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Temporary Adjunctive Cilostazol vs Clopidogrel Loading for ST-segment Elevation Acute Myocardial Infarction

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Abstract

Background

Clopidogrel loading is a standard method to achieve rapid platelet inhibition and prevent thrombotic events. At the current time, little information is available to determine the effect of adjunctive cilostazol compared with clopidogrel loading.

Methods

We retrospectively analyzed 212 patients undergoing primary percutaneous coronary intervention with drug-eluting stents for ST-segment elevation acute myocardial infarction. All patients were administered aspirin (100 mg once a day) and clopidogrel (75 mg once a day). The patients were divided into two groups according to the presence (loading group, n = 100) or absence (cilostazol group, n = 112) of clopidogrel loading (300 mg). Patients in the cilostazol group were administered adjunctive cilostazol (100 mg twice a day) in place of clopidogrel loading. Patient characteristics, medications, and 30-day clinical outcomes were examined.

Results

The mean duration of cilostazol administration in the cilostazol group was 6.2 ± 4.9 days from the time of primary coronary intervention. No significant difference was observed in major adverse cardiac events (cardiac death, definite stent thrombosis, and non-fatal myocardial infarction) between the loading group and the cilostazol group (9/100; 9.0 vs. 8/112; 7.1 %, p = 0.62). Definite stent thrombosis was observed for two patients in the loading group and one patient in the cilostazol group. The occurrence ratio of bleeding events did not differ significantly between the two groups (9.0 vs. 5.4 %, p = 0.30).

Conclusion

There was no significant difference in the incidence of major adverse cardiac events between temporary adjunctive cilostazol treatment and clopidogrel loading in ST-segment elevation acute myocardial infarction patients. Our findings suggest one potential of cilostazol.

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References

  1. Yusuf S, Zhao F, Mehta SR, Chrolavicius S, et al. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med. 2001;345:494–502.

    Article  PubMed  CAS  Google Scholar 

  2. Mehta SR, Yusuf S, Peters RJ, et al. Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study. Lancet. 2001;358:527–33.

    Article  PubMed  CAS  Google Scholar 

  3. Steinhubl SR, Berger PB, Mann JT 3rd, et al. Early and sustained dual oral antiplatelet therapy following percutaneous coronary intervention: a randomized controlled trial. JAMA. 2002;288:2411–20.

    Article  PubMed  CAS  Google Scholar 

  4. Chen ZM, Jiang LX, Chen YP, et al. Addition of clopidogrel to aspirin in 45,852 patients with acute myocardial infarction: randomised placebo-controlled trial. Lancet. 2005;366:1607–21.

    Article  PubMed  CAS  Google Scholar 

  5. Sabatine MS, Cannon CP, Gibson CM, et al. Addition of clopidogrel to aspirin and fibrinolytic therapy for myocardial infarction with ST-segment elevation. N Engl J Med. 2005;352:1179–89.

    Article  PubMed  CAS  Google Scholar 

  6. Wright RS, Anderson JL, Adams CD, et al. ACCF/AHA focused update incorporated into the ACC/AHA 2007 Guidelines for the Management of Patients with Unstable Angina/Non-ST-Elevation Myocardial Infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines developed in collaboration with the American Academy of Family Physicians, Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons. J Am Coll Cardiol. 2011;57:e215–367.

    Article  PubMed  Google Scholar 

  7. Cruden NL, Morch K, Wong DR, et al. Clopidogrel loading dose and bleeding outcomes in patients undergoing urgent coronary artery bypass grafting. Am Heart J. 2011;161:404–10.

    Article  PubMed  CAS  Google Scholar 

  8. Goto S. Cilostazol: potential mechanism of action for antithrombotic effects accompanied by a low rate of bleeding. Atheroscler Suppl. 2005;6:3–11.

    Article  PubMed  CAS  Google Scholar 

  9. Yasunaga K, Mase K. Antiaggregatory effect of oral cilostazol and recovery of platelet aggregability in patients with cerebrovascular disease. Arzneimittelforschung. 1985;35:1189–92.

    PubMed  CAS  Google Scholar 

  10. Bovill EG, Terrin ML, Stump DC, et al. Hemorrhagic events during therapy with recombinant tissue-type plasminogen activator, heparin, and aspirin for acute myocardial infarction. Results of the Thrombolysis in Myocardial Infarction (TIMI), Phase II Trial. Ann Intern Med. 1991;115:256–65.

    Article  PubMed  CAS  Google Scholar 

  11. Wiviott SD, Braunwald E, McCabe CH, et al. Intensive oral antiplatelet therapy for reduction of ischaemic events including stent thrombosis in patients with acute coronary syndromes treated with percutaneous coronary intervention and stenting in the TRITON-TIMI 38 trial: a subanalysis of a randomised trial. Lancet. 2008;371:1353–63.

    Article  PubMed  CAS  Google Scholar 

  12. Bhatt DL. Intensifying platelet inhibition–navigating between Scylla and Charybdis. N Engl J Med. 2007;357:2078–81.

    Article  PubMed  CAS  Google Scholar 

  13. Kang W, Theman TE, Reed JF 3rd, et al. The effect of preoperative clopidogrel on bleeding after coronary artery bypass surgery. J Surg Educ. 2007;64:88–92.

    Article  PubMed  Google Scholar 

  14. Berger JS, Frye CB, Harshaw Q, et al. Impact of clopidogrel in patients with acute coronary syndromes requiring coronary artery bypass surgery: a multicenter analysis. J Am Coll Cardiol. 2008;52:1693–701.

    Article  PubMed  CAS  Google Scholar 

  15. Herman CR, Buth KJ, Kent BA, et al. Clopidogrel increases blood transfusion and hemorrhagic complications in patients undergoing cardiac surgery. Ann Thorac Surg. 2010;89:397–402.

    Article  PubMed  Google Scholar 

  16. Meadows TA, Bhatt DL. Clinical aspects of platelet inhibitors and thrombus formation. Circ Res. 2007;100:1261–75.

    Article  PubMed  CAS  Google Scholar 

  17. Wilhite DB, Comerota AJ, Schmieder FA, et al. Managing PAD with multiple platelet inhibitors: the effect of combination therapy on bleeding time. J Vasc Surg. 2003;38:710–3.

    Article  PubMed  Google Scholar 

  18. Chen KY, Rha SW, Li YJ, et al. Triple versus dual antiplatelet therapy in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Circulation. 2009;119:3207–14.

    Article  PubMed  CAS  Google Scholar 

  19. Tamhane U, Meier P, Chetcuti S, et al. Efficacy of cilostazol in reducing restenosis in patients undergoing contemporary stent based PCI: a meta-analysis of randomised controlled trials. EuroIntervention. 2009;5:384–93.

    Article  PubMed  Google Scholar 

  20. Han Y, Li Y, Wang S, et al. Cilostazol in addition to aspirin and clopidogrel improves long-term outcomes after percutaneous coronary intervention in patients with acute coronary syndromes: a randomized, controlled study. Am Heart J. 2009;157:733–9.

    Article  PubMed  CAS  Google Scholar 

  21. Geng DF, Liu M, Jin DM, et al. Cilostazol-based triple antiplatelet therapy compared to dual antiplatelet therapy in patients with coronary stent implantation: a meta-analysis of 5,821 patients. Cardiology. 2012;122:148–57.

    Article  PubMed  CAS  Google Scholar 

  22. Jang JS, Jin HY, Seo JS, et al. A meta-analysis of randomized controlled trials appraising the efficacy and safety of cilostazol after coronary artery stent implantation. Cardiology. 2012;122:133–43.

    Article  PubMed  CAS  Google Scholar 

  23. Friedland SN, Eisenberg MJ, Shimony A. Meta-analysis of randomized controlled trials on effect of cilostazol on restenosis rates and outcomes after percutaneous coronary intervention. Am J Cardiol. 2012;109:1397–404.

    Article  PubMed  CAS  Google Scholar 

  24. Weber AA, Braun M, Hohlfeld T, et al. Recovery of platelet function after discontinuation of clopidogrel treatment in healthy volunteers. Br J Clin Pharmacol. 2001;52:333–6.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

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Acknowledgments

No external funding was used in the conduct of this study. AT, HI, MS, SO, YJ, KO, SS, YI, and TM have no potential conflicts of interest that might be relevant to this work.

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Correspondence to Akihito Tanaka.

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Tanaka, A., Ishii, H., Sakakibara, M. et al. Temporary Adjunctive Cilostazol vs Clopidogrel Loading for ST-segment Elevation Acute Myocardial Infarction. Am J Cardiovasc Drugs 14, 131–136 (2014). https://doi.org/10.1007/s40256-013-0059-7

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  • DOI: https://doi.org/10.1007/s40256-013-0059-7

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