title: Pharmacodynamic effect of cilostazol plus standard clopidogrel versus double-dose clopidogrel in patients with type 2 diabetes undergoing percutaneous coronary intervention.
abstract: OBJECTIVE
  To determine the effect of adding cilostazol (100 mg b.i.d.) to standard-dose clopidogrel (75 mg/d) (TRIPLE) compared with double-dose clopidogrel (150 mg/d) (DOUBLE) and the influence of the cytochrome P450 (CYP2C19*2/*3, CYP3A5*3)and ATP-binding cassette subfamily B1(ABCB1 C3435T) genetic polymorphisms in type 2 diabetes (T2DM) patients.
  
  
  METHODS
  T2DM patients were treated with TRIPLE (n = 41) or DOUBLE (n = 39) after percutaneous coronary intervention. Conventional aggregometry and VerifyNow were performed at baseline and at 30 days. The primary end point was absolute change in 20-μM ADP-induced maximal platelet aggregation (ΔMPA(20)) between baseline and switching values.
  
  
  RESULTS
  TRIPLE versus DOUBLE showed greater ΔMPA(20) (22.9 ± 11.6 vs.12.7 ± 15.5%; difference, 10.2% [95% CI 4.2-16.3]; P < 0.001). Carriage of one (β coefficient, -5.4%; P = 0.162) and two CYP2C19 loss-of-function allele(s) (-8.3%; P = 0.007) were associated with lower ΔMPA(20) in DOUBLE-treated patients, but not in TRIPLE-treated patients.
  
  
  CONCLUSIONS
  Among T2DM patients, adding cilostazol achieves greater platelet inhibition compared with clopidogrel (150 mg/d), which is not influenced by genetic polymorphisms.
authors: Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, Korea. goodoctor@naver.com
authors: Young-Hoon
authors: YH
authors: Jeong
authors: Udaya S
authors: US
authors: Tantry
authors: Yongwhi
authors: Y
authors: Park
authors: Tae Jung
authors: TJ
authors: Kwon
authors: Jeong Rang
authors: JR
authors: Park
authors: Seok-Jae
authors: SJ
authors: Hwang
authors: Kevin P
authors: KP
authors: Bliden
authors: Eun-Ha
authors: EH
authors: Koh
authors: Choong Hwan
authors: CH
authors: Kwak
authors: Jin-Yong
authors: JY
authors: Hwang
authors: Sunjoo
authors: S
authors: Kim
authors: Paul A
authors: PA
authors: Gurbel
mesh_terms: D000077407:Cilostazol; D000077144:Clopidogrel; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000235:genetics / Q000378:metabolism; D005260:Female; D006801:Humans; D008297:Male; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D010974:Platelet Aggregation / Q000187:drug effects; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000627:therapeutic use*; D011110:Polymorphism, Genetic / Q000235:genetics; D013777:Tetrazoles / Q000008:administration & dosage* / Q000627:therapeutic use*; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D010975:Platelet Aggregation Inhibitors; D013777:Tetrazoles; D000077144:Clopidogrel; D000077407:Cilostazol; D013988:Ticlopidine