Cilostazol is associated with improved outcomes after peripheral endovascular interventions.
OBJECTIVE
Although cilostazol is commonly used as an adjunct after peripheral vascular interventions, its efficacy remains uncertain. We assessed the effect of cilostazol on outcomes after peripheral vascular interventions using meta-analytic techniques.


METHODS
We searched MEDLINE (1946-2012), Cochrane CENTRAL (1996-2012), and trial registries for studies comparing cilostazol in combination with antiplatelet therapy to antiplatelet therapy alone after peripheral vascular interventions. Treatment effects were reported as pooled risk/hazard ratio (HR) with random-effects models.


RESULTS
Two randomized trials and four retrospective cohorts involving 1522 patients met inclusion criteria. Across studies, mean age ranged from 65 to 76 years, and the majority of patients were male (64%-83%); mean follow-up ranged from 18 to 37 months. Most interventions were in the femoropopliteal segment, and overall, 68% of patients had stents placed. Pooled estimates demonstrated that the addition of cilostazol was associated with decreased restenosis (relative risk [RR], 0.71; 95% confidence interval [CI], 0.60-0.84; P < .001), improved amputation-free survival (HR, 0.63; 95% CI, 0.47-0.85; P = .002), improved limb salvage (HR, 0.42; 95% CI, 0.27-0.66; P < .001), and improved freedom from target lesion revascularization (RR, 1.36; 95% CI, 1.14-1.61; P < .001). There was no significant reduction in mortality among those receiving cilostazol (RR, 0.73; 95% CI, 0.45-1.19; P = .21).


CONCLUSIONS
The addition of cilostazol to antiplatelet therapy after peripheral vascular interventions is associated with a reduced risk of restenosis, amputation, and target lesion revascularization in our meta-analysis of six studies. Consideration of cilostazol as a medical adjunct after peripheral vascular interventions is warranted, presuming these findings are broadly generalizable.
Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH. Electronic address: courtney.j.warner@hitchcock.org.
Courtney J
CJ
Warner
The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH.
Spencer W
SW
Greaves
The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH.
Robin J
RJ
Larson
Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
David H
DH
Stone
Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
Richard J
RJ
Powell
Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
Daniel B
DB
Walsh
Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
Philip P
PP
Goodney
D001157:Arterial Occlusive Diseases / Q000628:therapy*; D000077407:Cilostazol; D057510:Endovascular Procedures / Q000379:methods*; D005263:Femoral Artery; D014943:Global Health; D006083:Graft Occlusion, Vascular / Q000453:epidemiology / Q000517:prevention & control*; D006085:Graft Survival / Q000187:drug effects; D006801:Humans; D015994:Incidence; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D011150:Popliteal Artery; D016032:Randomized Controlled Trials as Topic; D015996:Survival Rate / Q000639:trends; D013777:Tetrazoles / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome
D010975:Platelet Aggregation Inhibitors; D013777:Tetrazoles; D000077407:Cilostazol