Randomized comparison of cilostazol versus ticlopidine hydrochloride for antiplatelet therapy after coronary stent implantation for prevention of late restenosis.
BACKGROUND
Cilostazol is a newly developed antiplatelet drug that has been widely applied for clinical use. Its antiplatelet action appears to be mainly related to inhibition of intracellular phosphodiesterase activity. Recently, cilostazol has been used for antiplatelet therapy after coronary stent implantation. However, its evaluation has not been established yet.


METHODS
This prospective randomized trial was designed to investigate the efficacy of cilostazol for the prevention of late restenosis and acute or subacute stent thrombosis in comparison with ticlopidine hydrochloride. One hundred thirty consecutive patients, scheduled for elective coronary stenting, were randomly assigned to receive oral aspirin (81 mg/day) plus ticlopidine hydrochloride therapy (200 mg/day; group I) or aspirin plus cilostazol therapy (200 mg/day; group II). These medications were started at least 2 days before coronary intervention and continued until follow-up coronary angiography was performed 6 months later.


RESULTS
Subacute stent thrombosis was observed in 2 patients of group I but in no patients of group II. Major cardiac events were similarly present in both groups. Elevated transaminase levels were observed more frequently in group I than in group II (P <.05). Each of the quantitative coronary angiography variables before and immediately after coronary stenting were similar in both groups. At follow-up angiography, however, late lumen loss (0.69 +/- 0.79 mm vs 0.28 +/- 0.40 mm; P <.01) and loss index (0.42 +/- 0.56 vs 0.16 +/- 0.27; P <.01) were smaller in group II than in group I. Restenosis rate (13% vs 31%; P <.05) and target lesion revascularization rate (7% vs 21%; P <.05) were both lower in group II than in group I.


CONCLUSIONS
Aspirin plus cilostazol therapy may be an effective regimen for prevention of not only stent thrombosis but also restenosis.
Department of Cardiology, Koshigaya Hospital, Dokkyo University School of Medicine, Saitama, Japan.
Hirotoshi
H
Kamishirado
Teruo
T
Inoue
Keiichi
K
Mizoguchi
Toshihiko
T
Uchida
Toshiyuki
T
Nakata
Masashi
M
Sakuma
Kan
K
Takayanagi
Shigenori
S
Morooka
D000368:Aged; D001241:Aspirin / Q000008:administration & dosage; D000077407:Cilostazol; D017023:Coronary Angiography; D003327:Coronary Disease / Q000628:therapy*; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011182:Postoperative Care; D011446:Prospective Studies; D012107:Research Design; D015607:Stents / Q000009:adverse effects; D013777:Tetrazoles / Q000627:therapeutic use*; D013988:Ticlopidine / Q000627:therapeutic use*
D010975:Platelet Aggregation Inhibitors; D013777:Tetrazoles; D000077407:Cilostazol; D013988:Ticlopidine; D001241:Aspirin