Use of Cilostazol in Percutaneous Coronary Interventions

Rogers, Kelly C.; Faircloth, Jenna M.; Finks, Shannon W.

doi:10.1345/aph.1q765

Cited by 14 publications

(10 citation statements)

References 42 publications

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“…Prasugrel and ticagrelor, also P2Y 12 receptor inhibitors, are both approved in combination with aspirin as alternatives to clopidogrel in patients undergoing stent implantation; and in some situations are recommended over clopidogrel [50,51]. Additionally, the safety and efficacy of cilostazol as part of a TAPT regimen in combination with aspirin and clopidogrel in patients undergoing PCI has been studied over the last decade and has been thoroughly reviewed recently [52][53][54][55][56][57]. Due to its unique mechanism of action including both antiplatelet and antiproliferation effects, cilostazol potentially targets both restenosis and ST.…”

Section: Percutaneous Coronary Interventionmentioning

confidence: 99%

Clinical Efficacy and Safety of Cilostazol: A Critical Review of the Literature

Rogers

Oliphant

Finks

2015

Drugs

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Cilostazol is a unique antiplatelet agent that has been commercially available for over two decades. As a phosphodiesterase III inhibitor, it reversibly inhibits platelet aggregation yet also possesses vasodilatory and antiproliferative properties. It has been widely studied in a variety of disease states, including peripheral arterial disease, cerebrovascular disease, and coronary artery disease with percutaneous coronary intervention. Overall, cilostazol appears to be a promising agent in the management of these disease states with a bleeding profile comparable to placebo; even when combined with other antiplatelet agents, cilostazol does not appear to increase the rate of bleeding. Despite the possible benefit of cilostazol, its use is limited by tolerability as some patients often report drug discontinuation due to headache, diarrhea, dizziness, or increased heart rate. To date, it has been predominantly studied in the Asian population, making it difficult to extrapolate these results to a more diverse patient population. This paper discusses the evolving role of cilostazol in the treatment of vascular diseases.

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Section: Percutaneous Coronary Interventionmentioning

confidence: 99%

Clinical Efficacy and Safety of Cilostazol: A Critical Review of the Literature

Rogers

Oliphant

Finks

2015

Drugs

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“…CIL has antiplatelet and vasodilatatory properties (35) and is approved in the United States for the treatment of patients with intermittent claudication symptoms related to peripheral arterial disease. However, several studies (41,57,62) have shown that CIL added to dual antiplatelet therapy with aspirin and clopidogrel improves angiographic and clinical outcomes after percutaneous coronary interventions. Augmenting the effects of GLP-1R activation by preventing the degradation of cAMP may add to the favorable effects of both classes of drugs on myocardial protection and platelet hyperreactivity.…”

Section: Effects Of Treatment On Biochemical Parametersmentioning

confidence: 99%

Phosphodiesterase-3 inhibition augments the myocardial infarct size-limiting effects of exenatide in mice with type 2 diabetes

Qian

Castillo

et al. 2013

American Journal of Physiology-Heart and Circulatory Physiology

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Glucagon-like peptide (GLP)-1 receptor activation increases intracellular cAMP with downstream activation of PKA. Cilostazol (CIL), a phosphodiesterase-3 inhibitor, prevents cAMP degradation. We assessed whether CIL amplifies the exenatide (EX)-induced increase in myocardial cAMP levels and PKA activity and augments the infarct size (IS)-limiting effects of EX in db/db mice. Mice fed a Western diet received oral CIL (10 mg/kg) or vehicle by oral gavage 24 h before surgery. One hour before surgery, mice received EX (1 μg/kg sc) or vehicle. Additional mice received H-89, a PKA inhibitor, alone or with CIL + EX. Mice underwent 30 min of coronary artery occlusion and 24 h of reperfusion. Both EX and CIL increased myocardial cAMP levels and PKA activity. Levels were significantly higher in the EX + CIL group. Both EX and CIL reduced IS. IS was the smallest in the CIL + EX group. H-89 completely blocked the IS-limiting effects of EX + CIL. EX + CIL decreased phosphatase and tensin homolog on chromosome 10 upregulation and increased Akt and ERK1/2 phosphorylation after ischemia-reperfusion. These effects were blocked by H-89. In conclusion, EX and CIL have additive effects on IS limitation in diabetic mice. The additive effects are related to cAMP-induced PKA activation, as H-89 blocked the protective effect of CIL + EX.

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“…When compared with DAPT (based on aspirin and clopidogrel), TAPT (aspirin, clopidogrel and cilostazol) showed a reduced clot rate (p < 0.05) and fewer hemorrhagic events (p > 0.05) in patients having undergone PCI [53]. Meta-analyses have also confirmed the reduced incidence of MACE with a lower risk of in-stent thrombosis and bleeding in patients receiving TAPT as compared to DAPT [54]. …”

Section: Clinical Trials: Tapt With Cilostazol Versus Daptmentioning

confidence: 99%

Triple versus Dual Antiplatelet Therapy in Acute Coronary Syndromes: Adding Cilostazol to Aspirin and Clopidogrel?

Niazi¹,

DiNicolantonio

Lavie

et al. 2013

Cardiology

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Dual antiplatelet therapy (DAPT) with aspirin and a P2Y₁₂ receptor antagonist is the standard of care in acute coronary syndromes. Additionally, novel P2Y₁₂ receptor antagonists such as prasugrel and ticagrelor are even recommended over clopidogrel in certain clinical guidelines. Despite the fact that clopidogrel is fraught with significant variability in on-treatment platelet reactivity, the novel P2Y₁₂ receptor antagonists come at the price of increased side effects and cost. Therefore, alternative or supplementary antiplatelet therapies are needed. Cilostazol, a phosphodiesterase III inhibitor, has been shown to significantly improve high on-treatment platelet reactivity in patients receiving both aspirin and clopidogrel and has antiproliferative effects (inhibiting neointimal hyperplasia and smooth muscle proliferation), thus reducing the risk of restenosis after coronary stent implantation. Further, cilostazol in addition to aspirin and clopidogrel versus DAPT in patients undergoing percutaneous coronary intervention showed that triple antiplatelet therapy (TAPT) was associated with a significantly greater platelet inhibition, reduced major adverse cardiovascular events, target lesion revascularization, and target vessel revascularization with no increased risk for a hemorrhagic event. Moving forward, larger randomized controlled trials are required comparing TAPT versus DAPT (clopidogrel, prasugrel or ticagrelor on top of aspirin).

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Use of Cilostazol in Percutaneous Coronary Interventions

Cited by 14 publications

References 42 publications

Clinical Efficacy and Safety of Cilostazol: A Critical Review of the Literature

Clinical Efficacy and Safety of Cilostazol: A Critical Review of the Literature

Phosphodiesterase-3 inhibition augments the myocardial infarct size-limiting effects of exenatide in mice with type 2 diabetes

Triple versus Dual Antiplatelet Therapy in Acute Coronary Syndromes: Adding Cilostazol to Aspirin and Clopidogrel?

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