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Comparison of Cilostazol and Ticlopidine for One-Month Effectiveness and Safety after Elective Coronary Stenting

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Abstract

Purpose: To compare the oral antiplatelets, phosphodiesterase III inhibitor cilostazol and the thienopyridine ticlopidine, for one-month effectiveness and safety as an adjunctive therapy after coronary stenting.

Methods: Published studies retrieved through Medline and other databases from 1966–2002. Meta-analyses evaluated effectiveness and adverse side effects for one-month administrations of aspirin plus cilostazol or aspirin plus ticlopidine therapy after coronary stenting. Major adverse cardiac events (MACE), stent-associated thrombosis or adverse side effects after coronary stenting were compared between the two study arms and expressed with the odds ratios (OR) specific for the individual studies and meta-analytic summary for OR.

Results: Five clinical studies met the inclusion criteria, and 4 of these studies underwent meta-analysis. With regard to the comparison of the OR summary for MACE and stent-associated thrombosis for the clinical outcome, there were no statistical significant differences between aspirin plus cilostazol and aspirin plus ticlopidine. While, the incidence of adverse side effects tended to be lower, they were not statistically significant in patients with aspirin plus cilostazol.

Conclusions: Our meta-analysis results indicated that there were no differences between cilostazol (plus aspirin) and ticlopidine (plus aspirin) with regard to effectiveness and safety for a one-month period when used as an adjunctive therapy after coronary stenting.

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References

  1. Fischman DL, Leon MB, Baim DS, et al. A randomized comparison of coronary-stent placement and balloon angioplasty in the treatment of coronary artery disease. Stent Restenosis Study Investigators. N Engl J Med 1994;331:496–501.

    Google Scholar 

  2. Serruys PW, de Jaegere P, Kiemeneij F, et al. A comparison of balloon-expandable-stent implantation with balloon angioplasty in patients with coronary artery disease. Benestent Study Group. N Engl J Med 1994;331:489–495.

    Google Scholar 

  3. Smith SC Jr, Dove JT, Jacobs AK, et al. ACC/AHA guidelines for percutaneous coronary intervention (revision of the 1993 PTCA guidelines)-executive summary. Circulation 2001;103:3019–3041.

    Google Scholar 

  4. Harding SA, Walters DL, Palacios IF, Oesterle SN. Adjunctive pharmacotherapy for coronary stenting. Curr Opin Cardiol 2001;16:293–299.

    Google Scholar 

  5. Quinn MJ, Fitzgerald DJ. Ticlopidine and clopidogrel. Circulation 1999;100:1667–1672.

    Google Scholar 

  6. Patrono C, Coller B, Dalen JE, et al. Platelet-active drugs: The relationships among dose, effectiveness, and side effects. Chest 2001;119:39S–63S.

    Google Scholar 

  7. Leon MB, Baim DS, Popma JJ, et al. A clinical trial comparing three antithrombotic-drug regimens after coronary-artery stenting. Stent Anticoagulation Restenosis Study Investigators. N Engl J Med 1998;339:1665–1671.

    Google Scholar 

  8. Tanaka T, Ishikawa T, Hagiwara M, Onoda K, Itoh H, Hidaka H. Effects of cilostazol, a selective cAMP phosphodiesterase inhibitor on the contraction of vascular smooth muscle. Pharmacology 1988;36:313–320.

    Google Scholar 

  9. Dawson DL, Cutler BS, Meissner MH, Strandness DE Jr. Cilostazol has beneficial effects in treatment of intermittent claudication: Results from a multicenter, randomized, prospective, double-blind trial. Circulation 1998;98:678–686.

    Google Scholar 

  10. Ikeda Y, Kikuchi M, Murakami H, et al. Comparison of the inhibitory effects of cilostazol, acetylsalicylic acid and ticlopidine on platelet functions ex vivo. Randomized, double-blind cross-over study. Arzneimittelforschung 1987;37:563–566.

    Google Scholar 

  11. Take S, Matsutani M, Ueda H, et al. Effect of cilostazol in preventing restenosis after percutaneous transluminal coronary angioplasty. Am J Cardiol 1997;79:1097–1099.

    Google Scholar 

  12. Yoshitomi Y, Kojima S, Sugi T, Yano M, Matsumoto Y, Kuramochi M. Antiplatelet treatment with cilostazol after stent implantation. Heart 1998;80:393–396.

    Google Scholar 

  13. Umekawa H, Tanaka T, Kimura Y, Hidaka H. Purification of cyclic adenosine monophosphate phosphodiesterase from human platelets using new-inhibitor Sepharose chromatography. Biochem Pharmacol 1984;33:3339–3344.

    Google Scholar 

  14. Kimura Y, Tani T, Kanbe T, Watanabe K. Effect of cilostazol on platelet aggregation and experimental thrombosis. Arzneimittelforschung 1985;35:1144–1149.

    Google Scholar 

  15. El-Beyrouty C, Spinler SA. Cilostazol for prevention of thrombosis and restenosis after intracoronary stenting. Ann Pharmacother 2001;35:1108–1113.

    Google Scholar 

  16. Kunishima T, Musha H, Eto F, et al. A randomized trial of aspirin versus cilostazol therapy after successful coronary stent implantation. Clin Ther 1997;19:1058–1066.

    Google Scholar 

  17. Yamasaki M, Hara K, Ikari Y, et al. Effects of cilostazol on late lumen loss after Palmaz-Schatz stent implantation. Cathet Cardiovasc Diagn 1998;44:387–391.

    Google Scholar 

  18. Morizane T., ed. EBM Upgrade-for Physicians. Tokyo: Igakushoin; 2002. (In Japanese)

  19. Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health 1998;52:377–384.

    Google Scholar 

  20. Cho MK, Bero LA. Instruments for assessing the quality of drug studies published in the medical literature. JAMA 1994;272:101–104.

    Google Scholar 

  21. Kamishirado H, Inoue T, Mizoguchi K, et al. Randomized comparison of cilostazol versus ticlopidine hydrochloride for antiplatelet therapy after coronary stent implantation for prevention of late restenosis. Am Heart J 2002;144:303–308.

    Google Scholar 

  22. Kozuma K, Hara K, Yamasaki M, et al. Effects of cilostazol on late lumen loss and repeat revascularization after Palmaz-Schatz coronary stent implantation. Am Heart J 2001;141:124–130.

    Google Scholar 

  23. Park SW, Lee CW, Kim HS, et al. Effects of cilostazol on angiographic restenosis after coronary stent placement. Am J Cardiol 2000;86:499–503.

    Google Scholar 

  24. Park SW, Lee CW, Kim HS, et al. Comparison of cilostazol versus ticlopidine therapy after stent implantation. Am J Cardiol 1999;84:511–514.

    Google Scholar 

  25. Yoon Y, Shim WH, Lee DH, et al. Usefulness of cilostazol versus ticlopidine in coronary artery stenting. Am J Cardiol 1999;84:1375–1380.

    Google Scholar 

  26. Goods CM, al-Shaibi KF, Liu MW, et al. Comparison of aspirin alone versus aspirin plus ticlopidine after coronary artery stenting. Am J Cardiol 1996;78:1042–1044.

    Google Scholar 

  27. Takahashi S, Oida K, Fujiwara R, et al. Effect of cilostazol, a cyclic AMP phosphodiesterase inhibitor, on the proliferation of rat aortic smooth muscle cells in culture. J Cardiovasc Pharmacol 1992;20:900–906.

    Google Scholar 

  28. Kubota Y, Kichikawa K, Uchida H, et al. Pharmacologic treatment of intimal hyperplasia after metallic stent placement in the peripheral arteries. An experimental study. Invest Radiol 1995;30:532–537.

    Google Scholar 

  29. Pan X, Arauz E, Krzanowski JJ, Fitzpatrick DF, Polson JB. Synergistic interactions between selective pharmacological inhibitors of phosphodiesterase isozyme families PDE III and PDE IV to attenuate proliferation of rat vascular smooth muscle cells. Biochem Pharmacol 1994;48:827–835.

    Google Scholar 

  30. Kayanoki Y, Che W, Kawata S, Matsuzawa Y, Higashiyama S, Taniguchi N. The effect of cilostazol, a cyclic nucleotide phosphodiesterase III inhibitor, on heparin-binding EGF-like growth factor expression in macrophages and vascular smooth muscle cells. Biochem Biophys Res Commun 1997;238:478–481.

    Google Scholar 

  31. Okuda Y, Kimura Y, Yamashita K. Cilostazol. Cardiovasc Drug Rev. 1993;11:451–465.

    Google Scholar 

  32. Defreyn G, Bernat A, Delebassee D, Maffrand JP. Pharmacology of ticlopidine: A review. Semin Thromb Hemost 1989;15:159–166.

    Google Scholar 

  33. Harker A, Bruno JJ. Ticlopidine's mechanism on action on human platelets. In: Hass K, Easton JD, eds. Ticlopidine, Platelets, and Vascular Disease. New York: Springer-Verlag, 1993:41–59.

    Google Scholar 

  34. Cone J, Wang S, Tandon N, et al. Comparison of the effects of cilostazol and milrinone on intracellular cAMP levels and cellular function in platelets and cardiac cells. J Cardiovasc Pharmacol 1999;34:497–504.

    Google Scholar 

  35. Mishkel GJ, Aguirre FV, Ligon RW, Rocha-Singh KJ, Lucore CL. Clopidogrel as adjunctive antiplatelet therapy during coronary stenting. J Am Coll Cardiol 1999;34:1884–1890.

    Google Scholar 

  36. Berger PB, Bell MR, Rihal CS, et al. Clopidogrel versus ticlopidine after intracoronary stent placement. J Am Coll Cardiol 1999;34:1891–1894.

    Google Scholar 

  37. Muller C, Buttner HJ, Petersen J, Roskamm H. A randomized comparison of clopidogrel and aspirin versus ticlopidine and aspirin after the placement of coronary-artery stents. Circulation 2000;101:590–593.

    Google Scholar 

  38. Bertrand ME, Rupprecht HJ, Urban P, Gershlick AH, Investigators FT. Double-blind study of the safety of clopidogrel with and without a loading dose in combination with aspirin compared with ticlopidine in combination with aspirin after coronary stenting: The clopidogrel aspirin stent international cooperative study (CLASSICS). Circulation 2000;102:624–629.

    Google Scholar 

  39. Topol EJ, Byzova TV, Plow EF. Platelet GPIIb-IIIa blockers. Lancet 1999;353:227–231.

    Google Scholar 

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Authors and Affiliations

  1. Department of Medication Use Analysis and Clinical Research, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo, 204-8588, Japan

    Masayuki Hashiguchi, Keiko Ohno, Rieko Nakazawa & Satoshi Kishino

  2. Division for Evaluation and Analysis of Drug Information, Center of Clinical Pharmacy and Clinical Sciences, School of Pharmaceutical Sciences, Kitasato University, 5-9-1 Shirokane, Minato-ku, Tokyo, 108-8641, Japan

    Masayuki Hashiguchi & Mayumi Mochizuki

  3. Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku, Tokyo, 162-8666, Japan

    Tsuyoshi Shiga

Authors
  1. Masayuki Hashiguchi
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  2. Keiko Ohno
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  3. Rieko Nakazawa
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  4. Satoshi Kishino
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  5. Mayumi Mochizuki
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  6. Tsuyoshi Shiga
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Hashiguchi, M., Ohno, K., Nakazawa, R. et al. Comparison of Cilostazol and Ticlopidine for One-Month Effectiveness and Safety after Elective Coronary Stenting. Cardiovasc Drugs Ther 18, 211–217 (2004). https://doi.org/10.1023/B:CARD.0000033642.49162.04

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  • DOI: https://doi.org/10.1023/B:CARD.0000033642.49162.04

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