Cilostazol for Prevention of Thrombosis and Restenosis after Intracoronary Stenting

Abstract

Spanish

French

OBJECTIVE:

To evaluate the potential use of cilostazol in intracoronary stenting.

DATA SOURCES:

Clinical literature was accessed through MEDLINE (1966–March 2001). Key search terms included cilostazol, intracoronary stenting, and coronary angioplasty. Abstracts of clinical trials presented at major cardiology professional association meetings were also reviewed.

DATA SYNTHESIS:

Intracoronary stent placement represents the fastest growing medical device implant. Complications of stent implantation include acute and subacute vessel closure, as well as late restenosis. Currently, antiplatelet agents are used for preventive therapy. Cilostazol is a vasodilating antiplatelet agent that reversibly inhibits platelet aggregation induced by many factors. In seven randomized trials comparing cilostazol with either aspirin or ticlopidine, cilostazol was found to be superior to aspirin and equivalent to ticlopidine in decreasing both cardiac events and rates of restenosis. In addition, cilostazol was found to be well tolerated, with no reports of adverse hematologic events.

CONCLUSIONS:

Although further comparative trials are required, cilostazol appears to be a safe and effective alternative to clopidogrel and glycoprotein IIb/IIIa receptor antagonists following intracoronary stent implantation.

Keywords

cilostazol coronary angioplasty intracoronary stenting

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References

Lane

. Dramatic increase in use of coronary stents (letter). Am J Cardiol 1999; 84: 1141.

Mauro

Borovicka

Kline

. Introduction to coronary artery stents and their pharmacotherapeutic management. Ann Pharmacother 1997; 31: 1490–8.

Mishkel

Aguirre

Ligon

Rocha-Singh

Lucore

. Clopidogrel as adjunctive antiplatelet therapy during coronary stenting. J Am Coll Cardiol 1999; 34: 1884–90.

Fischman

Leon

Baim

Schatz

Savage

Penn

. A randomized comparison of coronary-stent placement and balloon angioplasty in the treatment of coronary artery disease. Stent Restenosis Study Investigators. N Engl J Med 1994; 331: 496–501.

Serruys

de Jaegere

Kiemeneij

Macaya

Rutsch

Heyndrickx

. A comparison of balloon-expandable-stent implantation with balloon angioplasty in patients with coronary artery disease. Benestent Study Group. N Engl J Med 1994; 331: 489–95.

Ochiai

Eto

Takeshita

Yokoyama

Oshima

Kondo

. Impact of cilostazol on clinical and angiographic outcome after primary stenting for acute myocardial infarction. Am J Cardiol 1999; 84: 1074–6.

Popma

Ohman

Weitz

Lincoff

Harrington

Berger

. Antithrombotic therapy in patients undergoing percutaneous coronary intervention. Chest 2001; 119 (Suppl):321S–336S.

Leon

Baim

Popma

Gordon

Cutlip

. A clinical trial comparing three antithrombotic drug regimens after coronary-artery stenting. N Engl J Med 1998; 339: 1665–71.

Dawson

Cutler

Meissner

Strandness

Jr. . Cilostazol has beneficial effects in treatment of intermittent claudication. Circulation 1998; 98: 678–85.

10.

Pletal: Clinical Pharmacology. Available from URL: http://www.pletal.com/pro/0_7.asp. [accessed 2001 March 16].

11.

Okuda

Kimura

Yamashita

. Cilostazol. Cardiovasc Drug Rev 1993; 11: 451–65.

12.

Package insert. Pletal (cilostazol). Rockville, MD: Otsuka Pharmaceutical, January 1999.

13.

Packer

Carver

Rodeheffer

Ivanhoe

DiBianco

Zeldis

. Effect of oral milrinone on mortality in severe congestive heart failure. N Engl J Med 1991; 325: 1468–75.

14.

Yamasaki

Hara

Ikari

Kobayashi

Kozuma

Ohmoto

. Effects of cilostazol on late lumen loss after Palmaz-Schatz stent implantation. Catheter Cardiovasc Diagnosis 1998; 44: 387–91.

15.

Kunishima

Musha

Eto

Iwasaki

Nagashima

Masui

. A randomized trial of aspirin versus cilostazol therapy after successful coronary stent implantation. Clin Ther 1997; 19: 1058–65.

16.

Yoon

Shim

Lee

Pyun

Kim

Jang

. Usefulness of cilostazol versus ticlopidine in coronary artery stenting. Am J Cardiol 1999; 84: 1375–80.

17.

Park

Lee

Kim

Lee

Park

Hong

. Comparison of cilostazol versus ticlopidine therapy after stent implantation. Am J Cardiol 1999; 84: 511–4.

18.

Park

Lee

Kim

Lee

Nah

Hong

. Effects of cilostazol on angiographic restenosis after coronary stent placement. Am J Cardiol 2000; 86: 499–503.

19.

Sekiya

Funada

Watanabe

Miyagawa

Akutsu

. Effects of probucol and cilostazol alone and in combination on frequency of post-stenting restenosis. Am J Cardiol 1998; 82: 144–7.

20.

Yoshitomi

Kojima

Sugi

Yano

Matsumoto

Kuramochi

. Antiplatelet treatment with cilostazol after stent implantation. Heart 1998; 80: 393–6.

21.

Kozuma

Hara

Yamasaki

Morino

Ayabe

Kuroda

. Effects of cilostazol on late lumen loss and repeat revascularization after Palmaz-Schatz coronary stent implantation. Am Heart J 2001; 141: 124–30.

22.

Marso

Lincoff

Ellis

Bhatt

Tanguay

J-F

Kleiman

. Optimizing the percutaneous interventional outcomes for patients with diabetes mellitus: Results of the EPISTENT (Evaluation of Platelet IIb/IIIa Inhibitor for Stenting Trial) diabetic substudy. Circulation 1999; 100: 2477–84.

23.

Bertrand

Rupprecht

Urban

Gershlick

. Double-blind study of the safety of clopidogrel with and without a loading dose in combination with aspirin compared with ticlopidine in combination with aspirin after coronary stenting: The Clopidogrel Aspirin Stent International Cooperative Study (CLASSICS). Circulation 2000; 102: 624–9.

24.

Lincoff

Califf

Moliterno

Ellis

Ducas

Kramer

. Complementary clinical benefits of coronary-artery stenting and blockade of platelet glycoprotein IIb/IIIa receptors. N Engl J Med 1999; 341: 319–27.

25.

Topol

Mark

Lincoff

Cohen

Burton

Kleiman

. Outcomes at 1 year and economic implications of platelet glycoprotein IIb/IIIa blockade in patients undergoing coronary stenting: Results from a multicentre randomised trial. EPISTENT Investigators. Evaluation of Platelet IIb/IIIa Inhibitor for Stenting. Lancet 1999; 354: 2019–24.

26.

The EPISTENT Investigators. Randomised placebo-controlled and balloon-angioplasty-controlled trial to assess safety of coronary stenting with use of platelet glycoprotein-IIb/IIIa blockade. Evaluation of Platelet IIb/IIIa Inhibitor for Stenting. Lancet 1998; 352: 87–92.

27.

The ESPRIT Investigators. Novel dosing regimen of eptifibatide in planned coronary stent implantation (ESPRIT): A randomised, placebo-controlled trial. Lancet 2000; 356: 2037–44.