Why the study?
No large-scale study had compared the clinical impact of triple antiplatelet therapy (aspirin, clopidogrel, and cilostazol) versus dual antiplatelet therapy on adverse limb events in patients with diabetes after endovascular therapy for peripheral artery disease.
Does triple antiplatelet therapy including cilostazol reduce major adverse limb events in patients with diabetes undergoing endovascular therapy for peripheral artery disease?
Cohort (n=990)
Yes
Does triple antiplatelet therapy including cilostazol reduce major adverse limb events in patients with diabetes undergoing endovascular therapy for peripheral artery disease?
Adding cilostazol to standard dual antiplatelet therapy after lower-extremity endovascular therapy does not reduce overall major adverse limb events but may specifically decrease the risk of minor amputation in diabetic patients.
Triple therapy should not yet change dual antiplatelet practice for major limb events post-EVT in diabetes; leaves open possible minor amputation benefit for prospective trials.
Background No large‐scale study has compared the clinical impact of triple antiplatelet therapy (TAPT: aspirin, clopidogrel, and cilostazol) and dual antiplatelet therapy (DAPT) on adverse limb events in patients with diabetes after endovascular therapy (EVT) for peripheral artery disease. Thus, we investigate the effect of cilostazol added to a DAPT on the clinical outcomes after EVT in patients with diabetes using a nationwide, multicenter, real‐world registry. Methods and Results A total of 990 patients with diabetes who underwent EVT were enrolled from the retrospective cohorts of a Korean multicenter EVT registry and were divided according to the antiplatelet regimen (TAPT [n=350; 35.4%] versus DAPT [n=640; 64.6%]). After propensity score matching based on clinical characteristics, a total of 350 pairs were compared for clinical outcomes. The primary end points were major adverse limb events, a composite of major amputation, minor amputation, and reintervention. For the matched study groups, the lesion length was 125.4±102.0 mm, and severe calcification was observed in 47.4%. The technical success rate (96.9% versus 94.0%; P =0.102) and the complication rate (6.9% versus 6.6%; P >0.999) were similar between the TAPT and DAPT groups. At 2‐year follow‐up, the incidence of major adverse limb events (16.6% versus 19.4%; P =0.260) did not differ between the 2 groups. However, the TAPT group showed less minor amputation than the DAPT group (2.0% versus 6.3%; P =0.004). In multivariate analysis, TAPT was an independent predictor of minor amputation (adjusted hazard ratio, 0.354 [95% CI, 0.158–0.794]; P =0.012). Conclusions In patients with diabetes undergoing EVT for peripheral artery disease, TAPT did not decrease the incidence of major adverse limb events but may be associated with a decreased risk of minor amputation.
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Cha et al. (2023) conducted a cohort in Peripheral artery disease with diabetes (n=990). Triple antiplatelet therapy (aspirin, clopidogrel, and cilostazol) vs. Dual antiplatelet therapy (aspirin and clopidogrel) was evaluated on Major adverse limb events (composite of major amputation, minor amputation, and reintervention) (p=0.260).
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