Triple therapy reduces stent restenosis in diabetics

MANILA, Philippines - Many diabetics suffer from constricted heart arteries requiring a procedure to open up the arteries called angioplasty with drug-eluting stent (DES) implantation.

Restenosis or recurrence of the narrowing of the arteries, however, has remained a big threat especially for diabetics.

Triple antiplatelet or blood-thinning therapy with cilostazol after DES implantation has been shown to reduce the risk of restenosis in diabetic patients compared to dual therapy with just aspirin and clopidogrel.

This was the result of the Diabetes Trial or Drug-Eluting Stenting Followed by Cilostazol Treatment Reduces Late Restenosis in Patients with Diabetes Mellitus (DECLARE) study.   

The study was conducted to evaluate the impact of cilostazol on neointimal hyperplasia, a major cause of restenosis that results from an excessive proliferative response of vascular smooth muscle cells to mechanical injury after DES implantation for long coronary lesions.

This randomized, multi-center, prospective study compared triple antiplatelet therapy (aspirin, clopidogrel and cilostazol) and dual antiplatelet therapy (aspirin and clopidogrel) for six months in patients with long lesions requiring a long drug-eluting stent.

It also assessed 200 patients with diabetes who underwent DES implantation and were randomized to receive aspirin and clopidogrel with or without cilostazol for six months.

Dr. Seong-Wook Park of the University of Ulsan, College of Medicine in Seoul, South Korea and his colleagues reported that cilostazol treatment was associated with significant reduction rates of in-stent late loss, in-segment late loss, six-month in-segment restenosis and nine-month target lesion revascularization (TLR). 

“This translates into a trend toward less angiographic restenosis and significant reduction of TLR (target lesion revascularization) and major adverse cardiac events,” the authors wrote.

These findings indicated a trend toward lower rates of major adverse heart events, heart attack and death with the addition of cilostazol to aspirin and clopidogrel.

“This study is the first to our knowledge to determine whether cilostazol reduces neointimal hyperplasia after DES implantation in complex lesions, especially in long coronary lesions, which remain at a higher risk of restenosis despite the use of DES,” the authors said.