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Meta-analysis
Original research article
Cilostazol increases patency and reduces adverse outcomes in percutaneous femoropopliteal revascularisation: a meta-analysis of randomised controlled trials
  1. Alexandre M Benjo1,
  2. Daniel C Garcia2,
  3. J Stephen Jenkins1,
  4. Rhanderson M N Cardoso2,
  5. Taina P Molina3,
  6. Georges E El-Hayek4,
  7. Girish N Nadkarni5,
  8. Emad F Aziz4,
  9. James J Dinicolantonio6 and
  10. Tyrone Collins1
  1. 1Division of Interventional Cardiology, Ochsner Medical Center, New Orleans, Louisiana, USA
  2. 2Department of Internal Medicine, University of Miami, Miami, Florida, USA
  3. 3Department of Internal Medicine, Centro Universitario Luziadas School of Medicine, Santos, Brazil
  4. 4Department of Cardiology, St. Luke's-Roosevelt Hospital Center at Mount Sinai, New York, USA
  5. 5Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, USA
  6. 6Cardiology Department, St. Luke's Mid America Heart Institute, Kansas City, Missouri, USA
  1. Correspondence to Dr Alexandre M Benjo; abenjo{at}ochsner.org

Abstract

Background Cilostazol is an oral antiplatelet agent currently indicated for treatment of intermittent claudication. There is evidence that cilostazol may reduce femoropopliteal restenosis after percutaneous endovascular intervention.

Methods We searched PubMed, Scopus and Cochrane databases from 1966 through September 2013 for randomised controlled trials (RCTs) evaluating the addition of cilostazol to standard care in patients receiving femoropopliteal endovascular treatment. Restenosis, target lesion revascularisation and combined adverse outcomes (death, revascularisation and amputation) within 1–2 years postprocedure were evaluated.

Results Of 205 articles, three RCTs were included in the analysis. The pooled data provided a total of 396 patients, 195 of whom received cilostazol. When compared to standard medical therapy alone, cilostazol significantly reduced the risk of restenosis (risk difference −0.20; 95% CI −0.29 to −0.11; p<0.0001; number needed to treat 5), target lesion revascularisation (risk difference −0.17; 95% CI −0.25 to −0.09; p<0.0001; number needed to treat 6). Death and amputation were not different in between groups.

Conclusions and limitation Cilostazol significantly increases femoropopliteal patency and decreases adverse outcomes in percutaneous endovascular intervention. However, further RCTs are needed because of limited sample size; this meta-analysis represents the best current evidence.

  • PERIPHERAL VASCULAR DISEASE

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/openhrt-2014-000154

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