Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Korean Circ J. 2010 Jan;40(1):10-5. doi: 10.4070/kcj.2010.40.1.10. Epub 2010 Jan 27.
Placement of drug-eluting stents (DES) can be complicated by stent thrombosis; prophylactic antiplatelet therapy has been used to prevent such events. We evaluated the efficacy of cilostazol with regard to stent thrombosis as adjunctive antiplatelet therapy.
A total of 1,315 patients (846 males, 469 females) were prospectively enrolled and analyzed for the frequency of stent thrombosis. Patients with known risk factors for stent thrombosis, except diabetes and acute coronary syndrome, were excluded from the study. All patients maintained antiplatelet therapy for at least six months. To evaluate the effects of cilostazol as another option for antiplatelet therapy, triple antiplatelet therapy (aspirin+clopidogrel+cilostazol, n=502) was compared to dual antiplatelet therapy (aspirin+clopidogrel, n=813). Six months after stent placement, all patients received only two antiplatelet drugs: treatment either with cilostazol+aspirin (cilostazol group) or clopidogrel+aspirin (clopidogrel group). There were 1,033 patients (396 in cilostazol group and 637 in clopidogrel group) that maintained antiplatelet therapy for at least 12 months and were included in this study. Stent thrombosis was defined and classified according to the definition reported by the Academic Research Consortium (ARC).
defined and classified according to the definition reported by the Academic Research Consortium (ARC).
During follow-up (561.7+/-251.4 days), 15 patients (1.14%) developed stent thrombosis between day 1 to day 657. Stent thrombosis occurred in seven patients (1.39%) on triple antiplatelet therapy and four patients (0.49%) on dual antiplatelet therapy (p=NS) within the first six months after stenting. Six months and later, after stent implantation, one patient (0.25%) developed stent thrombosis in the cilostazol group, and three (0.47%) in the clopidogrel group (p=NS).
During the first six months after DES triple antiplatelet therapy may be more effective than dual antiplatelet therapy for the prevention of stent thrombosis. However, after the first six months, dual antiplatelet treatment, with aspirin and cilostazol, may have a better cost benefit ratio for the prevention of stent thrombosis.
药物洗脱支架（DES）的置入可能会导致支架内血栓形成；预防性抗血小板治疗已被用于预防此类事件。我们评估了西洛他唑作为辅助抗血小板治疗在支架内血栓形成方面的疗效。
共前瞻性纳入 1315 例患者（846 例男性，469 例女性），分析支架内血栓形成的频率。除糖尿病和急性冠脉综合征外，有已知支架内血栓形成危险因素的患者被排除在研究之外。所有患者均维持至少 6 个月的抗血小板治疗。为评估西洛他唑作为另一种抗血小板治疗选择的效果，将三联抗血小板治疗（阿司匹林+氯吡格雷+西洛他唑，n=502）与双联抗血小板治疗（阿司匹林+氯吡格雷，n=813）进行比较。支架置入后 6 个月，所有患者仅接受两种抗血小板药物治疗：西洛他唑+阿司匹林（西洛他唑组）或氯吡格雷+阿司匹林（氯吡格雷组）。有 1033 例（西洛他唑组 396 例，氯吡格雷组 637 例）患者维持抗血小板治疗至少 12 个月，并纳入本研究。支架内血栓形成根据学术研究联盟（ARC）报告的定义进行定义和分类。
在随访期间（561.7+/-251.4 天），15 例患者（1.14%）在第 1 天至第 657 天发生支架内血栓形成。支架置入后前 6 个月，三联抗血小板治疗组 7 例（1.39%）和双联抗血小板治疗组 4 例（0.49%）发生支架内血栓形成（p=NS）。支架置入 6 个月后，西洛他唑组 1 例（0.25%）、氯吡格雷组 3 例（0.47%）发生支架内血栓形成（p=NS）。
DES 置入后前 6 个月，三联抗血小板治疗可能比双联抗血小板治疗更能有效预防支架内血栓形成。然而，6 个月后，阿司匹林和西洛他唑双联抗血小板治疗可能具有更好的成本效益比，以预防支架内血栓形成。
