Long-term clinical efficacy and safety of adding cilostazol to dual antiplatelet therapy after drug-eluting stent implantation in coronary arteries: A meta-analysis of randomized controlled trials. Issue 5 (November 2015)

• Record Type: Journal Article
• Authors: Zou, Yandun; Hu, Chunling; Ye, Wenhui; Fan, Limei; Xu, Likun; Zhang, Aidong
• Is Part Of: Thrombosis research. Volume 136:Issue 5(2015)
• Page Start: 870
• Page End: 877
• Publication Date: 2015-11
• Subjects: Triple antiplatelet therapy -- Dual antiplatelet therapy -- Cilostazol -- Drug-eluting stent; Thrombosis -- Periodicals; 616.135
• DOI: 10.1016/j.thromres.2015.08.018
• Languages: English
• ISSNs: 0049-3848

Abstract

Abstract: Objective: To assess the long-term clinical efficacy and safety of adding cilostazol (TAT) to conventional dual antiplatelet therapy (DAT) for patients undergoing drug-eluting stent (DES) implantation in coronary arteries. Methods: We performed PUBMED, MEDLINE, EMBASE, and Cochrane CENTRAL searches for randomized clinical trials of TAT versus DAT in patients after DES implantation with criteria to include trials with a follow-up of more than 6 months. Results: Seven RCTs with a total of 3487 patients were included in this review. The meta-analysis showed that TAT was associated with a significant reduction in major adverse cardiac events (MACEs) (relative risk (RR) = 0.66; 95% CI = 0.50–0.88), target lesion revascularization (TLR) (RR = 0.61, 95% CI = 0.43–0.84), target vessel revascularization (TVR) (RR = 0.53, 95% CI = 0.37–0.75), in-stent restenosis (RR = 0.64, 95% CI = 0.44–0.85), in-segment restenosis (RR = 0.58, 95% CI = 0.43–0.79, P < .01), in-stent late loss (LL) (standardized mean difference (SMD) = − 0.21, 95% CI = 0.32–0.17), and in-segment LL (SMD = − 0.27, 95% CI = − 0.38–0.16). TAT also did not appear to significantly alter any of the other meta-analysis secondary efficacy outcomes and had similar rates of bleeding, but TAT had significantly higher rates of rash, gastrointestinal side-effects, headache and drug discontinuation. Conclusions: Compared with standard DAT, the long-term use of TAT in patients after DES implantation gave more benefits in reducing the incidence of MACEs, TLR, TVR, in-stent and in-segment LL and restenosis without increasing bleeding but was associated with an increase in minor adverse events. Highlights: Patients receiving additional cilostazol (TAT) have significantly reduced risk of major adverse cardiac events They also have reduced target lesion revascularization and target vessel revascularization TAT also reduces in-stent restenosis, in-segment restenosis and in-stent late loss TAT, however, significantly increases rash, gastrointestinal side-effects, headache and drug discontinuation.