title: Efficacy and safety of adjunctive cilostazol to dual antiplatelet therapy after stent implantation: an updated meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  Aspirin and clopidogrel dual antiplatelet therapy (DAT) reduce ischemic events in patients with cardiovascular disease. However, recurrent ischemic event occurrence during DAT remains a major concern. This systematic review assesses the efficacy and safety of adjunctive cilostazol to DAT in combination with DAT on reducing clinical adverse events.
  
  
  METHODS
  We searched randomized controlled trials (RCTs) in PubMed, Embase, Cochrane library, clinicaltrial.gov, and Chinese Biomedical Database through July 2011. Pooled risk ratio (RR) with 95% confidence intervals (CIs) was calculated. Two independent reviewers evaluated the included studies. The extracted data were analyzed by Review Manager 5.1.2 (The Cochrane Collaboration, Oxford, UK) and GRADEprofiler 3.6 (GRADE Working Group).
  
  
  RESULTS
  A total of 7 RCTs (4351 patients) were included in the analysis, with a follow-up period of 6 to 12 months. Pooled analysis showed that cilostazol was associated with a significant reduction in major adverse cardiac events (MACEs; pooled RR 0.69, 95% CI 0.52-0.91; P = .008) and repeat revascularization (RR 0.74, 95% CI 0.61-0.89; P = .002); however, cilostazol was not associated with a reduction in the risk of stent thrombosis (RR 1.00, 95% CI 0.41-2.45; P = 1.00). Cilostazol seems to be safe, with no significant increase in the risk of bleeding (RR 1.06, 95% CI 0.72-1.56; P = .77). The 4 outcomes were low-quality evidence for MACE, moderate-quality evidence for repeat revascularization, and high-quality evidence for bleeding and stent thrombosis.
  
  
  CONCLUSIONS
  When compared to the currently recommended DAT, triple antiplatelet therapy with cilostazol can reduce repeat revascularization with no increase in the risk of bleeding.
authors.affiliation: Clinical Pharmacology Research Laboratory, The First Affiliated of Soochow University, Suzhou, China.
authors.forename: Xiao Liang
authors.initials: XL
authors.lastname: Ding
authors.forename: Cheng
authors.initials: C
authors.lastname: Xie
authors.forename: Bin
authors.initials: B
authors.lastname: Jiang
authors.forename: Jie
authors.initials: J
authors.lastname: Gao
authors.forename: Ling Li
authors.initials: LL
authors.lastname: Zhang
authors.forename: Hua
authors.initials: H
authors.lastname: Zhang
authors.forename: Jing Jing
authors.initials: JJ
authors.lastname: Zhang
authors.forename: Li Yan
authors.initials: LY
authors.lastname: Miao
mesh_terms: D001241:Aspirin / Q000009:adverse effects / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery; D000077407:Cilostazol; D003131:Combined Modality Therapy / Q000009:adverse effects; D016861:Cyclooxygenase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D019317:Evidence-Based Medicine; D006801:Humans; D017202:Myocardial Ischemia / Q000209:etiology / Q000517:prevention & control; D058987:Phosphodiesterase 3 Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D055502:Secondary Prevention; D015607:Stents; D013777:Tetrazoles / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D016861:Cyclooxygenase Inhibitors; D058987:Phosphodiesterase 3 Inhibitors; D010975:Platelet Aggregation Inhibitors; D013777:Tetrazoles; D000077407:Cilostazol; D001241:Aspirin