Clinical Pharmacology Research Laboratory, The First Affiliated of Soochow University, Suzhou, China.
J Cardiovasc Pharmacol Ther. 2013 May;18(3):222-8. doi: 10.1177/1074248412468944. Epub 2012 Dec 21.
Aspirin and clopidogrel dual antiplatelet therapy (DAT) reduce ischemic events in patients with cardiovascular disease. However, recurrent ischemic event occurrence during DAT remains a major concern. This systematic review assesses the efficacy and safety of adjunctive cilostazol to DAT in combination with DAT on reducing clinical adverse events.
We searched randomized controlled trials (RCTs) in PubMed, Embase, Cochrane library, clinicaltrial.gov, and Chinese Biomedical Database through July 2011. Pooled risk ratio (RR) with 95% confidence intervals (CIs) was calculated. Two independent reviewers evaluated the included studies. The extracted data were analyzed by Review Manager 5.1.2 (The Cochrane Collaboration, Oxford, UK) and GRADEprofiler 3.6 (GRADE Working Group).
A total of 7 RCTs (4351 patients) were included in the analysis, with a follow-up period of 6 to 12 months. Pooled analysis showed that cilostazol was associated with a significant reduction in major adverse cardiac events (MACEs; pooled RR 0.69, 95% CI 0.52-0.91; P = .008) and repeat revascularization (RR 0.74, 95% CI 0.61-0.89; P = .002); however, cilostazol was not associated with a reduction in the risk of stent thrombosis (RR 1.00, 95% CI 0.41-2.45; P = 1.00). Cilostazol seems to be safe, with no significant increase in the risk of bleeding (RR 1.06, 95% CI 0.72-1.56; P = .77). The 4 outcomes were low-quality evidence for MACE, moderate-quality evidence for repeat revascularization, and high-quality evidence for bleeding and stent thrombosis.
When compared to the currently recommended DAT, triple antiplatelet therapy with cilostazol can reduce repeat revascularization with no increase in the risk of bleeding.
阿司匹林和氯吡格雷双联抗血小板治疗（DAT）可降低心血管疾病患者的缺血性事件发生率。然而，DAT 期间仍存在反复发生缺血性事件的主要问题。本系统评价评估了联合西洛他唑与 DAT 辅助 DAT 治疗对减少临床不良事件的疗效和安全性。
我们检索了 PubMed、Embase、Cochrane 图书馆、clinicaltrial.gov 和中国生物医学文献数据库中的随机对照试验（RCTs），检索时间截至 2011 年 7 月。使用 95%置信区间（CI）计算合并的风险比（RR）。两名独立的审查员评估纳入的研究。使用 Review Manager 5.1.2（Cochrane 协作网，牛津，英国）和 GRADEprofiler 3.6（GRADE 工作组）分析提取的数据。
共有 7 项 RCT（4351 例患者）纳入分析，随访时间为 6 至 12 个月。汇总分析显示，西洛他唑可显著降低主要不良心脏事件（MACE；合并 RR 0.69，95%CI 0.52-0.91；P=0.008）和再次血运重建（RR 0.74，95%CI 0.61-0.89；P=0.002）；然而，西洛他唑与支架血栓形成风险降低无关（RR 1.00，95%CI 0.41-2.45；P=1.00）。西洛他唑似乎是安全的，出血风险无显著增加（RR 1.06，95%CI 0.72-1.56；P=0.77）。4 项结局为 MACE 的低质量证据、再次血运重建的中等质量证据、出血和支架血栓形成的高质量证据。
与目前推荐的 DAT 相比，联合西洛他唑的三联抗血小板治疗可减少再次血运重建，且不增加出血风险。
