Antiplatelet treatment with cilostazol after stent implantation

Abstract

Objectives-To evaluate the eYcacy of cilostazol, a new synthetic inhibitor of phosphodiesterase, in preventing stent thrombosis after successful implantation. Design-Preliminary prospective study. Setting-A single coronary care unit in Japan. Patients-Elective, bailout, or primary stents were implanted in 85 consecutive patients with 93 lesions. Primary stent implantation was performed in 18 patients with acute myocardial infarction. Patients received 200 mg cilostazol and 243 mg aspirin after stenting. Main outcome measures-Stent thrombosis, major and minor complications, and side eVects were assessed in the six months after stenting. Results-Gianturco-Roubin stents were implanted in 37 lesions, Wiktor stents in 55, and Palmaz-Schatz stents in 27. Multiple stents were used in 26 lesions. There was no mortality, stent thrombosis related Q wave myocardial infarction, emergency bypass surgery, repeat intervention, or vascular complications in the six months of follow up. Acute or subacute closure did not occur after stenting. There were no serious side eVects such as leucopenia and/or abnormal liver function for three months. Cilostazol was withdrawn in one patient because of skin rash. Patients who underwent primary stenting had no clinical events, such as acute or subacute thrombosis, or side eVects. Conclusions-Cilostazol is an eVective antiplatelet agent with minimum side eVects after elective, bailout, or primary stent implantation. (Heart 1998;80:393-396)

Cilostazol (Pletal®): A Dual Inhibitor of Cyclic Nucleotide Phosphodiesterase Type 3 and Adenosine Uptake

“…Thus, because of cilostazol's broad range of antiplatelet properties, the effect of cilostazol alone or in combination with aspirin to prevent subacute thrombosis associated with the coronary stenting procedure was investigated. In two small, prospective, non-randomized Japanese studies (48,84), cilostazol 200 mg daily appeared to be as safe and effective as aspirin 243 mg/day following stent implantation. Park et al (55) compared the effect of cilostazol, 200 mg/day for six months, with that of ticlopidine, 500 mg/day for four weeks, in a randomized, controlled trial in 490 patients undergoing elective stent implantation.…”

Triple Versus Dual Antiplatelet Therapy in Patients With Acute ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

“…9 Antiplatelet therapy with cilostazol after PCI has similar safety and efficacy outcomes compared with aspirin or clopidogrel. [11][12][13] A recent study suggested that cilostazol could ameliorate platelet responsiveness to clopidogrel in patients who underwent primary PCI. 14 Furthermore, some other studies showed that the administration of cilostazol after PCI could significantly lower the incidence of in-stent restenosis.…”

Comparison of Cilostazol and Ticlopidine Coadministered with Aspirin for Long-Term Efficacy and Safety after Coronary Stenting; a Meta-Analysis

“…Cilostazol is another potent oral antiplatelet agent with a more rapid onset of action that selec tively inhibits phosphodiesterase III, and is associat ed with a lower incidence of adverse effects [8][9][10][11][12][13][14]. In a prospective study of coronary stenting with con comitant aspirin and cilostazol, no thrombosis was observed even though cases of emergency stent placement were included 12).…”