Effects of cilostazol on platelet activation in coronary stenting patients who already treated with aspirin and clopidogrel.
BACKGROUND
A recent study has shown that triple anti-platelet therapy (cilostazol+clopidogrel+aspirin) resulted in a significantly lower restenosis rate after coronary stenting than did conventional therapy (clopidogrel+aspirin). However, the anti-platelet effects of cilostazol, when combined with clopidogrel and aspirin, have not been evaluated.


METHODS
Low dose cilostazol (50 mg/BID) was given to 47 patients who had already been taking clopidogrel (75 mg/day) and aspirin (100 mg/day) for more than 1 month subsequent to coronary stenting due to AMI and unstable angina. Markers of platelet activation, P-selectin and activated GPIIb/IIIa on platelets, were measured at baseline and 2 weeks after cilostazol treatment. We empirically divided patients into tertiles (low, n =16; moderate, n = 14; high group, n = 17), according to the baseline P-selectin expression. We then performed a comparative assessment of the anti-platelet effects of cilostazol at baseline and after 2 weeks of cilosatzol administration.


RESULTS
P-selectin was significantly decreased after 2 weeks of cilostazol treatment in total patients (n = 47, 3.2 +/- 2.4% to 2.0 +/- 1.9%, p = 0.03). This inhibition of P-selectin expression was mainly achieved in the moderate and high P-selectin groups (low group; 1.4 +/- 0.5 to 1.9 +/- 1.3%, p > 0.05, moderate group; 2.5 +/- 0.3 to 1.3 +/- 0.3%, p < 0.05, high group; 5.4 +/- 2.7 to 2.7 +/- 2.8%, p < 0.05). Activated GPIIb/IIIa was not significantly changed (13.5% to 17.6%, p > 0.05). Underying disease, cardiovascular risk factors, concomitant medication including statin, and hsCRP were not related to the degree of P-selectin expression.


CONCLUSIONS
Our data demonstrated that cilostazol treatment in addition to conventional anti-platelet therapy provides more effective suppression of platelet P-selectin expression in patients with relatively high platelet activity.
Ahn
Jeong Cheon
JC
Department of Internal Medicine, Ansan Hospital, Korea University College of Medicine, Seoul, Korea.
Song
Woo Hyuk
WH
Kwon
Jung Ah
JA
Park
Chang Gyu
CG
Seo
Hong Seok
HS
Oh
Dong Joo
DJ
Rho
Young Moo
YM
D001241:Aspirin / Q000627:therapeutic use*; D000077407:Cilostazol; D000077144:Clopidogrel; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000601:surgery; D019007:P-Selectin / Q000097:blood; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000032:analysis; D015607:Stents; D013777:Tetrazoles / Q000627:therapeutic use*; D013927:Thrombosis / Q000097:blood / Q000517:prevention & control*; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use*
D019007:P-Selectin; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D013777:Tetrazoles; D000077144:Clopidogrel; D000077407:Cilostazol; D013988:Ticlopidine; D001241:Aspirin