Addition of cilostazol to aspirin and a thienopyridine for prevention of restenosis after coronary artery stenting: a meta-analysis.
The purpose of this study is to evaluate the effect of adding cilostazol to dual antiplatelet therapy (aspirin and thienopyridine) on rates of restenosis after coronary artery stenting. A meta-analysis is conducted of randomized, controlled trials comparing 3 drug regimens (cilostazol, thienopyridine, aspirin [triple therapy]) with dual antiplatelet therapy to reduce restenosis after coronary stenting. A total of 5 studies are included for analysis. The analysis reveals that triple therapy is used in 796 patients, whereas dual therapy is used in 801 patients. Approximately 56% of patients receive a drug-eluting stent. The 6-month restenosis rates are significantly lower with triple versus dual antiplatelet therapy (12.7% vs 21.9%; odds ratio 0.5; 95% confidence interval, 0.38-0.66; P < .001). This benefit is seen regardless of whether a bare-metal or drug-eluting stent is used. Rates of major adverse cardiac events and bleeding are reported for 3 of the 5 studies (n = 1426); analysis of these outcomes shows no difference between treatment groups (P = .21 and .48, respectively). The addition of cilostazol to standard dual antiplatelet therapy reduces angiographic restenosis and increases MLD at 6 months without significantly affecting rates of major adverse cardiac events or bleeding.
Jennings
Douglas L
DL
Henry Ford Hospital, Department of Pharmacy Administration, 2799 West Grand Blvd, Detroit, MI 48201, USA. djennin1@hfhs.org
Kalus
James S
JS
D001241:Aspirin / Q000008:administration & dosage*; D000077407:Cilostazol; D023903:Coronary Restenosis / Q000209:etiology / Q000517:prevention & control*; D003331:Coronary Vessels / Q000187:drug effects / Q000473:pathology; D004359:Drug Therapy, Combination; D054855:Drug-Eluting Stents; D006801:Humans; D011725:Pyridines / Q000008:administration & dosage* / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D013777:Tetrazoles / Q000008:administration & dosage* / Q000627:therapeutic use
D011725:Pyridines; D013777:Tetrazoles; C446540:thienopyridine; D000077407:Cilostazol; D001241:Aspirin