Cilostazol added to aspirin and clopidogrel reduces revascularization without increases in major adverse events in patients with drug-eluting stents: A meta-analysis of randomized controlled trials
| Autor: | Heidi N. Bonneau, Bon-Kwon Koo, Ryozo Nagai, Hideaki Kaneda, Ryota Sakurai |
|---|---|
| Rok vydání: | 2013 |
| Předmět: |
medicine.medical_specialty
Ticlopidine medicine.medical_treatment Tetrazoles Revascularization law.invention Coronary Restenosis Randomized controlled trial law Internal medicine medicine Humans Adverse effect Randomized Controlled Trials as Topic Aspirin business.industry Stent Drug-Eluting Stents Clopidogrel Cilostazol Cardiovascular Diseases Drug-eluting stent Anesthesia Cardiology Drug Therapy Combination Cardiology and Cardiovascular Medicine business Platelet Aggregation Inhibitors medicine.drug |
| Zdroj: | International Journal of Cardiology. 167:2250-2258 |
| ISSN: | 0167-5273 |
| DOI: | 10.1016/j.ijcard.2012.06.010 |
| Popis: | The effects of cilostazol added to aspirin and clopidogrel (triple antiplatelet therapy: TAT) on clinical outcomes after drug-eluting stent (DES) implantation are unknown.We conducted a meta-analysis of randomized controlled trials (RCTs) comparing TAT with aspirin and clopidogrel (dual antiplatelet therapy: DAT) in DES patients. Clinical end points were target lesion (TLR) and/or vessel (TVR) revascularization, death, myocardial infarction (MI), stent thrombosis (ST), bleeding, rash, gastrointestinal (GI) side effects, and drug discontinuation. We calculated the pooled estimate based on a fixed-effects model using Peto odds ratio (OR) for rare events. If heterogeneity was observed across an individual RCT, an analysis based on a random-effects model was performed.Eight RCTs were included in this meta-analysis, involving 3590 patients (TAT:DAT=1800:1790). Up to 24 months, TAT showed a significant reduction in TLR (OR: 0.58, 95% confidence interval (CI): 0.43 to 0.78, p0.001) and TVR (OR: 0.58, 95% CI: 0.40 to 0.83, p=0.003) compared with DAT. The incidence of death, MI, ST, or overall or major bleeding was comparable between the 2 groups, whereas the proportion of rash (OR: 2.50, 95% CI: 1.52 to 4.10, p0.001), GI side effects (OR: 3.14, 95% CI: 1.79 to 5.50, p0.001), or drug discontinuation (OR: 6.81, 95% CI: 2.12 to 21.86, p0.001) was higher in TAT than DAT.In this meta-analysis, TAT was associated with significantly effective outcomes for TLR and TVR without any increase in major adverse events but was associated with tolerance issues compared with DAT after DES implantation. |
| Databáze: | OpenAIRE |
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