The Effect of Cilostazol on Stent Thrombosis After Drug-Eluting Stent Implantation

Abstract

Background and ObjectivesPlacement of drug-eluting stents (DES) can be complicated by stent thrombosis; prophylactic antiplatelet therapy has been used to prevent such events. We evaluated the efficacy of cilostazol with regard to stent thrombosis as adjunctive antiplatelet therapy.Subjects and MethodsA total of 1,315 patients (846 males, 469 females) were prospectively enrolled and analyzed for the frequency of stent thrombosis. Patients with known risk factors for stent thrombosis, except diabetes and acute coronary syndrome, were excluded from the study. All patients maintained antiplatelet therapy for at least six months. To evaluate the effects of cilostazol as another option for antiplatelet therapy, triple antiplatelet therapy (aspirin+clopidogrel+cilostazol, n=502) was compared to dual antiplatelet therapy (aspirin+clopidogrel, n=813). Six months after stent placement, all patients received only two antiplatelet drugs: treatment either with cilostazol+aspirin (cilostazol group) or clopidogrel+aspirin (clopidogrel group). There were 1,033 patients (396 in cilostazol group and 637 in clopidogrel group) that maintained antiplatelet therapy for at least 12 months and were included in this study. Stent thrombosis was defined and classified according to the definition reported by the Academic Research Consortium (ARC).Resultsdefined and classified according to the definition reported by the Academic Research Consortium (ARC). Results: During follow-up (561.7±251.4 days), 15 patients (1.14%) developed stent thrombosis between day 1 to day 657. Stent thrombosis occurred in seven patients (1.39%) on triple antiplatelet therapy and four patients (0.49%) on dual antiplatelet therapy (p=NS) within the first six months after stenting. Six months and later, after stent implantation, one patient (0.25%) developed stent thrombosis in the cilostazol group, and three (0.47%) in the clopidogrel group (p=NS).ConclusionDuring the first six months after DES triple antiplatelet therapy may be more effective than dual antiplatelet therapy for the prevention of stent thrombosis. However, after the first six months, dual antiplatelet treatment, with aspirin and cilostazol, may have a better cost benefit ratio for the prevention of stent thrombosis.

Cilostazol Induces eNOS and TM Expression via Activation with Sirtuin 1/Krüppel-like Factor 2 Pathway in Endothelial Cells

“…Moreover, Jeon et al compared triple antiplatelet therapy to dual therapy after implanting drug-eluting stents. According to their findings, adding cilostazol to aspirin and clopidogrel may be more effective in preventing stent thrombosis during the first six months [ 32 ]. The formation of stent thrombosis is related to platelet function activation, endothelial cell dysfunction, and smooth muscle cell migration.…”

Clopidogrel-Induced Neutropenia after Coronary Stenting: Is Cilostazol a Good Alternative?

“…More recently, a large, randomised Korean study in 1315 DES-treated patients proved the efficacy of cilostazol in the prevention of stent thrombosis. During the initial six months after PCI, patients were randomized to TA or DA (aspirin + clopidogrel); then, after this first period, all patients were randomized to DA with aspirin and cilostazol or DA with aspirin and clopidogrel [ 28 ]. Results were encouraging for cilostazol both in TA (association) and in DA (alternative) for the prevention of stent thrombosis.…”

Aspirin and Probenecid Inhibit Organic Anion Transporter 3–Mediated Renal Uptake of Cilostazol and Probenecid Induces Metabolism of Cilostazol in the Rat

“…Dual antiplatelet treatment with aspirin and cilostazol may result in a more favorable patient risk-benefit analysis in the prevention of stent thrombosis (Jeon et al, 2010). However, questions still remain regarding whether transporters mediate the beneficial drug-drug interaction (DDI) between cilostazol and aspirin.…”