Randomized comparison of cilostazol versus ticlopidine hydrochloride for antiplatelet therapy after coronary stent implantation for prevention of late restenosis

Kamishirado, Hirotoshi; Inoue, Teruo; Mizoguchi, Keiichi; Uchida, Toshihiko; Nakata, Toshiyuki; Sakuma, Masashi; Takayanagi, Kunio; Morooka, Shigenori

doi:10.1067/mhj.2002.122874

Cited by 39 publications

(13 citation statements)

References 37 publications

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“…In addition, it has been demonstrated to attenuate smooth muscle proliferation and reduce neointimal hyperplasia and furthermore to reduce the incidence of restenosis in patients undergoing stent implantation [5,6,7,8,9,10,11,12,13]. However, studies evaluating the usefulness of triple antiplatelet therapy (cilostazol, aspirin and clopidogrel combination) for prevention of adverse outcomes in patients who receive coronary stents are few in number and are limited by small study populations.…”

Section: Introductionmentioning

confidence: 99%

A Meta-Analysis of Randomized Controlled Trials Appraising the Efficacy and Safety of Cilostazol after Coronary Artery Stent Implantation

et al. 2012

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Objectives: To evaluate the impact of cilostazol on the angiographic and clinical outcomes in patients undergoing percutaneous coronary intervention (PCI) with stents and treated with aspirin and thienopyridine. Methods: A total of 11 randomized controlled trials including 8,525 patients comparing triple antiplatelet therapy (aspirin, thienopyridine and cilostazol) with standard dual antiplatelet therapy were included in the analysis. The primary end points were in-segment late loss and angiographic restenosis at angiographic follow-up. Secondary end points included mortality, stent thrombosis, target lesion revascularization (TLR) and major adverse cardiac events (MACE). Results: Triple antiplatelet therapy was associated with a significant reduction in late loss [weighted mean difference 0.14, 95% confidence interval (CI) 0.08–0.20; p < 0.001] and angiographic restenosis [odds ratio (OR) 0.58, 95% CI 0.48–0.71; p < 0.001]. Addition of cilostazol to dual antiplatelet therapy was associated with a significant reduction in TLR (OR 0.56, 95% CI 0.41–0.77; p < 0.001) and MACE (OR 0.72, 95% CI 0.60–0.86; p < 0.001) with no differences in mortality (p = 0.29), stent thrombosis (p = 0.60) or bleeding episodes (p = 0.77). Conclusions: Cilostazol in addition to dual antiplatelet therapy appears to be effective in reducing the risk of restenosis and repeat revascularization after PCI without any significant benefits for mortality or stent thrombosis.

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Section: Introductionmentioning

confidence: 99%

A Meta-Analysis of Randomized Controlled Trials Appraising the Efficacy and Safety of Cilostazol after Coronary Artery Stent Implantation

et al. 2012

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“…Cilostazol also has direct inhibitory effects on smooth muscle cell growth and extracellular matrix synthesis through its PDE III-inhibiting action, which causes an increase of intracellular cAMP and a decrease of 3H-thymidine uptake (2,3). These effects possibly lead to direct inhibition of neointimal growth and a reduction in restenosis (4,(27)(28)(29). In addition to the direct inhibition of neointimal growth through the action of PDE III, the results of the present study suggest that cilostazol may act as a Mac-1 blocker, and that this may play a role in the reduction of restenosis.…”

Section: Discussionmentioning

confidence: 96%

“…Its antiplatelet action is mainly due to phosphodiesterase (PDE) III inhibition, which also results in reduced smooth muscle cell growth and extracellular matrix synthesis (2,3), and these additional effects might be expected to reduce post-stent restenosis. Indeed, several clinical trials, including our own randomized trial, have provided data that cilostazol can lower the restenosis rate (4). However, most of these trials were done in the setting of a single-center trial with a small sample size.…”

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confidence: 96%

Cilostazol inhibits leukocyte integrin Mac-1, leading to a potential reduction in restenosis after coronary stent implantation

Inoue

Uchida

Sakuma

et al. 2004

Journal of the American College of Cardiology

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“…Cilostazol is another potent antiplatelet agent which selectively inhibits phosphodiesterase III. It has been studied in series of patients undergoing stent placement and has been found to be effective [72,73,74,75]. Although there are no data on the use of cilostazol with drug-eluting stents in patients intolerant to clopidogrel or ticlopidine, it should be strongly considered.…”

Section: Clopidogrel Intolerancementioning

confidence: 99%

Antiplatelet Therapy after Percutaneous Coronary Intervention

Holmes¹

2006

Cerebrovasc Dis

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There is intense interest in the relationship between inflammation, thrombosis, platelet aggregation, and hyperlipidemia in patients with coronary artery disease. The specific role of inflammation with its linkage to the coagulation cascade has been well studied. A number of inflammatory markers have been identified which can be used for risk stratification in patients with acute coronary syndromes. Patients with acute coronary syndromes at the time of presentation often have an underlying inflammatory state which needs therapy with antiplatelet regimens including now increasingly frequently clopidogrel in addition to the standard of aspirin. In those patients who are treated medically for their acute coronary syndromes, long-term treatment with dual antiplatelet therapy has been documented to be associated with improved outcome. In patients who undergo an invasive approach with placement of intracoronary stents, the importance of dual antiplatelet therapy is increased. Drug-eluting stents are now used in approximately 90% of all interventional procedures. There is evidence to suggest that while these patients have improved outcome in terms of a decreased need for subsequent procedures to treat restenosis, there is the potential for late subacute stent thrombosis. When late subacute stent thrombosis occurs, it results in mortality or infarction in 40–60% of patients. Dual antiplatelet therapy is therefore recommended for an increasingly longer time in this patient group. At the present time, protocols indicate 3 months for one of the drug-eluting stents and 6 months for the other. However, increasingly longer antiplatelet therapy is being used clinically. Assessment of platelet function during follow-up is as yet early. There are issues about which specific test to use and the definition of platelet hyperreactivity. In the future, more individually targeted therapy may be possible if we can more adequately assess the degree of hyperreactivity and underlying inflammation.

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Randomized comparison of cilostazol versus ticlopidine hydrochloride for antiplatelet therapy after coronary stent implantation for prevention of late restenosis

Cited by 39 publications

References 37 publications

A Meta-Analysis of Randomized Controlled Trials Appraising the Efficacy and Safety of Cilostazol after Coronary Artery Stent Implantation

A Meta-Analysis of Randomized Controlled Trials Appraising the Efficacy and Safety of Cilostazol after Coronary Artery Stent Implantation

Cilostazol inhibits leukocyte integrin Mac-1, leading to a potential reduction in restenosis after coronary stent implantation

Antiplatelet Therapy after Percutaneous Coronary Intervention

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