title: Antiplatelet Therapy of Cilostazol or Sarpogrelate with Aspirin and Clopidogrel after Percutaneous Coronary Intervention: A Retrospective Cohort Study Using the Korean National Health Insurance Claim Database.
abstract: OBJECTIVE
  Addition of cilostazol or sarpogrelate to the standard dual antiplatelet therapy of aspirin and clopidogrel has been implemented in patients that underwent percutaneous coronary intervention (PCI) with stents in Korea. This study aimed to evaluate the efficacy and safety of triple antiplatelet therapies.
  
  
  METHODS
  This retrospective cohort study was performed using the Korean National Insurance Claim Data of the Health Insurance Review and Assessment Service from January 1, 2009 to December 31, 2014. The study cohort population consisted of patients with ischemic heart diseases and a history of PCI. They were treated with antiplatelet therapy of aspirin, clopidogrel (AC); aspirin, clopidogrel, cilostazol (ACCi); or aspirin, clopidogrel, sarpogrelate (ACSa) during the index period from January 1, 2010 to December 31, 2011. During the follow-up period up to December 31, 2014, the major adverse cardiac or cerebral events (MACCE) including death, myocardial infarction, target lesion revascularization, and ischemic stroke were assessed. Bleeding complications were also evaluated as adverse drug events.
  
  
  RESULTS
  Out of 93,876 patients with PCI during the index period, 69,491 patients started dual (AC) or triple therapy (ACSa or ACCi). The clinical outcomes of comparing ACSa and ACCi therapy showed beneficial effects in the ACSa group in the prevention of subsequent cardiac or cerebral events. After Propensity score-matching between ACSa and ACCi groups, there were significant differences in MI and revascularization, with corresponding HR of 0.38 (95% CI, 0.20-0.73) and 0.66 (95% CI, 0.53-0.82) in ACSa vs. ACCi at 12 months, respectively. At the 24-month follow-up, the triple therapy groups (ACS or ACC) had a higher incidence of MACCE compared to the dual therapy (AC) group; ACSa vs. AC HR of 1.69 (95% CI, 1.62-1.77); ACC vs. AC HR of 1.22 (95% CI, 1.06-1.41). There was no significant difference in severe or life-threatening bleeding risk among three groups; ACSa vs. AC, HR of 0.68 (95% CI, 0.37-1.24), ACCi vs. AC, HR of 0.91 (95% CI, 0.77-1.09).
  
  
  CONCLUSIONS
  Sarpogrelate-containing triple antiplatelet therapy demonstrated comparable rates of MACCE prevention to the conventional dual antiplatelet therapy after PCI without significantly increasing bleeding risk during the two-year follow-up period.
authors.affiliation: College of Pharmacy, Ajou University, Suwon, South Korea.
authors.forename: Yoojin
authors.initials: Y
authors.lastname: Noh
authors.affiliation: College of Pharmacy, Ajou University, Suwon, South Korea.
authors.forename: Jimin
authors.initials: J
authors.lastname: Lee
authors.affiliation: College of Pharmacy, Ajou University, Suwon, South Korea.
authors.forename: Sooyoung
authors.initials: S
authors.lastname: Shin
authors.affiliation: Department of Cardiology, School of Medicine, Ajou University, Suwon, South Korea.
authors.forename: Hong-Seok
authors.initials: HS
authors.lastname: Lim
authors.affiliation: College of Pharmacy, The Catholic University of Korea, Bucheon, South Korea.
authors.forename: Soo Kyung
authors.initials: SK
authors.lastname: Bae
authors.affiliation: College of Pharmacy, The Catholic University of Korea, Bucheon, South Korea.
authors.forename: Euichul
authors.initials: E
authors.lastname: Oh
authors.affiliation: Division of Biomedical Informatics, College of Medicine, Seoul National University, Seoul, South Korea.
authors.forename: Grace Juyun
authors.initials: GJ
authors.lastname: Kim
authors.affiliation: Division of Biomedical Informatics, College of Medicine, Seoul National University, Seoul, South Korea.
authors.forename: Ju Han
authors.initials: JH
authors.lastname: Kim
authors.affiliation: College of Pharmacy, Ajou University, Suwon, South Korea.
authors.forename: Sukhyang
authors.initials: S
authors.lastname: Lee
mesh_terms: D001241:Aspirin / Q000009:adverse effects / Q000627:therapeutic use; D000077407:Cilostazol; D000077144:Clopidogrel; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology / Q000473:pathology; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology / Q000473:pathology; D006801:Humans; D007348:Insurance, Health; D007723:Korea; D009203:Myocardial Infarction / Q000453:epidemiology / Q000473:pathology / Q000628:therapy*; D062645:Percutaneous Coronary Intervention; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D013386:Succinates / Q000009:adverse effects / Q000627:therapeutic use*; D013777:Tetrazoles / Q000009:adverse effects / Q000627:therapeutic use*; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D013386:Succinates; D013777:Tetrazoles; C064294:sarpogrelate; D000077144:Clopidogrel; D000077407:Cilostazol; D013988:Ticlopidine; D001241:Aspirin