Long-term clinical efficacy and safety of adding cilostazol to dual antiplatelet therapy for patients undergoing PCI: A meta-analysis of randomized trials with adjusted indirect comparisons.
ABSTRACT Abstract Objective: To assess the long-term clinical efficacy and safety of adding cilostazol to aspirin plus clopidogrel (Triple antiplatelet therapy, TAT) in patients undergoing percutaneous coronary intervention (PCI) and explore its role in the era of new generation ADP-receptor antagonists. Methods: PUBMED, EMBASE, and the Cochrane Central Register of Controlled Trials were searched for randomized controlled trials (RCTs) comparing TAT versus dual antiplatelet therapy (DAT), following by a manual search. Then, a meta-analysis of RCTs comparing TAT versus standard DAT in patients undergoing PCI was performed. Furthermore, indirect comparisons of TAT versus new generation ADP-receptor antagonists-based DAT (prasugrel or ticagrelor-based DAT) were undertaken, with standard DAT as a common comparator. The included end-points were major adverse cardiovascular (MACE), Target lesion revascularization (TLR), target vessel revascularization (TVR), death, myocardial infarction (MI), stent thrombosis, bleeding and other drug adverse events. Results: 12 RCTs with a total of 31789 were included. Compared with standard DAT (n=2551), TAT (n=2545) significantly reduced the incidence of MACE (OR: 0.56, 95%CI: 0.47-0.68, P<0.00001), TLR (OR: 0.51, 95%CI: 0.34-0.75, P=0.0006) and TVR (OR: 0.59, 95%CI: 0.46-0.75, P＜0.0001), and did not change significantly in death (OR: 0.68, 95%CI: 0.44-1.05, P=0.08), MI (OR: 0.80, 95%CI: 0.45-1.44, P=0.46), stent thrombosis (OR: 0.61, 95%CI: 0.27-1.36, P=0.23), major bleeding (OR: 1.42, 95%CI: 0.52-3.85, P=0.49) and overall bleeding (OR:1.16, 95%CI: 0.79-1.69, P=0.45). Compared with prasugrel (n=6813) or ticagrelor-based DAT (n=6732), TAT (n=2545) further reduced the incidence of MACE (OR: 0.80, 95%CI: 0.72- 0.90, P =0.0012; OR: 0.83, 95%CI: 0.75- 0.92, P=0.0003, respectively). Conclusions: Compared with standard DAT, the long-term use of TAT in patients with PCI gives more benefits in reducing the incidence of MACE, TLR and TVR without increasing bleeding. Furthermore, it might be superior to prasugrel or ticagrelor-based DAT in term of MACE, which need be confirmed by future studies with direct comparisons.
SourceAvailable from: Vasilios Gabriel Athyros
Atherosclerosis 12/2014; 238(2):182-184. DOI:10.1016/j.atherosclerosis.2014.12.001 · 3.97 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: The proper use of antiplatelet agents in the cardiac catheterization laboratory is important for ensuring optimal results in patients undergoing percutaneous revascularization. Understanding the mechanisms by which these drugs exerts their effects is important for both interventional and non-interventional cardiologists. The effects of these agents on platelet function can be assessed and monitored using a variety of commercially available laboratory assays but so far these tests have not been adopted in routine clinical practice. Currently, aspirin, thienopyridines and glycoprotein IIb/IIIa inhibitors are the primary types of antiplatelet drugs being utilized. The use of these drugs and of several newer antiplatelet drugs in the treatment of patients undergoing percutaneous revascularization in the cardiac catheterization laboratory will be discussed, especially in the light of the recently published guidelines.Expert Review of Cardiovascular Therapy 04/2014; 12(4):463-74. DOI:10.1586/14779072.2014.901149