Archief Roodbont

Triple antiplatelet therapy fails to reduce clinical events

26 March 2010

MedWire News: Triple antiplatelet therapy achieved by adding cilostazol to usual dual antiplatelet therapy with clopidogrel and aspirin did not result in improved 6-month clinical outcomes after drug-eluting stent implantation, the CILON-T investigators reported.

The team put this down to there being a high proportion of hypo-responders even to triple antiplatelet therapy, and highlighted the importance of the observed association between post-treatment platelet reactivity measurements and cardiovascular events.

Lead investigator Hyo-Soo Kim (Seoul National University Hospital, Korea) presented the results at the American College of Cardiology annual scientific sessions held in Atlanta, Georgia, USA.

The CILON-T (CILostazol-based triple antiplatelet therapy ON Ischemic Complication after drug-eluting stenT implantation) trial included 960 patients undergoing percutaneous coronary intervention and drug-eluting stent implantation who were randomly assigned to receive triple antiplatelet therapy with cilostazol, clopidogrel, and aspirin (n=477) or dual antiplatelet therapy with clopidogrel and aspirin (n=483).

Overall, Kim reported, post-treatment platelet reactivity at 6 months was lower with triple than dual antiplatelet therapy, at 210.7 versus 255.7 P2Y12-receptor reaction units (PRU) in the respective groups (p<0.001).

However, there was no difference in the primary composite endpoint of cardiac death, myocardial infarction, ischemic stroke, and target lesion revascularization between groups, which had occurred in 39 (8.5%) patients who received triple antiplatelet therapy and 42 (9.2%) of those who received dual antiplatelet therapy at the 6-month follow-up.

Acknowledging that the study was underpowered to assess hard clinical endpoints, Kim nevertheless proposed that this was at least partly due to the substantial number in the triple antiplatelet therapy group with high post-treatment platelet reactivity.

Indeed, PRU tertiles correlated significantly with the primary endpoint, and there were no thrombotic events (cardiac death, MI, or ischemic stroke) among patients with low PRU values (<210) irrespective of antiplatelet regimen, he emphasized.

“Tailored decision on the adjunctive use of cilostazol according to post-treatment platelet reactivity may be important to reduce clinical events in patients with drug-eluting stent implantation,” Kim concluded.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

American College of Cardiology Annual Scientific Sessions; Atlanta, Georgia: 13–16 March 2010