This article is more than 5 years old. Information may no longer be current.
CILON-T: Triple antiplatelet therapy associated with improved platelet reactivity
The addition of cilostazol to aspirin plus clopidogrel did not reduce major adverse cardiovascular and cerebrovascular events.
Click Here to Manage Email Alerts
American College of Cardiology 59th Annual Scientific Sessions
ATLANTA – Patients implanted with stents may have improved platelet activity when assigned to a triple antiplatelet therapy regimen compared with a dual-antiplatelet therapy regimen, study results indicated.
Researchers for the 2×2 factorial CILON-T study enrolled 960 patients with coronary artery disease who were randomly assigned to either dual antiplatelet therapy with aspirin and clopidogrel (Plavix, Sanofi-Aventis) or a triple antiplatelet regimen consisting of cilostazol (Pletal, Otsuka Pharmaceutical), aspirin and clopidogrel.
Patients received the drug regimens for six months following implantation of a drug-eluting stent, with clinical follow-up at one, three and six months. The co-primary study endpoints were a composite of cardiac death, myocardial infarction, ischemic stroke and target lesion revascularization within six months of stent implantation, and the safety endpoint included bleeding complications, the incidence of drug discontinuation and heart rate.
According to the study results, there was a reduction in P2Y12-receptor reaction units in patients assigned to triple antiplatelet therapy at hospital discharge vs. those assigned to dual antiplatelet therapy (206.6 vs. 232.1, P<.001), and at six months (210.7 vs. 255.7, P<.001), signaling improved platelet reactivity. There was no difference in the occurrence of the composite primary study endpoint based on the number of P2Y12-receptor reaction units, but there was an increase in the composite endpoint of cardiac death, nonfatal MI and ischemic stroke across the low, medium and high tertiles of P2Y12-receptor reaction units (P=.037).
Triple antiplatelet therapy did not necessarily improve major CV or cerebrovascular events vs. dual antiplatelet therapy (8.5% vs. 9.2%). There was a greater amount of drug discontinuation in the triple antiplatelet therapy group vs. the dual antiplatelet therapy group (6.6% vs. 0.7%, P<.001), and an increase in heart rate between baseline and at six months in the triple antiplatelet therapy group vs. dual antiplatelet therapy (P<.001). Results of a Cox regression analysis suggested that lesion length >28 mm and an increase in the tertile of P2Y12-receptor reaction units were independent predictors of major adverse CV and cerebrovascular events.
“Tailored decision on the adjunctive use of cilostazol according to post-treatment platelet reactivity can be helpful to reduce adverse clinical outcomes in patients who undergo drug-eluting stent implantation,” Hyo-Soo Kim, MD, PhD, of Seoul National University Hospital in Seoul, South Korea, concluded in his presentation. – Eric Raible
For more information:
- Kim H. LBCT II. Presented at: American College of Cardiology 59th Annual Scientific Sessions; March 13-16, 2010; Atlanta.
Follow
EndocrineToday.com on Twitter.