Courtney J. Warner1, Spencer W. Greaves2, Robin J. Larson2, Randall R. De Martino1, Richard J. Powell1, Daniel B. Walsh1, Philip P. Goodney1
1Vascular Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH; 2The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH.
OBJECTIVES: While cilostazol is commonly used as an adjunct following peripheral vascular interventions (PVI), its efficacy remains uncertain. We assessed the effect of cilostazol on outcomes following PVI using meta-analytic techniques.
METHODS: We searched MEDLINE (1946-2012), Cochrane CENTRAL (1996-2012) and trial registries for studies comparing cilostazol in combination with antiplatelet therapy to antiplatelet therapy alone following PVI. Treatment effects were reported as pooled risk/hazard ratios using random effects models.
RESULTS: Two randomized trials and 4 retrospective cohort studies met inclusion criteria (total n=1,522). Across studies, mean age ranged from 66-76 years, the majority of patients were male (59-82%), and mean follow-up ranged from 18-37 months. Pooled estimates demonstrated that the addition of cilostazol was associated with decreased restenosis (RR 0.71; p<0.001, 95% CI 0.60-0.84), improved amputation-free survival (HR 0.63; p=0.002, 95% CI 0.47-0.85), improved limb salvage (HR 0.42; p<0.001, 95% CI 0.27-0.66), and improved freedom from target lesion revascularization (TLR) (RR 1.36; p<0.001, 95% CI 1.14-1.61) (Figure 1). There was no significant reduction in mortality among those receiving cilostazol (RR 0.73; p=0.21, 95% CI 0.45-1.19).
CONCLUSIONS: The addition of cilostazol to standard therapy following PVI is associated with a reduced risk of restenosis, amputation and TLR in our meta-analysis of six studies. Consideration of cilostazol as a medical adjunct after PVI is warranted, presuming these findings are broadly generalizable.
AUTHOR DISCLOSURES: R. R. De Martino
: Nothing to disclose; P. P. Goodney
: Nothing to disclose; S. W. Greaves
: Nothing to disclose; R. J. Larson
: Nothing to disclose;
R. J. Powell: Nothing to disclose; D. B. Walsh
: Nothing to disclose; C. J. Warner
: Nothing to disclose.
Posted April 2013