Usefulness of cilostazol versus ticlopidine in coronary artery stenting

A combination of ticlopidine and aspirin has been accepted as the standard antithrombotic regimen after coronary stenting. However, ticlopidine poses serious side effects such as neutropenia or thrombocytopenia. Cilostazol, a cyclic adenosine monophosphate phosphodiesterase inhibitor, is a novel ant iplatelet agent with vasodilatory properties. We compared the efficacy and safety of cilostarol plus aspirin (C+A) with ticlopidine plus aspirin (T+A) in elective coronary stenting. Three hundred patients were randomly assign ed to receive C+A or T+A 2 days before stenting. The primary end point was a composite of angiographic stent thrombosis, or major cardiac events (deat h, myocardial infarction, bypass surgery, repeat intervention) at 30 days. The secondary end points were bleeding vascular complications, neutropenia, thrombocytopenia, or side effects requiring discontinuation of the drugs a t 30 days. The primary end point was reached in 1.4% in the C+A group and 2 .0% in the T+A group (p = 1.0). The rate of bleeding vascular complications was 1.4% in the C+A group and 2.0% in the T+A group (p = 1.0). The rate of drug-related side effects was not statistically different between the 2 gr oups but slightly higher in the T+A group than in the C+A group (2.7% vs 0. 7%, p = 0.37). However, neutropenia was seen in 2 patients only in the T+A group. As a poststenting antithrombotic, C+A is as effective as T+A in prev enting major cardiac events including stent thrombosis, and safer in that i t does not cause neutropenia despite the fact that there is no statistical difference in the incidence of adverse effects and complications. (C) 1999 by Excerpta Medico, Inc.