Cilostazol: More than just PAD and stroke prevention

MANILA, Philippines - Several studies have shown that cilostazol may not only prevent peripheral arterial disease (PAD), stroke and stent thrombosis but may also have positive effect in the prevention of restenosis.

In the CIDES (Cilostazol for Diabetic Patients in Drug-Eluting Stent) trial, the results demonstrated that combination therapy with aspirin and cilostazol for the prevention of stent restenosis is comparable or superior to that of aspirin and clopidogrel in patients with diabetes who undergo Drug Eluting Stent (DES) implantation.

Drug eluting stent is a breakthrough for the prevention of in-stent restenosis.

These stents carry a special drug that prevents scar tissue growth in the artery where the stent is placed, thus reducing the occurrence of in-stent restenosis.

However, in-stent restenosis is still relatively high among patients with diabetes mellitus.

The study revealed that besides cilostazol’s comparable effect to that of aspirin and clopidogrel therapy among high-risk patients with diabetes who underwent DES implantation, there was significant less binary restenosis in cilostazol-treated patients.

The authors of the study said that before the DES implantation era, recognized predictors of restenosis included diabetes mellitus, small vessel diameter, lesion length, and left anterior descending coronary artery site, chronic total occlusion, etc.

In this study, cilostazol was proven effective in diminishing the rate of restenosis in patients without diabetes.

Meanwhile, a 63-percent reduction in restenosis was observed in oral agent-treated patients with diabetes.

The authors remarked that although DES implantation has reduced incidence of post-procedural restenosis, adjunct drug therapy to prevent in-stent restenosis may be desirable, particularly among high-risk patients.

Further, recent reports showed that the risk of stent thrombosis is similar between DES and bare-metal stent.

However, there are two vital issues regarding DES. Various international guidelines have warned that a considerable rate of aspirin and clopidogrel resistance is present. Thus, a different mechanism or stronger antiplatelet agents will be needed in some patients, heart experts recommend.

Previous studies have also demonstrated that cilostazol is as safe and effective as other antiplatelet drugs, and confers additional benefits when used in combination with these drugs, in preventing thrombotic complications after stenting.

Cilostazol is manufactured by Otsuka Pharmaceutical Inc., which is known for research-based drugs that are proven to be safe and effective.