Journal Article

DAPT Plus Cilostazol is Better Than Traditional DAPT or Aspirin Plus Ticagrelor as Elective PCI for Intermediate-to-Highly Complex Cases: Prospective, Randomized, PRU-Based Study in Taiwan

Lin, Feng-Yen, Lin, Rong-Ho, Sheu, Jehn-Shing, Cheng, Shu-Meng, Tsai, Chien-Sung, Chen, Yueh-Chung, Chang, Chao-Chien, Chen, Shan-Min, Lin, Yi-Wen, Chuang, Chun-Ling

2019

Overview

Purpose Current treatment guidelines do not recommend different antiplatelet treatments for patients in different coronary risk categories; nor do they consider ethnic differences in responses to individual drugs. Objectives We performed a prospective, single-blind, randomized, comparative study of Taiwanese patients with stable angina and scheduled stent implantation for intermediate-to-highly complex coronary lesions and compared the platelet reactivity unit (PRU) levels and 24-month outcomes of groups receiving three different antiplatelet treatments. Methods Patients ( N  = 334) were randomized into three treatment groups (aspirin + clopidogrel, aspirin + ticagrelor, or aspirin + clopidogrel + cilostazol) for 6 months of treatment and were then switched to aspirin only. PRU levels were determined 24 h, 7 days, and 1 month after stent implantation. Clinical outcomes and adverse events were recorded over 24 months. Results Clopidogrel treatment reached full effect after 1 month. Ticagrelor decreased PRU levels more than did clopidogrel but often to levels that increased the risk of hemorrhage. The addition of cilostazol to clopidogrel decreased PRU levels earlier and more strongly than clopidogrel alone but not as strongly as did ticagrelor. Ticagrelor treatment caused fewer major adverse cardiovascular events (MACEs) and more episodes of minor bleeding than the other two treatments. Conclusions Clopidogrel appears safer than ticagrelor in Taiwanese patients with stable angina after stent implantation for intermediate-to-highly complex coronary lesions. The addition of cilostazol to clopidogrel may provide a more rapid decrease in PRU to therapeutic levels without increasing the risk of hemorrhage. Clinical trial registration number NCT02101411.

• Publisher: Springer International Publishing,Springer Nature B.V
• Subject: Acute coronary syndromes / Angina pectoris / Aspirin / Blood clots / Cardiology / Cardiovascular disease / Clinical outcomes / Clinical trials / Cultural differences / Drug dosages / Hemorrhage / Medicine / Medicine & Public Health / Original Research Article / Pharmacology/Toxicology / Pharmacotherapy / Stents / Thrombosis