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 PS162. Cilostazol Is Associated with Improved Outcomes After Peripheral Endovascular Interventions: A Meta-Analysis

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.
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Posted April 2013

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