Effects of cilostazol on resting ankle pressures and exercise-induced ischemia in patients with intermittent claudication

Abstract

Abstract:During exercise, patients with intermittent claudication (IC) have decreased limb arterial blood pressure that recovers during rest. A novel method for assessing dynamic recovery of function is measurement of the hemodynamic response after exercise. Cilostazol (Pletal  ), a new agent for the treatment of IC, increases walking distance and may decrease ischemic burden. The objective of this study was to assess the effect of cilostazol versus placebo on hemodynamic measurements after exercise-induced ischemia in patients with IC.Two double-blind, placebo-controlled studies with similar inclusion/exclusion criteria and duration (24 weeks) were pooled. Patients walked on a treadmill at 2.0 miles/h (3.2 km/h) on a 12.5% grade until the claudication-limited maximal walking distance (MWD) was reached. Anterior and posterior tibial pressures were measured with Doppler ultrasound at baseline and at 1, 5, and 9 min during recovery. Area under the curve (AUC), a measure of the time course of recovery of systolic pressure after exercise-induced ischemia, and ankle-brachial index (ABI) were calculated and compared using analysis of variance (ANOVA).All three treatment groups (308 patients randomized to cilostazol 100 mg bid, 303 to cilostazol 50 mg bid, and 299 to placebo) had similar baseline characteristics. Mean post-exercise AUC for cilostazol 100 mg and 50 mg bid versus placebo increased by 0.31 (p = 0.001) and 0.26 (p = 0.004), respectively. Mean resting ABI increased by 0.03 (p = 0.0039) and 0.04 (p = 0.0001) in the cilostazol 100 mg and 50 mg bid groups, respectively.In conclusion, following 24 weeks of treatment, cilostazol increased the ABI at rest and improved the recovery time of ankle pressures post-exercise.

ACC/AHA 2005 Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic): A Collaborative Report from the American Association for Vascular Surgery/Society for Vascular Surgery,⁎Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients

“…In dose-ranging trials, cilostazol administered at 100 mg twice daily was more effective than 50 mg twice daily (161,369). Cilostazol increased ABI modestly in these studies, but the hemodynamic effect could not account for the improvement in claudication (337,338,370,371). A meta-analysis of these trials indicated that cilostazol also improved walking ability and health-related quality of life (372).…”

ACC/AHA 2005 Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic): Executive Summary A Collaborative Report From the American Association for Vascular Surgery/Society for Vascular Surgery,⁎⁎AAVS/SVS when Guideline initiated, now merged into SVSSociety for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guideline

“…Cilostazol improves maximal walking distance by 40% to 60% after 12 to 24 weeks of therapy (56 -60). Cilostazol increases ABI modestly, but the hemodynamic effect cannot account for the improvement in claudication (56,57,59,61). A meta-analysis indicates that cilostazol also improves walking ability and health-related quality of life (62).…”

Pheochromocytoma with the Renovascular Hyperreninemia Attendant on Renal Artery Stenosis

“…In dose-ranging trials, cilostazol administered at 100 mg twice daily was more effective than 50 mg twice daily (161,369). Cilostazol increased ABI modestly in these studies, but the hemodynamic effect could not account for the improvement in claudication (337,338,370,371). A meta-analysis of these trials indicated that cilostazol also improved walking ability and health-related quality of life (372).…”