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DAPT Plus Cilostazol is Better Than Traditional DAPT or Aspirin Plus Ticagrelor as Elective PCI for Intermediate-to-Highly Complex Cases: Prospective, Randomized, PRU-Based Study in Taiwan

  • Yueh-Chung Chen
  • Feng-Yen Lin
  • Yi-Wen Lin
  • Shu-Meng Cheng
  • Rong-Ho Lin
  • Chun-Ling Chuang
  • Jehn-Shing Sheu
  • Shan-Min Chen
  • Chao-Chien Chang
  • Chien-Sung TsaiEmail author
Original Research Article
  • 27 Downloads

Abstract

Purpose

Current treatment guidelines do not recommend different antiplatelet treatments for patients in different coronary risk categories; nor do they consider ethnic differences in responses to individual drugs.

Objectives

We performed a prospective, single-blind, randomized, comparative study of Taiwanese patients with stable angina and scheduled stent implantation for intermediate-to-highly complex coronary lesions and compared the platelet reactivity unit (PRU) levels and 24-month outcomes of groups receiving three different antiplatelet treatments.

Methods

Patients (N = 334) were randomized into three treatment groups (aspirin + clopidogrel, aspirin + ticagrelor, or aspirin + clopidogrel + cilostazol) for 6 months of treatment and were then switched to aspirin only. PRU levels were determined 24 h, 7 days, and 1 month after stent implantation. Clinical outcomes and adverse events were recorded over 24 months.

Results

Clopidogrel treatment reached full effect after 1 month. Ticagrelor decreased PRU levels more than did clopidogrel but often to levels that increased the risk of hemorrhage. The addition of cilostazol to clopidogrel decreased PRU levels earlier and more strongly than clopidogrel alone but not as strongly as did ticagrelor. Ticagrelor treatment caused fewer major adverse cardiovascular events (MACEs) and more episodes of minor bleeding than the other two treatments.

Conclusions

Clopidogrel appears safer than ticagrelor in Taiwanese patients with stable angina after stent implantation for intermediate-to-highly complex coronary lesions. The addition of cilostazol to clopidogrel may provide a more rapid decrease in PRU to therapeutic levels without increasing the risk of hemorrhage.

Clinical trial registration number

NCT02101411.

Notes

Compliance with Ethical Standards

Funding

No external funding was used in the preparation of this manuscript.

Conflict of interest

Yueh-Chung Chen, Feng-Yen Lin, Yi-Wen Lin, Shu-Meng Cheng, Rong-Ho Lin, Chun-Ling Chuang, Jehn-Shing Sheu, Shan-Min Chen, Chau-Chien Chang, and Chien-Sung Tsai have no conflicts of interest that might be related to the contents of this manuscript.

Supplementary material

40256_2018_302_MOESM1_ESM.doc (31 kb)
Supplementary material 1 (DOC 30 kb)

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Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  • Yueh-Chung Chen
    • 1
    • 2
  • Feng-Yen Lin
    • 3
    • 4
  • Yi-Wen Lin
    • 5
    • 6
  • Shu-Meng Cheng
    • 1
    • 7
  • Rong-Ho Lin
    • 8
  • Chun-Ling Chuang
    • 9
  • Jehn-Shing Sheu
    • 10
  • Shan-Min Chen
    • 10
  • Chao-Chien Chang
    • 11
    • 12
  • Chien-Sung Tsai
    • 13
    • 14
    • 15
    Email author
  1. 1.Graduate Institute of Medical SciencesNational Defense Medical CenterTaipeiTaiwan, ROC
  2. 2.Division of Cardiology, Department of Internal MedicineTaipei City HospitalTaipeiTaiwan, ROC
  3. 3.Department of Internal Medicine, School of Medicine, College of MedicineTaipei Medical UniversityTaipeiTaiwan, ROC
  4. 4.Division of Cardiology, Department of Internal MedicineTaipei Medical UniversityTaipeiTaiwan, ROC
  5. 5.Division of Cardiovascular Surgery, Tri-Service General HospitalNational Defense Medical CenterTaipeiTaiwan, ROC
  6. 6.Institute of Oral BiologyNational Yang-Ming UniversityTaipeiTaiwan, ROC
  7. 7.Division of Cardiology, Tri-Service General HospitalNational Defense Medical CenterTaipeiTaiwan, ROC
  8. 8.Department of Industrial Engineering and ManagementNational Taipei University of TechnologyTaipeiTaiwan, ROC
  9. 9.Department of Information ManagementKai-Nan UniversityTaoyuanTaiwan, ROC
  10. 10.Department of Laboratory MedicineTaipei City Hospital Renai BranchTaipeiTaiwan, ROC
  11. 11.Department of CardiologyCathay General HospitalTaipeiTaiwan, ROC
  12. 12.Department of Pharmacology, School of MedicineTaipei Medical UniversityTaipeiTaiwan, ROC
  13. 13.Division of Cardiovascular Surgery, Department of SurgeryTri Service General HospitalTaipeiTaiwan, ROC
  14. 14.Department and Graduate Institute of PharmacologyNational Defense Medical CenterTaipeiTaiwan, ROC
  15. 15.Division of Cardiovascular Surgery, Department of SurgeryTaoyuan Armed Forces General HospitalTaoyuanTaiwan, ROC

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