Efficacy and safety of cilostazol based triple antiplatelet treatment versus dual antiplatelet treatment in patients undergoing coronary stent implantation: an updated meta-analysis of the randomized controlled trials.

Abstract

The aim of this study was to obtain best estimates of the efficacy and safety of cilostazol-based triple antiplatelet therapy (TAPT: aspirin, clopidogrel and cilostazol) compared with dual antiplatelet therapy (DAPT: aspirin and clopidogrel) in patients undergoing coronary stent implantation. We searched the literature to identify all randomized clinical trials examining efficacy and safety of TAPT versus DAPT in patients undergoing coronary stent implantation. Major efficacy outcomes were death, non-fatal myocardial infarction (MI), ischemic stroke and stent thrombosis (ST) and the safety outcome was bleeding. Data were analyzed using the Review Manager 5.0.0 software. A total of 19 trials involving 7,464 patients were included. TAPT and DAPT were associated with similar rates of death, non-fatal MI, ischemic stroke and ST, but compared with DAPT, TAPT had lower rates of target lesion revascularization (TLR) (RR 0.67, 95 % CI 0.56-0.82, P < 0.0001) and target vessel revascularization (TVR) (RR 0.65, 95 % CI 0.55-0.77, P < 0.00001), as well as less late loss of minimal lumen diameter (mean difference -0.14, 95 % CI -0.17--0.11, P < 0.00001), and less binary angiographic restenosis (RR 0.54, 95 % CI 0.45-0.65, P < 0.00001). TAPT and DAPT had similar rates of bleeding, but TAPT had significantly higher rates of headache, palpitation, rash and gastrointestinal side-effects. Cilostazol-based TAPT compared with DAPT is associated with improved angiographic outcomes and decreased risk of TLR and TVR but does not reduce major cardiovascular events and is associated with an increase in minor adverse events.

• Authors: Jun Chen, Haoyu Meng, Lei Xu, Jie Liu, Deyu Kong, Pengsheng Chen, Xiaoxuan Gong, Jianling Bai, Fengwei Zou, Zhijian Yang, Chunjian Li, John W Eikelboom
• Journal: Journal of thrombosis and thrombolysis (J Thromb Thrombolysis) Vol. 39 Issue 1 Pg. 23-34 (Jan 2015) ISSN: 1573-742X [Electronic] Netherlands
• PMID: 24869717 (Publication Type: Comparative Study, Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Review)

Chemical References

• Platelet Aggregation Inhibitors
• Tetrazoles
• Clopidogrel
• Cilostazol
• Ticlopidine
• Aspirin

Topics

• Aspirin (adverse effects, therapeutic use)
• Brain Ischemia (chemically induced)
• Cilostazol
• Clopidogrel
• Drug Therapy, Combination
• Female
• Humans
• Male
• Myocardial Infarction (chemically induced)
• Percutaneous Coronary Intervention
• Platelet Aggregation Inhibitors (adverse effects, therapeutic use)
• Randomized Controlled Trials as Topic
• Stents
• Stroke (chemically induced)
• Tetrazoles (adverse effects, therapeutic use)
• Thrombosis (chemically induced)
• Ticlopidine (adverse effects, analogs & derivatives, therapeutic use)