Comparison of cilostazol and ticlopidine coadministered with aspirin for long-term efficacy and safety after coronary stenting; a meta-analysis

Aims: To compare cilostazol with ticlopidine for long-term efficacy and safety as an adjunctive antiplatelet therapy after coronary stenting. Methods: Using published clinical studies retrieved through Medline and other databases from 1986-2604, meta-analyses were employed to evaluate efficacy and adverse clinical events for cilostazol or ticlopidine coadministered with aspirin after coronary stenting. Major adverse cardiac events (MACE), quantitative coronary angiographic parameters (QCA) including minimal lumen diameter (MLD) late loss, loss index of diseased vessels, and net gain, or adverse clinical events after coronary stenting were compared between the two study arms and expressed with the mean difference or odds ratios (OR) specific for the individual studies and meta-analytic pooled estimate for the mean difference or OR. Results: Five of the clinical studies we reviewed met the inclusion criteria and underwent meta-analysis. The cilostazol was found to be superior in the pooled estimate of the total clinical outcomes and QCA as compared to ticlopidine (OR [95% CI]: 0.59 [0.46, 0.75]), MLD (WMD [95% CI]: 0.27 mm [0.17, 0.37]), late loss (WMD [95% CI]: -0.36mm [-0.51, -0.22]), loss index (WMD [95% CI]: - 0.16 [-0.24, -0.08]), and net gain (WMD [95% CI]: 0.49 mm [0.30, 0.68]). The pooled estimate of all adverse clinical events in cilostazol was approximately the same as that seen for ticlopidine. Conclusions: Our results suggest that cilostazol plus aspirin therapy, as compared to ticlopidine plus aspirin therapy, might be superior with regard to long-term efficacy, particularly in preventing late restenosis. Although cilostazol exhibits few serious adverse clinical events, we must pay attention to increased heart rate or the occurrence of arrhythmias during treatments.