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• W2776133670 abstract "HomeCirculationVol. 136, No. 25Letter by Farina Regarding Article, “A Structured Review of Antithrombotic Therapy in Peripheral Artery Disease With a Focus on Revascularization: A TASC (InterSociety Consensus for the Management of Peripheral Artery Disease) Initiative” Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBLetter by Farina Regarding Article, “A Structured Review of Antithrombotic Therapy in Peripheral Artery Disease With a Focus on Revascularization: A TASC (InterSociety Consensus for the Management of Peripheral Artery Disease) Initiative” Alberto Farina, PharmD Alberto FarinaAlberto Farina Medical Affairs Department, Italfarmaco SpA, Cinisello Balsamo, Milan, Italy. Search for more papers by this author Originally published19 Dec 2017https://doi.org/10.1161/CIRCULATIONAHA.117.030151Circulation. 2017;136:2522–2523To the Editor:I read with great interest “A Structured Review of Antithrombotic Therapy in Peripheral Artery Disease With a Focus on Revascularization” by Hess et al1 published on June 20, 2017.Cilostazol has been cited in the Antithrombotic Therapy After Endovascular Peripheral Revascularization section, where it was reported to significantly improve vascular patency at 36 months after peripheral endovascular interventions in a single randomized trial including 127 patients with femoropopliteal disease undergoing endovascular intervention randomized to cilostazol plus aspirin versus aspirin alone (odds ratio, 0.40; 95% confidence interval, 0.19–0.83).2In the aforementioned section, some points deserve clarification and integration. First, the study did not randomize patients to cilostazol plus aspirin versus aspirin alone but to cilostazol plus aspirin versus ticlopidine plus aspirin. This was correctly reported in Table 2. Second, it is stated that the effect of cilostazol in patients undergoing peripheral endovascular interventions has been studied in a single randomized trial. Two additional randomized controlled trials that have demonstrated the favorable effects of cilostazol in reducing restenosis and ameliorating the clinical outcome after peripheral endovascular interventions are present in the literature.3,4 The study by Soga et al,3 published in the Journal of the American College of Cardiology in 2009, randomized 80 patients with intermittent claudication caused by a femoropopliteal lesion to receive or not receive cilostazol in addition to aspirin after endovascular therapy. Two years after endovascular therapy, cilostazol significantly improved freedom from target vessel revascularization (84.6% versus 62.2%; P=0.04), the rate of restenosis (43.6% versus 70.3%; P=0.02), and freedom from major adverse cardiovascular events (79.5% versus 48.7%; P=0.006).3 The STOP-IC study (Sufficient Treatment of Peripheral Intervention by Cilostazol) by Iida et al,4 published in Circulation in 2013, randomized 200 patients with intermittent claudication caused by a femoropopliteal lesion to receive aspirin with or without cilostazol. One year after endovascular therapy, cilostazol significantly improved the rate of angiographic restenosis (20.0% versus 49.0%; P=0.0001) and event-free survival, defined as freedom from death, major amputation, clinically driven target lesion revascularization, and target limb ischemia requiring surgical intervention (83% versus 71%; P=0.02).4 A systematic review and meta-analysis of these 3 studies has confirmed the effects of cilostazol in the prevention of restenosis (risk difference, −0.20; 95% confidence interval, −0.29 to −0.11; P<0.0001; number needed to treat, 5) and target lesion revascularization (risk difference, −0.17; 95% confidence interval, −0.25 to −0.09; P<0.0001; number needed to treat, 6).5In conclusion, although current evidence on the administration of cilostazol after revascularization of the lower limbs is still relatively limited, its role in therapy may be reconsidered. It should also be taken into account that cilostazol has been demonstrated to significantly improve the rate of restenosis and the clinical outcome after coronary and carotid revascularization in several randomized controlled trials including thousands of patients. This is also consistent with a large number of observational studies. To date, cilostazol seems to be the only oral therapy that showed adequate efficacy in the prevention of restenosis after coronary or peripheral revascularization procedures.Alberto Farina, PharmDDisclosuresDr Farina is an employee of Italfarmaco SpA, Cinisello Balsamo, Milan, Italy.FootnotesCirculation is available at http://circ.ahajournals.org.References1. Hess CN, Norgren L, Ansel GM, Capell WH, Fletcher JP, Fowkes FGR, Gottsäter A, Hitos K, Jaff MR, Nordanstig J, Hiatt WR. A structured review of antithrombotic therapy in peripheral artery disease with a focus on revascularization: a TASC (InterSociety Consensus for the Management of Peripheral Artery Disease) initiative.Circulation. 2017; 135:2534–2555. doi: 10.1161/CIRCULATIONAHA.117.024469.LinkGoogle Scholar2. Iida O, Nanto S, Uematsu M, Morozumi T, Kitakaze M, Nagata S. Cilostazol reduces restenosis after endovascular therapy in patients with femoropopliteal lesions.J Vasc Surg. 2008; 48:144–149. doi: 10.1016/j.jvs.2008.02.062.CrossrefMedlineGoogle Scholar3. Soga Y, Yokoi H, Kawasaki T, Nakashima H, Tsurugida M, Hikichi Y, Nobuyoshi M. Efficacy of cilostazol after endovascular therapy for femoropopliteal artery disease in patients with intermittent claudication.J Am Coll Cardiol. 2009; 53:48–53. doi: 10.1016/j.jacc.2008.09.020.CrossrefMedlineGoogle Scholar4. Iida O, Yokoi H, Soga Y, Inoue N, Suzuki K, Yokoi Y, Kawasaki D, Zen K, Urasawa K, Shintani Y, Miyamoto A, Hirano K, Miyashita Y, Tsuchiya T, Shinozaki N, Nakamura M, Isshiki T, Hamasaki T, Nanto S; STOP-IC Investigators. Cilostazol reduces angiographic restenosis after endovascular therapy for femoropopliteal lesions in the Sufficient Treatment of Peripheral Intervention by Cilostazol study.Circulation. 2013; 127:2307–2315. doi: 10.1161/CIRCULATIONAHA.112.000711.LinkGoogle Scholar5. Benjo AM, Garcia DC, Jenkins JS, Cardoso RM, Molina TP, El-Hayek GE, Nadkarni GN, Aziz EF, Dinicolantonio JJ, Collins T. Cilostazol increases patency and reduces adverse outcomes in percutaneous femoropopliteal revascularisation: a meta-analysis of randomised controlled trials.Open Heart. 2014; 1:e000154. doi: 10.1136/openhrt-2014-000154.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetails December 19, 2017Vol 136, Issue 25 Advertisement Article InformationMetrics © 2017 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.117.030151PMID: 29255129 Originally publishedDecember 19, 2017 PDF download Advertisement" @default.
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