The effect of cilostazol on stent thrombosis after drug-eluting stent implantation.
OBJECTIVE
Placement of drug-eluting stents (DES) can be complicated by stent thrombosis; prophylactic antiplatelet therapy has been used to prevent such events. We evaluated the efficacy of cilostazol with regard to stent thrombosis as adjunctive antiplatelet therapy.


METHODS
A total of 1,315 patients (846 males, 469 females) were prospectively enrolled and analyzed for the frequency of stent thrombosis. Patients with known risk factors for stent thrombosis, except diabetes and acute coronary syndrome, were excluded from the study. All patients maintained antiplatelet therapy for at least six months. To evaluate the effects of cilostazol as another option for antiplatelet therapy, triple antiplatelet therapy (aspirin+clopidogrel+cilostazol, n=502) was compared to dual antiplatelet therapy (aspirin+clopidogrel, n=813). Six months after stent placement, all patients received only two antiplatelet drugs: treatment either with cilostazol+aspirin (cilostazol group) or clopidogrel+aspirin (clopidogrel group). There were 1,033 patients (396 in cilostazol group and 637 in clopidogrel group) that maintained antiplatelet therapy for at least 12 months and were included in this study. Stent thrombosis was defined and classified according to the definition reported by the Academic Research Consortium (ARC).


RESULTS
defined and classified according to the definition reported by the Academic Research Consortium (ARC).


RESULTS
During follow-up (561.7+/-251.4 days), 15 patients (1.14%) developed stent thrombosis between day 1 to day 657. Stent thrombosis occurred in seven patients (1.39%) on triple antiplatelet therapy and four patients (0.49%) on dual antiplatelet therapy (p=NS) within the first six months after stenting. Six months and later, after stent implantation, one patient (0.25%) developed stent thrombosis in the cilostazol group, and three (0.47%) in the clopidogrel group (p=NS).


CONCLUSIONS
During the first six months after DES triple antiplatelet therapy may be more effective than dual antiplatelet therapy for the prevention of stent thrombosis. However, after the first six months, dual antiplatelet treatment, with aspirin and cilostazol, may have a better cost benefit ratio for the prevention of stent thrombosis.
Jeon
Doo-Soo
DS
Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Yoo
Ki-Dong
KD
Park
Chan-Suk
CS
Shin
Dong-Il
DI
Her
Sung-Ho
SH
Park
Hoon-Joon
HJ
Choi
Yoon-Seok
YS
Kim
Dong-Bin
DB
Lee
Chong-Min
CM
Park
Chul-Soo
CS
Kim
Pum-Joon
PJ
Moon
Keon-Woong
KW
Jang
Ki-Yuk
KY
Kim
Hee-Yeol
HY
Chung
Wook-Sung
WS
Seung
Ki-Bae
KB
Kim
Jae-Hyung
JH
Choi
Kyu-Bo
KB