Triple antiplatelet therapy with cilostazol achieved greater inhibition of maximal platelet aggregation at 30 days (42.4%) compared to high-dose (19.1%) or standard clopidogrel (6.0%) (P<0.001).
RCT (n=90)
Randomly assigned to 1 of 3 groups
Does adjunctive cilostazol added to dual antiplatelet therapy improve platelet inhibition compared to high maintenance dose clopidogrel or standard dual antiplatelet therapy in patients with acute myocardial infarction undergoing coronary stenting?
Adding cilostazol to standard DAPT provides significantly greater platelet inhibition at 30 days compared to doubling the maintenance dose of clopidogrel in AMI patients after stenting.
Absolute Event Rate: 42.4% vs 6%
p-value: p=<0.001
BACKGROUND: Optimal platelet inhibition is an important therapeutic adjunct in patients acute myocardial infarction (AMI) undergoing coronary stenting. Whether adjunctive cilostazol to dual antiplatelet therapy (triple antiplatelet therapy) can inhibit enhanced platelet reactivity in patients with AMI yet has not been determined. The aim of this study was to assess the degree of platelet inhibition by triple antiplatelet therapy in patients with AMI. METHODS AND RESULTS: Immediately after emergency room arrival, patients with AMI received clopidogrel (600-mg loading dose, followed by 75 mg daily) and aspirin (300-mg loading dose and 200 mg daily throughout the study period). After patients underwent coronary stenting (n=90), they were randomly assigned to 1 of 3 groups before discharge: standard group, clopidogrel of 75 mg daily (n=30); high maintenance dose (MD) group, clopidogrel of 150 mg daily (n=30); and triple group, adjunctive cilostazol of 100 mg twice daily to clopidogrel of 75 mg daily (n=30). Platelet reactivity was assessed at predischarge and 30-day follow-up by conventional aggregometry and the VerifyNow P2Y12 assay. Predischarge platelet reactivities were similar in the 3 groups. At 30-day follow-up, inhibition of maximal aggregation with 20 microM ADP stimuli was 6.0% in the standard group, 19.1% in the high-MD group, and 42.4% in the triple group (P50% of light transmission), fewer patients in the triple group (13.3%) met the criteria as compared with those in the standard (76.7%) and high-MD groups (56.7%) at 30-day follow-up (P<0.001). In the triple group, there were more potent and consistent platelet inhibitions by all parameters as compared with the high-MD group except for percent changes of P2Y12 reaction unit (P=0.071). CONCLUSIONS: Among patients with AMI undergoing coronary stenting, triple antiplatelet therapy results in a greater antiplatelet effect at 30 days as compared with a high-MD clopidogrel or standard dual antiplatelet therapy.
Jeong et al. (Wed,) conducted a rct in Acute Myocardial Infarction (n=90). Triple antiplatelet therapy (cilostazol) vs. Standard clopidogrel (75 mg daily) or high maintenance dose clopidogrel (150 mg daily) was evaluated on Inhibition of maximal aggregation with 20 microM ADP stimuli at 30 days (p=<0.001). Triple antiplatelet therapy with cilostazol achieved greater inhibition of maximal platelet aggregation at 30 days (42.4%) compared to high-dose (19.1%) or standard clopidogrel (6.0%) (P<0.001).