Usefulness of cilostazol versus ticlopidine in coronary artery stenting

Yoon, Young Sup; Shim, Won Heum; Lee, Doo Hee; Pyun, Wook Bum; Kim, In Jai; Jang, Yangsoo; Cho, Seung Yun

doi:10.1016/s0002-9149(99)00579-2

Cited by 41 publications

(23 citation statements)

References 25 publications

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“…Furthermore, a recent randomized trial of coronary artery stenting revealed cilostazol to have advantages over ticlopidine with respect to adverse drug reactions. 28) Warnings of serious adverse reactions such as thrombocytopenia, 29) leukopenia 30) and aplastic anemia 31) have been issued with use of ticlopidine. Although side effects in the ticlopidine group in the present study (elevated aminotransferase and skin rash) were mild, they required repeated monitoring of liver function and blood cell counts.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Ticlopidine and Cilostazol for the Prevention of Restenosis after Percutaneous Transluminal Coronary Angioplasty.

et al. 2001

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SUMMARYPrevention of restenosis after percutaneous transluminal coronary angioplasty (PTCA) continues to be a significant problem. Recent controlled studies have demonstrated that cilostazol suppresses restenosis after PTCA. The effects of ticlopidine, another antiplatelet agent, were compared in terms of outcomes of patients randomized for treatment with the two drugs after PTCA. A total of 35 patients (47 lesions) were assigned prospectively and randomly to ticlopidine (17 patients, 24 lesions) and cilostazol (18 patients, 23 lesions) groups. Minimal luminal diameter (MLD) and percentage of stenosis to reference diameter were estimated before PTCA, just after the procedure and after 4 months follow-up. All patients underwent 4 months angiographic follow-up, at the end of which MLD was 2.03 ± 0.71 mm in the ticlopidine group and 2.05 ± 0.68 mm in the cilostazol group (p = 0.95), and the percentage of stenosis to reference diameter was 31.4 ± 16.7% and 30.0 ± 17.0%, respectively (p = 0.78). The restenosis rate was 12.5% in the ticlopidine group and 17.4% in the cilostazol group (p = 0.69), relatively low as compared to the 20% to 30% reported in previous studies. Adverse drug reactions during the followup period were observed in two of the ticlopidine group and none of the cilostazol group. We conclude that both ticlopidine and cilostazol are effective for the prevention of restenosis after PTCA, however the former may be associated with slight side effects. (Jpn Heart J 2001; 42: 43-54) Key words: Antiplatelet therapy, Follow-up studies, Quantitative coronary arteriography RESTENOSIS after percutaneous transluminal coronary angioplasty (PTCA) is still a major limitation to long-term successful therapy. Coronary stent implantation is associated with a significant reduction in the angiographic restenosis rate compared with conventional simple balloon angioplasty, with decreases to 20% to 30% reported by the BENESTENT 1) and STRESS 2) trials, but the search for

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Section: Discussionmentioning

confidence: 99%

Comparison of Ticlopidine and Cilostazol for the Prevention of Restenosis after Percutaneous Transluminal Coronary Angioplasty.

et al. 2001

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“…26 Another clinical trial in-volving 300 patients randomized to aspirin and ticlopidine, or aspirin and cilostazol, found that cilostazol was as efficacious as the standard regimen in preventing stent thrombosis. 24 A trend toward specific increased drug-related events (e.g., neutropenia) was seen for ticlopidine but not for cilostazol. 24 In another investigation involving 409 patients treated with ticlopidine or cilostazol, the overall rate of restenosis was similar for both agents, but a significantly lower rate of restenosis was seen among subjects with diabetes who received cilostazol (21.7% of cilostazol-treated patients with diabetes vs. 50.0% of ticlopidine-treated patients with diabetes, p < 0.05).…”

Section: Introductionmentioning

confidence: 96%

“…Two animal studies 22,23 and several small clinical trials in approximately 1,480 subjects [24][25][26][27][28] have demonstrated comparable or significantly increased antirestenosis effects for cilostazol versus aspirin and/or ticlopidine. Tsuchikane et al, with quantitative coronary arteriography (QCA), found significantly less restenosis (p < 0.001), as well as lower rates of target lesion revascularization, larger minimal luminal diameter, and lower percent diameter stenosis for cilostazol versus aspirin in 211 patients after successful PTCA.…”

Section: Introductionmentioning

confidence: 99%

Rationale and design of the randomized, multicenter, Cilostazol for restenosis (CREST) trial

Douglas

Weintraub

Holmes

2003

Clinical Cardiology

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Summary:Restenosis of a segment of diseased coronary artery following metallic stenting is a common clinical problem and a major limitation of the procedure. Systemic pharmacologic interventions to deal with this problem have met with little success. Several small studies suggest that cilostazol, a phosphodiesterase III inhibitor whose pharmacologic properties include antiplatelet, antithrombotic, and vasodilatory effects; a beneficial effect on serum lipids; and in vitro inhibition of smooth muscle cell proliferation, may help prevent platelet aggregation and impede the accumulation of new intimal tissue in the stented artery. The Cilostazol for RESTenosis (CREST) trial will aim to evaluate more definitively the ability of cilostazol to prevent restenosis following uncomplicated stent implantation for de novo coronary artery stenosis. In this randomized, double-blind, multicenter study, 700 patients will receive clopidogrel, aspirin, and either cilostazol or placebo after successful intracoronary stent implantation. The primary endpoint is minimal luminal diameter (MLD) of the first lesion stented after 6 months; secondary endpoints include MLD in all lesions, mean percent diameter stenosis, target lesion revascularization, and major angiographic endpoints. Safety endpoints are abnormal complete blood count and liver function tests at 1, 3, and 6 months. The trial has been initiated, and enrollment is anticipated to be concluded in 2003. Cilostazol has properties that may reduce or avert in-stent coronary restenosis. The CREST trial is a large, rigorously conducted trial that may corroborate the favorable effects of cilostazol on coronary stent restenosis suggested by earlier studies.

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“…Yoon et al reported that antiplatelet therapy with cilostazol + aspirin was as effective as ticlopidine + aspirin in preventing stent thrombosis and there was no statistical difference in the incidence of ADR and complications. 9 However, those patients had undergone elective coronary stenting, so it remains unclear whether antiplatelet therapy with cilostazol + aspirin is equally effective as ticlopidine + aspirin in emergency PCI cases in the "real world".…”

mentioning

confidence: 99%

Randomized Comparison of Cilostazol vs Ticlopidine for Antiplatelet Therapy After Coronary Stenting

Takeyasu

Watanabe

Noguchi

et al. 2005

Circ J

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Background Cilostazol and ticlopidine are commonly prescribed for prevention of thrombosis after coronary stenting, but few studies have compared them. Methods and ResultsIn the present study 642 patients who underwent stenting were randomized to treatment either with cilostazol + aspirin (C group, 321 patients) or ticlopidine + aspirin (T group, 321 patients). Quantitative coronary angiography (QCA) was performed immediately after stenting and at the 6-month follow-up. Treatment was continued until follow-up angiography. Baseline patient characteristics did not differ significantly. With the exception of a higher rate of stenting in a venous graft in the C group, there were no differences in angiographic characteristics or stent type. Baseline QCA analysis of the reference diameter, minimal lumen diameter (MLD) showed no significant differences. Follow-up QCA analysis of the MLD showed no significant differences. There were also no differences in restenosis or target lesion revascularization rates, or in the incidence of adverse reactions. However, the rate of subacute thrombosis (SAT) was significantly higher in the C group than in the T group (2% vs 0.3%, p=0.02). Conclusion In the present study there was a similar restenosis rate with cilostazol or ticlopidine, but the rate of SAT was significantly higher with cilostazol. There was no significant difference in adverse reactions. (Circ J 2005; 69: 780 -785)

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Usefulness of cilostazol versus ticlopidine in coronary artery stenting

Cited by 41 publications

References 25 publications

Comparison of Ticlopidine and Cilostazol for the Prevention of Restenosis after Percutaneous Transluminal Coronary Angioplasty.

Comparison of Ticlopidine and Cilostazol for the Prevention of Restenosis after Percutaneous Transluminal Coronary Angioplasty.

Rationale and design of the randomized, multicenter, Cilostazol for restenosis (CREST) trial

Randomized Comparison of Cilostazol vs Ticlopidine for Antiplatelet Therapy After Coronary Stenting

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