Cilostazol for elective percutaneous coronary intervention: Clinical studies

 

실로스타졸은 간헐적 파행의 치료를 위해 승인된 약제이고, 관상동맥 스텐트의 재협착쥴 감소와 관련이 있었습니다. 실로스타졸은 혈소판에서 type III phosphodiesterase의 억제제로서 효과적인 항혈소판 제제입니다. 안정형 또는 불안정 관상동맥 질환 환자에서 아스피린, 클로피도그렐, 실로스타졸의 triple antiplatelet therapy와 아스피린, 클로피도그렐의 dual antiplatelet therapy를 비교한 몇 개의 연구들이 있었습니다. 단기 결과는 2개의 연구에서 평가되었는데 double 또는 triple의 차이가 없었습니다. 장기 결과는 1개의 무작위 시험과 2개의 관찰 연구가 있습니다.

 

● In an open-label, randomized trial of 1212 patients with ACS undergoing stent placement with either bare metal stents or drug-eluting stents (DES), patients were treated with either aspirin and clopidogrel or cilostazol (for six months; no loading dose given) in addition to aspirin and clopidogrel. At one year, the primary end point (composite of cardiac death, nonfatal MI, stroke, or target vessel revascularization) occurred significantly less often in the group that received cilostazol (10.3 versus 15.1 percent; hazard ratio 0.65, 95% CI 0.41-0.91).

 

●In the KAMIR registry of patients with ST-elevation MI treated with primary PCI using DES, there were 2569 individuals who received aspirin and clopidogrel and 1634 who received cilostazol (for at least one month) in addition to aspirin and clopidogrel. At eight months, patients who received cilostazol had significantly lower rates of cardiac death (2.0 versus 3.2 percent; adjusted odds ratio [OR] 0.52, 95% CI 0.32-0.84), and total major adverse cardiac events (all-cause mortality, nonfatal MI, and repeat PCI or revascularization procedure) (7.6 versus 9.3 percent; adjusted OR 0.74, 95% CI 0.58-0.95).

 

●In the DECREASE registry of patients with stable or unstable coronary disease who underwent stenting with DES, 1443 received aspirin and clopidogrel and 1656 received cilostazol for at least four weeks in addition to aspirin and clopidogrel. At 12 months, there was no significant difference between the two groups in combined rate of death, MI, or stent thrombosis. However, the hazard ratios for MI or stent thrombosis were significantly lower in those who received all three antiplatelet agents (0.23, 95% CI 0.08-0.70 and 0.14, 95% CI 0.04-0.52, respectively).

 

In all studies, there was no significant difference in the rate of major bleeding between groups.

 

REF. UpToDate 2019.09.22