Article

Effect of cilostazol on optimized standard antiplatelet therapy in a patient with a cytochrome P450 2C19 *2/*2 genotype

Cardiovascular Intervention and Therapeutics 04/2012; 26(1):79-82. DOI:10.1007/s12928-010-0036-x pp.79-82

ABSTRACT A 54-year-old man with acute coronary syndrome underwent primary percutaneous coronary intervention (PCI) to implant a bare
metal stent. Three weeks later, a subclinical in-stent thrombus was found at staged PCI despite dual antiplatelet therapy
with aspirin and clopidogrel. Platelet function tests revealed high post-treatment platelet reactivity, indicating an inadequate
response to clopidogrel. The patient’s cytochrome P450 2C19 genotype was *2/*2. Cilostazol at 200mg/day was initiated in
addition. Three months later, platelet inhibition was enhanced, and no thrombus was detectable by coronary angiography. Our
experience suggests that triple antiplatelet therapy with cilostazol as well as aspirin and clopidogrel could prevent stent
thrombosis with improved clopidogrel responsiveness.

KeywordsAcute coronary syndrome–Coronary intervention–Antiplatelet therapy–Stent thrombosis

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Keywords

54-year-old man
 
acute coronary syndrome
 
aspirin
 
Cilostazol
 
clopidogrel responsiveness
 
coronary angiography
 
KeywordsAcute coronary syndrome–Coronary intervention–Antiplatelet therapy–Stent thrombosis
 
patient’s cytochrome P450 2C19 genotype
 
PCI
 
Platelet function tests
 
primary percutaneous coronary intervention
 
subclinical in-stent thrombus