar; Patel, Parthavkumar; Albalbissi, Kais; Molnár, J.; Coffey, Brandon; Khosla, Sandeep; Ramu, Vijay

doi:10.1177/1074248413495971

Cited by 8 publications

(7 citation statements)

References 63 publications

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“…It should be emphasized that cilostazol-based TAT has predominantly been studied in Koreans, a population with a high prevalence of loss of function CYP2C19 alleles, which is associated with HTPR and significantly diminished clopidogrel clinical efficacy. Consequently the results of the present meta-analysis 26 in concert with those of previous studies 21,22 strongly support the suggestion that addition of cilostazol to standard therapy with aspirin and clopidogrel is an effective way to overcome HTPR and improve clinical outcomes, especially in patients undergoing PCI, without increasing bleeding. However, TAT did not further reduce the incidence of death, MI or stent thrombosis compared with standard DAT and this is contradictory to the pharmacodynamic properties of cilostazol 17 .…”

Section: I a L D I S T R I B U T I O N U N A U T H O R I Z E D U S supporting

confidence: 73%

“…In accordance with the results of the above studies are those of a recent meta-analysis which included nine studies involving 2179 patients undergoing PCI, with the aim of comparing the efficacy of cilostazol-based TAT versus DAT in regard to on-treatment platelet reactivity. This meta-analysis concluded that TAT significantly lowers platelet reactivity suggesting that it may be more effective than DAT in reducing the thrombotic complications following PCI 22 . In addition to its antiplatelet efficacy, cilostazol-based TAT can also reduce restenosis following PCI 23,24 .…”

Section: I a L D I S T R I B U T I O N U N A U T H O R I Z E D U S mentioning

confidence: 99%

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Cilostazol-based triple antiplatelet therapy in the era of generic clopidogrel and new potent antiplatelet agents

Tselepis

2013

Current Medical Research and Opinion

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Section: I a L D I S T R I B U T I O N U N A U T H O R I Z E D U S supporting

confidence: 73%

Section: I a L D I S T R I B U T I O N U N A U T H O R I Z E D U S mentioning

confidence: 99%

Cilostazol-based triple antiplatelet therapy in the era of generic clopidogrel and new potent antiplatelet agents

Tselepis

2013

Current Medical Research and Opinion

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“…Of note, some preliminary studies on the impact of adjunctive cilostazol therapy on platelet reactivity in patients undergoing coronary stenting or with AMI have been performed [13, 22]; however, no studies have been reported to date in PAD patients. For example, in the ACCEL-RESISTANCE (i.e.…”

Section: Discussionmentioning

confidence: 99%

Effect of cilostazol on platelet reactivity among patients with peripheral artery disease on clopidogrel therapy

Hernández-Suárez

Nuñez-Medina

Scott

et al. 2018

Drug Metabolism and Personalized Therapy

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Background Antiplatelet therapy with clopidogrel is recommended to reduce cardiovascular events in patients with peripheral artery disease (PAD); however, clopidogrel efficacy has not been adequately studied in this patient population. Therefore, we aimed to determine the effects of cilostazol therapy on platelet reactivity among PAD patients on clopidogrel. Methods We performed a cross-sectional pilot study of 46 Puerto Rican patients diagnosed with PAD. The cohort was divided based on use of clopidogrel and cilostazol (n = 24) or clopidogrel alone (n = 22). Platelet function was measured ex vivo using the VerifyNow P2Y12 assay. Genomic DNA was extracted from peripheral blood samples using the QIAamp DNA Blood Midi Kit, which was subjected to candidate variant genotyping (CYP2C19, ABCB1, PON1 and P2RY12) using TaqMan quantitative polymerase chain reaction assays. All analyses were performed using SAS version 9.4 (SAS Institute). Results Among all enrolled patients, 18 (39%) had high on-treatment platelet reactivity (HTPR). The mean platelet reactivity was 207 ± 53 (range, 78–325) with higher P2Y12 reaction units in the non-cilostazol group, 224 ± 45 vs. 191 ± 55 on the cilostazol group (p = 0.03). No significant differences were observed in the clinical or genetic variables between the two groups. A multiple regression analysis determined that history of diabetes mellitus (p= 0.03), use of cilostazol (p = 0.03) and hematocrit (p = 0.02) were independent predictors of platelet reactivity. Conclusions In Puerto Rican PAD patients on clopidogrel therapy, history of diabetes mellitus, use of cilostazol and hematocrit are independent predictors of platelet reactivity. Adjunctive cilostazol therapy may enhance clopidogrel efficacy among PAD patients with HTPR.

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“…Ticagrelor and prasugrel had a rapid onset and offset of antiplatelet action, 44 and marked and consistent inhibitory action on platelet aggregation. 45 In the ONSET/OFFSET trial, 46 the maximum platelet inhibition (∼80%) was achieved within 1 hour of ticagrelor administration; the time to peak inhibition of platelet aggregation was 2 hours with ticagrelor compared with 7.8 hours with clopidogrel. Another trial with ticagrelor 6 showed an effective reduction in the incidence of CV death, MI, and stent thrombosis without increasing the risk of bleeding in patients with STEMI undergoing PCI and during a 12-month follow-up after PCI.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Novel Oral P2Y12 Receptor Inhibitors in Patients With ST-Segment Elevation Myocardial Infarction Undergoing PCI: A Systematic Review and Meta-Analysis

Sun

Xiang

et al. 2017

Journal of Cardiovascular Pharmacology

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Abstract:The efficacy and safety of novel oral P2Y12 receptor inhibitors (prasugrel and ticagrelor) are subjects of contention in patients with ST-segment elevation myocardial infarction (STEMI) undergoing PCI, and the optimal duration of therapy remains uncertain. We searched PubMed, Embase, Cochrane Library, CNKI, VIP, and WanFang Data to identify randomized controlled trials comparing novel oral P2Y12 receptor inhibitors with clopidogrel in patients with STEMI undergoing PCI until February 2016. The primary efficacy and safety endpoint were all-cause mortality and major/minor bleeding. Twelve studies were included. Novel oral P2Y12 inhibitors significantly reduced the incidence of all-cause death (relative risk: 0.65, 95% confidence interval, 0.53–0.78), major adverse cardiac events [0.68 (0.56–0.83)], and stent thrombosis [0.56 (0.43–0.75)] without significant difference in bleeding (P = 0.11) compared with clopidogrel. Identical results were observed in the longer dual antiplatelet therapy (DAPT) and shorter-DAPT subgroups, albeit Chinese patients with ticagrelor treatment had a slight increase in bleeding (P = 0.08). Furthermore, the pooled relative risk ratio for each endpoint showed no significant difference between the longer-DAPT and shorter-DAPT subgroups. In conclusion, prasugrel and ticagrelor decreased the risk of all-cause death, major adverse cardiac events, and stent thrombosis without causing more bleeding events compared with clopidogrel in patients with STEMI undergoing PCI.

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Comparison of On-Treatment Platelet Reactivity Between Triple Antiplatelet Therapy With Cilostazol and Standard Dual Antiplatelet Therapy in Patients Undergoing Coronary Interventions

Cited by 8 publications

References 63 publications

Cilostazol-based triple antiplatelet therapy in the era of generic clopidogrel and new potent antiplatelet agents

Cilostazol-based triple antiplatelet therapy in the era of generic clopidogrel and new potent antiplatelet agents

Effect of cilostazol on platelet reactivity among patients with peripheral artery disease on clopidogrel therapy

Efficacy and Safety of Novel Oral P2Y12 Receptor Inhibitors in Patients With ST-Segment Elevation Myocardial Infarction Undergoing PCI: A Systematic Review and Meta-Analysis

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