Efficacy And Safety Of Cilostazol In Acute Coronary Syndrome Patients With Aspirin Intolerance

ObjectiveTo compare the antiplatelet functions of cilostazol plus clopidogrel versus aspirin plusclopidogrel in patients with acute coronary syndrome (ACS), and to explore the efficacy andsafety of cilostazol in ACS patients with aspirin intolerance underwent primary percutaneouscoronary intervention (PCI).MethodsBetween June2011and December2012, a total of133consecutive ACS patients underwentprimary PCI were enrolled. Thirty-eight patients with aspirin intolerance were given cilostazol100mg twice a day plus clopidogrel75mg/d as cilostazol group; other95patients receivedstandard aspirin100mg/d and clopidogrel75mg/d as aspirin group. The platelet aggregation wasmeasured by whole blood impedance aggregometry (WBIA) at14days after therapy. In theassay, platelet aggregation was activated by arachidonic acid (AA), adenosine diphosphate (ADP)and collagen (COL). Overall patients were followed for30days. The clinical endpoints weremajor adverse cardiac events (MACE) and bleeding events. Both the platelet aggregation and theincidence of clinical endpoints were compared between the two groups.Results1. The baseline clinical characteristics were similar between the two groups.2. According to the platelet aggregation test at14days after therapy, the ADP-inducedimpedance values of cilostazol group were lower than values of aspirin group, but the differencewere not statistically significant(0.89±1.69vs.1.42±2.61, P=0.173). However, in aspiringroup, the AA-induced impedance values(0.03±0.18vs.1.42±2.14, P=0.001) and COL-induced impedance values(10.4±5.56vs.18.47±5.02, P=0.001) were significantly lowerthan the cilostazol group.3. After30days follow up, there was no target vessel revascularization (TVR) in both twogroups. In aspirin group, seventeen (17.9%) patients were diagnosed with recurrence angina andthirteen (13.7%) with deterioration of cardiac function, two (2.4%) patients had recurrentmyocardial infarction, one (1.2%) had ischemic stroke and one (1.2%)cardiac death; and therewere ten (26.3%) patients had recurrence angina, seven (18.4%) with deterioration of cardiacfunction and one (2.6%) with cardiac death, none of the recurrent myocardial infarction orischemic stroke were observed in cilostazol group. Each clinical endpoint event rates and theincidence of MACE were both not significantly different between the two groups (P＞0.05).4. After30days follow up, nine (9.5%) patients suffered from minimal bleeding and six (6.3%)had minor bleeding and two (2.4%) had major bleeding in aspirin group. There was just one(2.6%) minimal bleeding and no major and minor bleeding in cilostazol group. The incidence ofbleeding events was no significant differences between the two groups (P＞0.05). Nevertheless,the total bleeding events rates in cilostazol group was significantly lower than the aspirin group(17.9%vs.2.6%, P=0.02).ConclusionsIn ACS patients with aspirin intolerance after PCI, cilostazol100mg twice a day plusclopidogrel75mg/d is a safe and efficacious therapy regimen. Therefore, cilostazol can be agood alternative to aspirin for the treatment of ACS after stent implantation.