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VIDEO: Cilostazol ‘compelling’ as bridging therapy for high-risk patients to discontinue DAPT before surgery
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SAN DIEGO — In this video, Charles Laham, MD, FSCAI, an interventional cardiologist at Holy Family Memorial Hospital in Wisconsin, discusses results of the OUTSIDE START trial, which he presented at the Society for Cardiovascular Angiography and Interventions Scientific Sessions.
In the retrospective study, researchers evaluated cilostazol as a bridging therapy in 183 patients with paclitaxel-eluting stents who required discontinuation of dual antiplatelet therapy (DAPT) prior to surgery. Patients stopped DAPT 8 days before undergoing surgery and at 7 days before surgery started treatment with 50 mg or 100 mg cilostazol twice daily until 54 to 60 hours before surgery among patients at higher risk for bleeding, or 24 to 30 hours before surgery in lower-risk patients.
Successful bridging was reported in 171 patients, who were compliant with 500-mg cilostazol or more. None of the patients who successfully followed the protocol experienced any major adverse events or bleeding. Four of the remaining 12 patients who did not complete the protocol experienced events, three of which occurred more than 1 year post-procedure, Laham said.
Laham called the success rate “compelling,” but noted that patients must be very interactive with their physicians in order to ensure that the protocol is followed. He also acknowledged that some patients may consider the bridging therapy an opportunity to discontinue antiplatelet agents without resuming them, and could subsequently experience delayed events.
While this analysis was retrospective and not originally intended as research, Laham concluded that the results were hypothesis-generating, and that additional randomized studies evaluating newer-generation stents would be beneficial.