PDF herunterladen
Thromb Haemost 2020; 120(05): 857-865
DOI: 10.1055/s-0040-1709520
Atherosclerosis and Ischaemic Disease
Georg Thieme Verlag KG Stuttgart · New York

Cilostazol for Chinese Patients with Aspirin Intolerance after Coronary Drug-Eluting Stent Implantation

Chunfeng Dai   *
1   Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
,
Zhangwei Chen   *
1   Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
,
Jiayu Fu
2   Shanghai Medical College, Fudan University, Shanghai, China
,
Juying Qian
1   Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
,
Junbo Ge
1   Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
› Institutsangaben Funding This study was supported by National Natural Science Foundation of China (Grant No: 81970295, 81870267, 81570314, and 81670318), Grant of Shanghai Municipal Commission of Health and Family Planning (Grant No: 2017YQ057), Grant of Shanghai Science and Technology Committee (Grant No: 17411962300), the National Program on Key Basic Research Project of China (973 Program, Grant No: 2014CBA02003), Program for Outstanding Medical Academic Leader (Grant No: 2015-Weijiwei-24), Grant of Zhongshan Hospital Affiliated to Fudan University (Grant No: 2015ZSYXGG07 and 2017ZSYQ08), VG Funding of Clinical Trials (2017-CCA-VG-036), and Merck Funding (Xinxin-merck-fund-051).
Weitere Informationen

Publikationsverlauf

18. Dezember 2019

20. Februar 2020

Publikationsdatum:
05. Mai 2020 (online)

   Lizenzen und Reprints

Abstract

Background Cilostazol-based dual antiplatelet therapy (DAPT) is widely used in patients with aspirin intolerance after coronary drug-eluting stent (DES) implantation in China. However, this empirical strategy is not recommended or even mentioned in Chinese or international guidelines due to a lack of evidence from large-scale studies. We aimed to explore the efficacy and safety of cilostazol-based DAPT in this special population.

Methods In this cohort study, patients were grouped according to the DAPT strategy that they received after coronary DES implantation. The primary efficacy endpoint was major adverse cardiovascular and cerebrovascular events (MACCEs). Angiographic follow-up and major bleeding events were also recorded.

Results A total of 918 patients receiving cilostazol-based DAPT due to aspirin intolerance were enrolled, matched with 918 patients receiving aspirin-based DAPT. After 15-month prospective follow-up, the cilostazol group had lower risk of MACCE (5.1% vs. 7.6%, propensity score adjusted hazard ratio = 0.671 [95% confidence interval 0.462–0.974], p = 0.036) compared with the aspirin group. Lower rate of coronary lesion progression was also found through follow-up angiography in the cilostazol group (17.4% vs. 23.6%, p = 0.022), especially in nontarget lesions (12.1% vs. 17.6%, p = 0.019). The two groups had the same risk of major bleeding events (0.8% vs. 0.4%, p = 0.364).

Conclusion In the current study, cilostazol is a good substitute for aspirin in patients who have aspirin intolerance but need DAPT after coronary DES implantation in China. However, large-scale randomized controlled trials were still required to further confirm its efficacy and safety.

Keywords

cilostazol - aspirin intolerance - cohort study - coronary artery disease

* Chunfeng Dai and Zhangwei Chen contributed equally to this article.


Supplementary Material

 

  • References

  • 1 De Caterina R, Renda G. Clinical use of aspirin in ischemic heart disease: past, present and future. Curr Pharm Des 2012; 18 (33) 5215-5223
    CrossrefPubMedGoogle Scholar
  • 2 Brilakis ES, Patel VG, Banerjee S. Medical management after coronary stent implantation: a review. JAMA 2013; 310 (02) 189-198
    CrossrefPubMedGoogle Scholar
  • 3 Levine GN, Bates ER, Bittl JA. , et al. 2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. J Am Coll Cardiol 2016; 68 (10) 1082-1115
    CrossrefPubMedGoogle Scholar
  • 4 Valgimigli M, Bueno H, Byrne RA. , et al; ESC Scientific Document Group; ESC Committee for Practice Guidelines (CPG); ESC National Cardiac Societies. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: the Task Force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology (ESC) and of the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2018; 39 (03) 213-260
    CrossrefPubMedGoogle Scholar
  • 5 Moayyedi P, Leontiadis GI. The risks of PPI therapy. Nat Rev Gastroenterol Hepatol 2012; 9 (03) 132-139
    PubMedGoogle Scholar
  • 6 Lanas Á, Carrera-Lasfuentes P, Arguedas Y. , et al. Risk of upper and lower gastrointestinal bleeding in patients taking nonsteroidal anti-inflammatory drugs, antiplatelet agents, or anticoagulants. Clin Gastroenterol Hepatol 2015; 13 (05) 906-12.e2
    CrossrefPubMedGoogle Scholar
  • 7 Bundhun PK, Teeluck AR, Bhurtu A, Huang WQ. Is the concomitant use of clopidogrel and Proton Pump Inhibitors still associated with increased adverse cardiovascular outcomes following coronary angioplasty?: a systematic review and meta-analysis of recently published studies (2012 - 2016). BMC Cardiovasc Disord 2017; 17 (01) 3
    CrossrefPubMedGoogle Scholar
  • 8 Cutlip DE, Windecker S, Mehran R. , et al; Academic Research Consortium. Clinical end points in coronary stent trials: a case for standardized definitions. Circulation 2007; 115 (17) 2344-2351
    CrossrefPubMedGoogle Scholar
  • 9 Mehran R, Rao SV, Bhatt DL. , et al. Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium. Circulation 2011; 123 (23) 2736-2747
    CrossrefPubMedGoogle Scholar
  • 10 Xue Y, Feng ZW, Li XY. , et al. The efficacy and safety of cilostazol as an alternative to aspirin in Chinese patients with aspirin intolerance after coronary stent implantation: a combined clinical study and computational system pharmacology analysis. Acta Pharmacol Sin 2018; 39 (02) 205-212
    CrossrefPubMedGoogle Scholar
  • 11 Rossini R, Angiolillo DJ, Musumeci G. , et al. Aspirin desensitization in patients undergoing percutaneous coronary interventions with stent implantation. Am J Cardiol 2008; 101 (06) 786-789
    CrossrefPubMedGoogle Scholar
  • 12 Tournoij E, Peters RJ, Langenberg M, Kanhai KJ, Moll FL. The prevalence of intolerance for low-dose acetylsalicylacid in the secondary prevention of atherothrombosis. Eur J Vasc Endovasc Surg 2009; 37 (05) 597-603
    CrossrefPubMedGoogle Scholar
  • 13 Lee SW, Park SW, Kim YH. , et al; DECLARE-Long Study Investigators. Comparison of triple versus dual antiplatelet therapy after drug-eluting stent implantation (from the DECLARE-Long trial). Am J Cardiol 2007; 100 (07) 1103-1108
    CrossrefPubMedGoogle Scholar
  • 14 Lee SW, Park SW, Kim YH. , et al. Drug-eluting stenting followed by cilostazol treatment reduces late restenosis in patients with diabetes mellitus the DECLARE-DIABETES Trial (A Randomized Comparison of Triple Antiplatelet Therapy with Dual Antiplatelet Therapy After Drug-Eluting Stent Implantation in Diabetic Patients). J Am Coll Cardiol 2008; 51 (12) 1181-1187
    CrossrefPubMedGoogle Scholar
  • 15 Lee SW, Park SW, Kim YH. , et al; DECLARE-LONG II Study Investigators. A randomized, double-blind, multicenter comparison study of triple antiplatelet therapy with dual antiplatelet therapy to reduce restenosis after drug-eluting stent implantation in long coronary lesions: results from the DECLARE-LONG II (Drug-Eluting Stenting Followed by Cilostazol Treatment Reduces Late Restenosis in Patients with Long Coronary Lesions) trial. J Am Coll Cardiol 2011; 57 (11) 1264-1270
    CrossrefPubMedGoogle Scholar
  • 16 Sallustio F, Rotondo F, Di Legge S, Stanzione P. Cilostazol in the management of atherosclerosis. Curr Vasc Pharmacol 2010; 8 (03) 363-372
    CrossrefPubMedGoogle Scholar
  • 17 Kim JY, Lee K, Shin M. , et al. Cilostazol could ameliorate platelet responsiveness to clopidogrel in patients undergoing primary percutaneous coronary intervention. Circ J 2007; 71 (12) 1867-1872
    CrossrefPubMedGoogle Scholar
  • 18 Goto S. Cilostazol: potential mechanism of action for antithrombotic effects accompanied by a low rate of bleeding. Atheroscler Suppl 2005; 6 (04) 3-11
    PubMedGoogle Scholar