Key result
Adjunctive cilostazol cuts MACCE ~45% in PCI patients with low clopidogrel responsiveness.
Why the study?
Patients with low responsiveness to clopidogrel after percutaneous coronary intervention face a higher risk of cardiac ischemic events, prompting a head-to-head comparison of intensified antiplatelet therapies (double-dose clopidogrel or adjunctive cilostazol) against conventional standard strategy.
Does double-dose clopidogrel or adjunctive cilostazol reduce major adverse cardiac and cerebrovascular events compared to standard dual antiplatelet therapy in patients with high posttreatment platelet reactivity undergoing percutaneous coronary intervention?
RCT (n=1,078)
randomized
No
Does double-dose clopidogrel or adjunctive cilostazol reduce major adverse cardiac and cerebrovascular events compared to standard dual antiplatelet therapy in patients with high posttreatment platelet reactivity undergoing percutaneous coronary intervention?
In patients with high platelet reactivity after PCI, adding cilostazol to standard dual antiplatelet therapy significantly reduces major adverse cardiac and cerebrovascular events without increasing major bleeding.
Answers are grounded in this paper and cite their sources.
Supports cilostazol addition in clopidogrel nonresponders post-PCI; extends personalized DAPT evidence from RCTs.
Background: Patients undergoing percutaneous coronary intervention react differently to antiplatelet drugs. Those with low responsiveness to clopidogrel have a higher risk of cardiac ischemic events. The goal of this study is to conduct a head-to-head comparison of the safety and effectiveness of intensified antiplatelet therapies (either double-dose clopidogrel [DOUBLE] or adjunctive cilostazol [TRIPLE]) and conventional strategy (STANDARD) in patients after percutaneous coronary intervention. Methods: In this single-center, randomized, controlled trial, we used thromboelastography, a platelet function test, to select 1078 patients undergoing percutaneous coronary intervention at high thrombotic risk and compared the intensified antiplatelet therapies with standard antiplatelet therapy. The primary outcome was the incidence of major adverse cardiac and cerebrovascular events at 18 months after percutaneous coronary intervention, defined as a composite of all-cause death, myocardial infarction, target vessel revascularization, or stroke. Bleeding Academic Research Consortium defined bleeding complications (types 1, 2, 3, or 5) were the safety end points. Results: The primary end point occurred in 52 patients (14.4%) in the STANDARD group, 38 patients (10.6%) in the DOUBLE group, and 30 patients (8.5%) in the TRIPLE group (hazard ratio, 0.720; 95% confidence interval, 0.474–1.094, DOUBLE versus STANDARD; hazard ratio, 0.550; 95% confidence interval, 0.349–0.866, TRIPLE versus STANDARD). No significant difference in the rates of major bleeding (Bleeding Academic Research Consortium grade≥3) was found in the DOUBLE group (3.34% versus 1.93% in STANDARD, P =0.133) and the TRIPLE group (2.53% versus 1.93% in STANDARD, P =0.240). The rate of Bleeding Academic Research Consortium–defined minor bleeding increased in the DOUBLE group (27.4% versus 20.3% in STANDARD, P =0.031), but not in the TRIPLE group (23.6% versus 20.3% in STANDARD, P =0.146). Conclusions: In patients with low responsiveness to clopidogrel, as measured by thromboelastography, the intensified antiplatelet strategies with adjunctive use of cilostazol significantly improved the clinical outcomes without increasing the risk of major bleeding. Decreased trend of negative outcomes could be observed in patients with double dosage of clopidogrel, but the difference was not significant. Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT01779401.
No takes yet. Share an insight, caveat, or question.
Tang et al. (2018) conducted an RCT in high posttreatment platelet reactivity after percutaneous coronary intervention (n=1,078). Adjunctive cilostazol (TRIPLE) or double-dose clopidogrel (DOUBLE) vs. Standard dual antiplatelet therapy was evaluated on major adverse cardiac and cerebrovascular events (composite of all-cause death, myocardial infarction, target vessel revascularization, or stroke) (HR 0.550, 95% CI 0.349-0.866). Adjunctive cilostazol reduced major adverse cardiac and cerebrovascular events compared to standard therapy in PCI patients with low clopidogrel responsiveness.
Synapse has enriched 10 related papers. Consider them for comparative context: