TAT With Cilostazol + DAT May Increase Health Risks Compared With DAT Alone

The following article is a part of conference coverage from the American Heart Association Scientific Sessions 2021, being held virtually from November 13 to 15, 2021. The team at Cardiology Advisor will be reporting on the latest news and research conducted by leading experts in cardiology. Check back for more from the AHA Scientific Sessions 2021.

Compared with dual antiplatelet therapy (DAT) alone, triple antiplatelet therapy (TAT), which includes cilostazol on top of conventional DAT, may be associated with higher risk for cardiovascular death and bleeding, according to study results presented at AHA 2021, held from November 13 to 15, 2021.

This study included 985 participants, all of whom underwent primary percutaneous coronary intervention (PCI) using drug-eluting stents (DES), treated at 14 Korean medical centers. Participants were randomly assigned to the following groups: DAT for 12 months (aspirin and clopidogrel; n=320), TAT for 1 month (aspirin, clopidogrel, cilostazol; n=317), or TAT for 6 months (aspirin, clopidogrel, cilostazol; n=311). A composite of all-cause mortality, stroke, repeat vascularization, or nonfatal myocardial infarction (MI) composed the primary endpoint of 1-year major adverse cardiovascular events (MACE). Secondary endpoints included incidence of stent thrombosis, bleeding events, cardiac death, and each of the primary endpoint’s individual components.

The 3 study groups did not differ significantly with respect to the primary endpoint (DAT, 8.4%; TAT 1 month, 11%; TAT 6 months, 11.3%; P =.427). Both TAT groups experienced significantly higher rates of cardiac death (DAT, 0.3%; TAT 1 month, 2.5%; TAT 6 months, 1.3%; P =.047), as well as higher in-hospital bleeding events (0.3% vs 3.2% vs 1.9%, respectively; P =.027). No significant difference in major bleeding events was noted.

The study authors concluded that “TAT strategy with cilostazol on…top of DAT [was] not associated with reduced incidence of 1-year MACE…compared with DAT but may be associated with increased cardiovascular death and bleeding risk.” Furthermore, they noted that additional larger-population studies are needed to understand “whether routine additional use of cilostazol for STEMI patients would be beneficial.”

Reference

Park S, Choi BG, Choi SY, et al. Efficacy, optimal duration and safety of adjunctive cilostazol in acute ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention with drug-eluting stents; a multicenter, randomized, open label, phase 4 trial. Presented at: AHA Scientific Sessions 2021; November 13-15, 2021. Abstract/Poster: P8