Key result
In stented patients co-administered lansoprazole and aspirin, cilostazol treatment resulted in a similar platelet reactivity index compared to clopidogrel (63.1% vs 66.9%, mean difference 3.9%, p=0.174).
Why the study?
Does cilostazol improve platelet reactivity compared to clopidogrel in stented patients receiving lansoprazole?
RCT (n=100)
Single-blind
Computer-generated randomization sequence
No
Does cilostazol improve platelet reactivity compared to clopidogrel in stented patients receiving lansoprazole?
In stented patients requiring PPI co-administration, cilostazol achieves a more favorable platelet function profile than clopidogrel.
Cilostazol shows no platelet reactivity advantage over clopidogrel with lansoprazole; extends RCT data on antiplatelet options in stented patients requiring PPIs.
AIM: Proton pump inhibitor (PPI) therapy has been shown to attenuate the antiplatelet effects of clopidogrel. The aim of this study was to compare the antiplatelet effects of cilostazol versus clopidogrel in patients co-administered a PPI. METHODS: We enrolled PPI-naïve stented patients treated with standard clopidogrel and aspirin therapy for at least six months (n=100). The patients were randomly assigned to receive either cilostazol at a dose of 100mg twice daily (CILO group) or clopidogrel at a dose of 75mg daily (CLPD group) in addition to lansoprazole (30mg daily). The platelet aggregation (PA) determined using light transmittance aggregometry and the platelet reactivity index (PRI) obtained using a vasodilator-stimulated phosphoprotein phosphorylation assay were measured before randomization and at the 14-day follow-up visit. The primary endpoint was the PRI value at follow-up. RESULTS: At follow-up, the CLPD group showed similar values of PRI as the CILO group (66.9±14.0% vs. 63.1±14.1%; mean difference: 3.9%; 95% confidence interval of difference: -1.7% to 9.4%; p=0.174). However, the 6μg/mL collagen- and 0.5mg/mL arachidonic acid-induced PA values in the CLPD group were higher than those observed in the CILO group (mean differences: 9.8% to 11.1%; all p values ＜0.001). CYP2C19 loss-of-function allele carriage was the major contributing factor associated with the PRI level in the absence of lansoprazole treatment (with a gene-dose effect); this association was not observed in the subjects receiving lansoprazole co-administration in the CLPD group. CONCLUSIONS: During lansoprazole co-administration, cilostazol treatment achieves a more favorable platelet function profile than clopidogrel therapy. The use of combination treatment with cilostazol and aspirin deserves further attention with respect to the management of stable stented patients requiring PPI co-administration.
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Park et al. (2014) conducted an RCT in Coronary stenting on dual antiplatelet therapy (n=100). Cilostazol vs. Clopidogrel 75 mg daily was evaluated on Platelet reactivity index (PRI) at 14-day follow-up (mean difference: 3.9%, 95% CI -1.7 to 9.4, p=0.174). In stented patients co-administered lansoprazole and aspirin, cilostazol treatment resulted in a similar platelet reactivity index compared to clopidogrel (63.1% vs 66.9%, mean difference 3.9%, p=0.174).
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