• American heart journal · Aug 2002

    Randomized Controlled Trial Comparative Study Clinical Trial

    Randomized comparison of cilostazol versus ticlopidine hydrochloride for antiplatelet therapy after coronary stent implantation for prevention of late restenosis.

    • Hirotoshi Kamishirado, Teruo Inoue, Keiichi Mizoguchi, Toshihiko Uchida, Toshiyuki Nakata, Masashi Sakuma, Kan Takayanagi, and Shigenori Morooka.
    • Department of Cardiology, Koshigaya Hospital, Dokkyo University School of Medicine, Saitama, Japan.
    • Am. Heart J. 2002 Aug 1; 144 (2): 303-8.

    BackgroundCilostazol is a newly developed antiplatelet drug that has been widely applied for clinical use. Its antiplatelet action appears to be mainly related to inhibition of intracellular phosphodiesterase activity. Recently, cilostazol has been used for antiplatelet therapy after coronary stent implantation. However, its evaluation has not been established yet.MethodsThis prospective randomized trial was designed to investigate the efficacy of cilostazol for the prevention of late restenosis and acute or subacute stent thrombosis in comparison with ticlopidine hydrochloride. One hundred thirty consecutive patients, scheduled for elective coronary stenting, were randomly assigned to receive oral aspirin (81 mg/day) plus ticlopidine hydrochloride therapy (200 mg/day; group I) or aspirin plus cilostazol therapy (200 mg/day; group II). These medications were started at least 2 days before coronary intervention and continued until follow-up coronary angiography was performed 6 months later.ResultsSubacute stent thrombosis was observed in 2 patients of group I but in no patients of group II. Major cardiac events were similarly present in both groups. Elevated transaminase levels were observed more frequently in group I than in group II (P <.05). Each of the quantitative coronary angiography variables before and immediately after coronary stenting were similar in both groups. At follow-up angiography, however, late lumen loss (0.69 +/- 0.79 mm vs 0.28 +/- 0.40 mm; P <.01) and loss index (0.42 +/- 0.56 vs 0.16 +/- 0.27; P <.01) were smaller in group II than in group I. Restenosis rate (13% vs 31%; P <.05) and target lesion revascularization rate (7% vs 21%; P <.05) were both lower in group II than in group I.ConclusionAspirin plus cilostazol therapy may be an effective regimen for prevention of not only stent thrombosis but also restenosis.

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