Korean J Intern Med.  2004 Dec;19(4):230-236.

Effects of Cilostazol on Platelet Activation in Coronary Stenting Patients Who Already Treated with Aspirin and Clopidogrel

• Ahn JC
• Song WH
• Kwon JA
• Park CG
• Seo HS
• Oh DJ
• Rho YM

Abstract

BACKGROUND
A recent study has shown that triple anti-platelet therapy (cilostazol+clopidogrel+aspirin) resulted in a significantly lower restenosis rate after coronary stenting than did conventional therapy (clopidogrel+aspirin). However, the anti-platelet effects of cilostazol, when combined with clopidogrel and aspirin, have not been evaluated. METHODS: Low dose cilostazol (50 mg/BID) was given to 47 patients who had already been taking clopidogrel (75 mg/day) and aspirin (100 mg/day) for more than 1 month subsequent to coronary stenting due to AMI and unstable angina. Markers of platelet activation, P-selectin and activated GPIIb/IIIa on platelets, were measured at baseline and 2 weeks after cilostazol treatment. We empirically divided patients into tertiles (low, n=16; moderate, n=14; high group, n=17), according to the baseline P-selectin expression. We then performed a comparative assessment of the anti-platelet effects of cilostazol at baseline and after 2 weeks of cilosatzol administration. RESULTS: P-selectin was significantly decreased after 2 weeks of cilostazol treatment in total patients (n=47, 3.2 +/- 2.4% to 2.0 +/- 1.9%, p=0.03). This inhibition of P-selectin expression was mainly achieved in the moderate and high P-selectin groups (low group; 1.4 +/- 0.5 to 1.9 +/- 1.3%, p> 0.05, moderate group; 2.5 +/- 0.3 to 1.3 +/- 0.3%, p< 0.05, high group; 5.4 +/- 2.7 to 2.7 +/- 2.8%, p< 0.05). Activated GPIIb/IIIa was not significantly changed (13.5% to 17.6%, p> 0.05). Underlying disease, cardiovascular risk factors, concomitant medication including statin, and hsCRP were not related to the degree of P-selectin expression. CONCLUSION: Our data demonstrated that cilostazol treatment in addition to conventional anti-platelet therapy provides more effective suppression of platelet P-selectin expression in patients with relatively high platelet activity.

Keyword

Antiplatelet therapy; Coronary stent

MeSH Terms

Aspirin/*therapeutic use
Dose-Response Relationship, Drug
Drug Therapy, Combination
Female
Humans
Male
Middle Aged
Myocardial Ischemia/surgery
P-Selectin/blood
Platelet Aggregation Inhibitors/*therapeutic use
Platelet Glycoprotein GPIIb-IIIa Complex/analysis
Stents
Tetrazoles/*therapeutic use
Thrombosis/blood/*prevention & control
Ticlopidine/*analogs & derivatives/*therapeutic use