Ginkgo biloba extract enhances antiplatelet and antithrombotic effects of cilostazol without prolongation of bleeding time.
Thrombosis and thromboembolic occlusions of major and minor blood vessels are a major complication in various peripheral vascular diseases. Antiplatelet agents (APA), key tools in the treatment of atherothrombosis, therefore became a mainstay medication for a wide range of vascular diseases. Cilostazol and Ginkgo biloba extract (GB), commonly used remedies for peripheral arterial disease, inhibit platelet aggregation with distinct therapeutic mechanisms. In this study, we have investigated if GB can potentiate the antiplatelet effects of cilostazol to explore the utility of combination therapy of cilostazol and GB against peripheral occlusive vascular diseases. GB or cilostazol was evaluated alone or in combination for the antiplatelet activity using in vitro and in vivo models. In addition, potential bleeding side effect of the combinative therapy was assessed by measuring bleeding time, prothrombin time (PT) and activated partial thromboplastin time (aPTT) in vivo after oral administration. In in vitro assays using freshly isolated human platelets, the combination of cilostazol and GB showed superior inhibition of both the shear and the collagen-induced platelet aggregation to those of each drug alone. In accordance with these enhanced in vitro antiplatelet activities, the combinative therapy showed enhanced anti-thrombotic effects in in vivo pulmonary embolism model and arterial thrombosis model. In particular, the increase of survival rate in pulmonary embolism model by combination treatment of cilostazol (25 mg/kg) and GB (20 mg/kg) was higher more than two-fold of those of the respective drugs. Notably, the combination of cilostazol and GB did not show a significant effect on the bleeding time, PT and aPTT increase, suggesting that GB may potentiate the antiplatelet effect of cilostazol without the prolongation of bleeding time or coagulation time. With these studies, we suggest that combinative therapy of GB and cilostazol might offer enhanced anti-thrombotic efficacies without increasing side-effects.
Pharmacology Team, Life Science R&D Center, SK Chemicals, Korea.
Keun Ho
KH
Ryu
Hye Young
HY
Han
So Young
SY
Lee
Sun Duck
SD
Jeon
Guang-Jin
GJ
Im
Bong Yong
BY
Lee
Keunyoung
K
Kim
Kyung-Min
KM
Lim
Jin-Ho
JH
Chung
D000818:Animals; D001760:Bleeding Time; D001777:Blood Coagulation / Q000187:drug effects*; D002478:Cells, Cultured; D000077407:Cilostazol; D004357:Drug Synergism; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D020441:Ginkgo biloba / Q000737:chemistry*; D006801:Humans; D008297:Male; D010936:Plant Extracts / Q000008:administration & dosage*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D051381:Rats; D013777:Tetrazoles / Q000008:administration & dosage*; D013812:Therapeutics; D013927:Thrombosis / Q000175:diagnosis / Q000188:drug therapy*; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D010936:Plant Extracts; D010975:Platelet Aggregation Inhibitors; D013777:Tetrazoles; D000077407:Cilostazol