Randomized Comparison of Cilostazol vs Ticlopidine for Antiplatelet Therapy After Coronary Stenting

Abstract

Background Cilostazol and ticlopidine are commonly prescribed for prevention of thrombosis after coronary stenting, but few studies have compared them. Methods and ResultsIn the present study 642 patients who underwent stenting were randomized to treatment either with cilostazol + aspirin (C group, 321 patients) or ticlopidine + aspirin (T group, 321 patients). Quantitative coronary angiography (QCA) was performed immediately after stenting and at the 6-month follow-up. Treatment was continued until follow-up angiography. Baseline patient characteristics did not differ significantly. With the exception of a higher rate of stenting in a venous graft in the C group, there were no differences in angiographic characteristics or stent type. Baseline QCA analysis of the reference diameter, minimal lumen diameter (MLD) showed no significant differences. Follow-up QCA analysis of the MLD showed no significant differences. There were also no differences in restenosis or target lesion revascularization rates, or in the incidence of adverse reactions. However, the rate of subacute thrombosis (SAT) was significantly higher in the C group than in the T group (2% vs 0.3%, p=0.02). Conclusion In the present study there was a similar restenosis rate with cilostazol or ticlopidine, but the rate of SAT was significantly higher with cilostazol. There was no significant difference in adverse reactions. (Circ J 2005; 69: 780 -785)

Late Angiographic Stent Thrombosis After Sirolimus-Eluting Stent Implantation

“…LAST is extremely rare with BMS, 14,15 and its incidence with DES has been reported as 0.4-1.3%. [16][17][18][19][20][21] In the present study it occurred in 0.6% (95% confidence limits 0.16-1.51) of the patient population who were treated with SES. LAST events may be a rare complication, even with DES, but they can be fatal, as ST-segment elevation MI occurred in 3 of the 4 patients.…”

“…have been reported. [16][17][18][19][20][21] All reports suggest that cessation of antiplatelet therapy contributes to LAST, but 1 of the present patients developed LAST while he was on dual antiplatelet therapy.…”

Incidence of Side-Effects of Ticlopidine After Sirolimus-Eluting Stent Implantation Retrospective Analysis From Three Hospitals

“…5,6 Ticlopidine has a relative high incidence of side-effects, including neutropenia and thrombotic thrombocytopenic purpura. [7][8][9] Takeyasu et al 8 reported that the incidence of side-effects of ticlopidine was 7% after bare metal stent (BMS) implantation (liver dysfunction 3%, cytopenia 1%, rash 1%, purpura 1%, gastrointestinal bleeding 0.3%, renal dysfunction 0.3%, and others 1%) and Sekiguchi et al 9 showed a sideeffect rate of 5.8% (liver dysfunction 5.1% and bleeding 0.7%) for the same procedure. Ticlopidine is used for 4 weeks after BMS implantation, but must be continued for ≥3 months after DES implantation.…”

Safety and Efficacy of Sirolimus-Eluting Stent in Patients With Acute Coronary Syndrome Undergoing Emergency Procedure

“…It is mandatory for patients with Cypher stent placement to be given ticlopidine for at least 3 months. Takeyasu et al reported the onset of adverse reactions after PCI because of ticlopidine to be 7% 18 and Fukushima et al reported it to be 9.3%. 19 In the present study, ticlopidine was administered for a mean of approximately 6 months after implantation of the Cypher stent and was discontinued in 11.1% of the patients because of adverse reactions.…”