Effects of Cilostazol-Based Triple Antiplatelet Therapy Versus Dual Antiplatelet Therapy After Coronary Drug-Eluting Stent Implantation: An Updated Meta-Analysis of the Randomized Controlled Trials

Zhao, Shijie; Zhong, Zhaoshuang; Qi, Guoxian; Shi, Liye; Tian, Wen

doi:10.1007/s40261-018-0711-8

Cited by 12 publications

(10 citation statements)

References 57 publications

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“…Cilostazol is widely used in patients with coronary artery disease after receiving PCI to reduce the risk of thrombotic events. The beneficial effects of cilostazol appear to extend beyond its obvious antiplatelet effects, and have been attributed to its reduction of in-stent and in-segment restenosis [28][29][30], protective effect against ischemia-reperfusion injury [31] and improvement of endothelial function [32,33]. A recent research suggested that cilostazol could inhibit apoptosis in some circumstances to protect cell viability [34] indicating that cilostazol might protect endothelia in a similar way.…”

Section: Discussionmentioning

confidence: 99%

Cilostazol Decreases Endothelin-1 Level in Patients with an Acute Coronary Syndrome: A Prospective Study

Ltd¹

2020

PPPS

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Objectives: This study aimed to determine whether the plasma markers of endothelial dysfunction could be influenced by cilostazol in patients with Acute Coronary Syndrome (ACS).Background: Endothelial dysfunction is associated with an imbalance between Nitric Oxide (NO) and Endothelin-1 (ET-1), which has been found to be involved in the pathogenesis of ACS. Cilostazol is a selective inhibitor of phosphodiesterase type III that inhibits platelet aggregation. The superior clinical benefit of cilostazol over aspirin suggests that the drug has non-plateletdirected properties. Animal and in vitro models suggested that the "pleiotropic" properties of cilostazol may be related to its "endothelial protection" effects. However, whether cilostazol can influence plasma markers of endothelial dysfunction in real-world patients is still unknown.Methods: This prospective study was conducted from February 2016 to July 2016 and enrolled consecutive 143 patients with ACS receiving primary Percutaneous Coronary Intervention (PCI) receiving either cilostazol (N = 61) or aspirin (N =82). Plasma levels of ET-1, NO and High-Sensitivity C-Reactive Protein (hs-CRP) were measured. Major Adverse Cardiovascular Events (MACEs), defined as cardiac death, recurrent Myocardial Infarction (MI), restenosis, Target Vessel Revascularization (TVR), or stroke, were assessed during the 6-month follow-up period. Results:The two groups had similar clinical, angiographic, and procedural characteristics at baseline. The baseline plasma levels of NO and ET-1 were similar in the patients of the two groups. NO concentration was similar in patients receiving cilostazol or aspirin (85.30 ± 30.46 vs. 84.57 ± 29.86 μmol/L, P =0.89). Meanwhile, patients receiving cilostazol had significantly lower plasma level of ET-1 than patients receiving aspirin (110.4 ± 96.94 vs. 141.3 ± 82.49 pg/ mg, P=0.049). In addition, ET-1 was positively correlated with hs-CRP with marginal statistical significance (p < 0.001). Conclusion:Cilostazol decreases ET-1concentration in ACS patients compared with aspirin. No statistically significant difference was observed in MACEs between the two groups. This pilot study provides scientific basis to call for a large-scale prospective study with long-term follow-up to further confirm those findings.

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Section: Discussionmentioning

confidence: 99%

Cilostazol Decreases Endothelin-1 Level in Patients with an Acute Coronary Syndrome: A Prospective Study

Ltd¹

2020

PPPS

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“…Finally, a more recent metaanalysis indicated that triple therapy had a significant benefit on in-stent restenosis (RR, 0.645; P = .007), and revascularization (RR, 0.52-0.57; P < .0001). 12 However, triple therapy caused more headache, rash, and GI disorders. Similar results were reported for the second-generation drug-eluting stent subgroup, except for all-cause mortality (RR, 2.161; P = .048) and liver dysfunction (RR, 0.176; P = .049).…”

Section: Meta-analyses On Triple Therapy Meta-analyses Ofmentioning

confidence: 99%

“…Accumulated experience indicates that it is a useful, albeit underutilized, agent for both coronary (CAD) and peripheral artery disease (PAD), particularly for patients undergoing percutaneous revascularization; it also has similar or greater efficacy and safety profiles vs conventional antiplatelet agents for secondary prevention of stroke, while it constitutes an alternative in those who are allergic or intolerant to classical antithrombotic agents, such as aspirin or clopidogrel 9–14 …”

Section: Figurementioning

confidence: 99%

“…7,8 Accumulated experience indicates that it is a useful, albeit underutilized, agent for both coronary (CAD) and peripheral artery disease (PAD), particularly for patients undergoing percutaneous revascularization; it also has similar or greater efficacy and safety profiles vs conventional antiplatelet agents for secondary prevention of stroke, while it constitutes an alternative in those who are allergic or intolerant to classical antithrombotic agents, such as aspirin or clopidogrel. [9][10][11][12][13][14] A comprehensive review of the literature was undertaken, and the results of studies involving the use of cilostazol in patients with cardiovascular disease (CVD), including CAD, PAD, and stroke, managed medically or with percutaneous revascularization, are discussed, including current guidelines; metaanalyses are tabulated, and the span of cilostazol's actions and therapeutic applications is pictorially illustrated (Tables 1-4, Figures 1-3). To conduct this review, all titles and abstracts of papers containing the term cilostazol were reviewed in the PubMed, Scopus, and Google Scholar, and full articles were retrieved and reviewed that were relevant to our objectives of pharmacological properties of the drug; its pharmacokinetics/pharmacodynamics; antithrombotic, antiplatelet/platelet-inhibitory, and cardiovascular (CV)/hemodynamic actions; metabolic actions; clinical effects/applications; side effects/safety; and CAD, PAD, stroke, and percutaneous procedures.…”

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confidence: 99%

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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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“…Another effective therapeutic regimen is the triple antiplatelet regimen with phosphodiesterase III inhibitor, namely cilostazol, the efficiency of which has been shown in the improvement of angiographic results after DES implantation in recent years [ 43 - 46 ]. Although this regimen is still controversial, the ability of cilostazol to increase cAMP (that inhibits VSMCs growth) along with the upregulation of p53 and p21 factors increasing apoptosis in VSMCs as well as the capacity of this drug to accelerate endothelial regeneration is likely to account for higher efficacy of the regimen [ 47 ]. Inhibitors of P2Y12 platelet receptor (including clopidogrel, prasugrel, and ticagrelor) are also used to treat patients with ISR.…”

Section: The Anti-platelet Approach Toward Isr: a Promising Solutionmentioning

confidence: 99%

Platelets in In-stent Restenosis: From Fundamental Role to Possible Prognostic Application

Haybar

Pezeshki

Saki

2021

CCR

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Background: Introduction of new generations of stents has decreased the percentage of patients experiencing in-stent restenosis (ISR) following the implantation of stent. However, a large number of patients are still afflicted with this phenomenon, which necessitates further study of ISR pathophysiology. Methods: Methods Relevant English literature was searched up to 2018 and retrieved form PubMed database and Google Scholar search engine. The following keywords were used: "In-stent restenosis", "Platelet", "Chemokine", "Inflammation", "Vascular smooth muscle cell" and "Neointima". Results: Previous studies have shown that ISR is a pathophysiologic response to damage of artery wall after its elongation and separation of the atherosclerotic plaque. Development of neointimal hyperplasia (NIH) following this pathophysiologic response is a function of inflammation caused by platelets, monocytes, macrophages, and lymphocytes, as well as rapid migration and proliferation of generally quiescent cells in median layer of artery wall. Conclusions: After damage to the artery wall, platelets play an essential role in the incidence of NIH by contributing to inflammation and migration of vascular smooth muscle cells and extracellular matrix remodeling, especially via secretion of different chemokines; therefore, developing therapeutic strategies for platelet inhibition in a controlled manner could be the basis of preventive treatments in the near future. In this study, for the first time we hypothesize that evaluation of platelet activity profile in patients before and after stent implantation may determine the prognosis and likelihood of ISR.

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Effects of Cilostazol-Based Triple Antiplatelet Therapy Versus Dual Antiplatelet Therapy After Coronary Drug-Eluting Stent Implantation: An Updated Meta-Analysis of the Randomized Controlled Trials

Cited by 12 publications

References 57 publications

Cilostazol Decreases Endothelin-1 Level in Patients with an Acute Coronary Syndrome: A Prospective Study

Cilostazol Decreases Endothelin-1 Level in Patients with an Acute Coronary Syndrome: A Prospective Study

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

Platelets in In-stent Restenosis: From Fundamental Role to Possible Prognostic Application

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