Key result
DAPT cuts in-hospital mortality ~73% versus cilostazol-based TAPT with no difference in MACE.
Why the study?
Guidelines for cilostazol-based triple antiplatelet therapy in patients with ischemic heart disease undergoing PCI remain unclear.
Does dual antiplatelet therapy (aspirin and clopidogrel) improve clinical outcomes and safety compared to cilostazol-based triple antiplatelet therapy in patients with ischemic heart disease undergoing PCI?
Meta-Analysis (n=5,299)
Does dual antiplatelet therapy (aspirin and clopidogrel) improve clinical outcomes and safety compared to cilostazol-based triple antiplatelet therapy in patients with ischemic heart disease undergoing PCI?
Relative Risk: 0.27 (95% CI 0.07–0.94)
p-value: p=0.04
In patients undergoing PCI, standard DAPT with aspirin and clopidogrel is associated with lower in-hospital mortality and fewer side effects (headache, palpitation) compared to cilostazol-based triple antiplatelet therapy, without increasing ischemic events.
Supports preferring standard DAPT over cilostazol-based triple therapy post-PCI to reduce mortality; challenges routine cilostazol addition in this population.
INTRODUCTION: Cilostazol has been widely used to prevent peripheral vascular events after PCI. However, guidelines in cilostazol-based triple antiplatelet therapy for patients with ischemic heart disease undergoing PCI remain unclear. The purpose of this study was to assess the efficacy and safety of DAPT (aspirin and clopidogrel) compared to cilostazol -based TAPT (aspirin, clopidogrel and cilostazol). METHODS: We conducted a comprehensive search of the Medline, Embase, Scopus, Cochrane, and Web of Science databases until November 2024 to identify RCTs comparing DAPT with cilostazol -based TAPT in patients with ischemic heart disease undergoing PCI. Pooled risk ratios (RRs) with 95% CIs were calculated. RESULTS: Eight RCTs (5,299 patients) were included in this systematic review and meta-analysis. A significantly reduced risk of all-cause mortality in hospital was observed with DAPT compared to cilostazol -based TAPT (RR: 0.27, 95% CI: 0.07 to 0.94, p = 0.04). Also, A significantly reduced risk of headache and palpitation was observed with DAPT compared to cilostazol -based TAPT, with pooled RR (RR: 0.15, 95% CI: 0.06 to 0.33, p < 0.001) and (RR: 0.24, 95% CI: 0.08 to 0.73, p = 0.01), respectively. However, no difference was observed between DAPT and cilostazol -based TAPT on vessel revascularization, stroke, stent thrombosis, myocardial infarction and major adverse cardiac events. CONCLUSION: Aspirin and clopidogrel were associated with a lower risk of adverse events compared to cilostazol-based TAPT. However, the addition of cilostazol did not improve clinical outcomes. Further trials are needed to clarify the role of cilostazol -based TAPT for patients with ischemic heart disease undergoing PCI.
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Odat et al. (2025) conducted a meta-analysis in Ischemic heart disease undergoing PCI (n=5,299). Dual antiplatelet therapy (aspirin and clopidogrel) vs. Cilostazol-based triple antiplatelet therapy was evaluated on In-hospital all-cause mortality (RR 0.27, 95% CI 0.07 to 0.94, p=0.04). Dual antiplatelet therapy (aspirin and clopidogrel) significantly reduced the risk of in-hospital all-cause mortality compared to cilostazol-based triple antiplatelet therapy (RR 0.27), with no significant difference in major adverse cardiac events.
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