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Cilostazol may improve freedom from amputation after lower-extremity revascularization
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Use of cilostazol after lower-extremity revascularization was associated with improved amputation-free survival at 1 year in a cohort of patients aged 65 years and older.
Researchers investigated potential associations between cilostazol use and limb salvage in 22,954 older patients undergoing endovascular or open surgery for lower-extremity revascularization from 2007 to 2008. In total, 14,353 patients underwent endovascular procedures and 8,601 underwent open procedures. Thirty-five percent of patients reported claudication, 13% rest pain and 51% ulceration or gangrene.
Before revascularization, 8.7% of patients received preoperative cilostazol.
The rate of amputation at 30 days was 7.8% for patients who received cilostazol vs. 13.4% for patients who did not receive cilostazol; at 90 days, the rate was 10.7% vs. 18%, respectively; and at 1 year, the rate was 14.8% vs. 24%, respectively (P < .0001 for all).
In an analysis adjusted for age, sex, race, comorbidities, procedure type and atherosclerosis severity, patients who did not receive cilostazol were more likely to undergo amputation within 1 year after endovascular or open surgery (HR = 1.15; 95% CI, 1.02-1.29). The researchers reported no significant difference between patients who did not receive cilostazol and those who received cilostazol after the procedure only.
Further subgroup analyses adjusted for age, sex and comorbidities revealed that rates of 1-year amputation-free survival were higher in patients with renal failure (HR = 1.61; 95% CI, 1.28-2.02) and diabetes (HR = 1.61; 95% CI, 1.36-1.92) who received cilostazol.
“This population analysis has demonstrated that cilostazol use among patients with [peripheral artery disease] was associated with significant freedom from amputation at 1 year after [lower-extremity revascularization],” the researchers concluded. “Only 13% of the Medicare population was taking cilostazol at the time of their procedure, suggesting this may be an underused agent for amputation-free survival. Further evaluation of cilostazol use in patients with [peripheral artery disease] is needed to maximize the suggested clinical benefit for patients undergoing [lower-extremity revascularization].” – by Rob Volansky
Disclosure: The researchers report no relevant financial disclosures.
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