The Multiple Combined Oral Platelet Aggregation Inhibitors of Aspirin, Ticlopidine and Cilostazol after PCI

BACKGROUND AND OBJECTIVES: Along with intracoronary stenting, medications, such as Ca++ channel blocker, nitric oxide and some platelet aggregation inhibitors, have contributed to the reduction of coronary restenosis. However, restenosis still remains as a challenging dilemma, with a frequency of 20-50%. Aspirin and ticlopidine are known as a standard anti-platelet regimen following PCI, but cilostazol is a comparably effective drug, which has a different mechanism to that of ticlopidine. It is unknown if the triple combination of aspirin, ticlopidine and cilostazol could further reduce adverse events and restenosis.

SUBJECTS AND METHODS: The clinical and angiographic data, which had been collected after PCIs at Wallace Memorial Baptist Hospital, between Jan. 2000 and Dec. 2001, were retrospectively analyzed. The patients had taken either aspirin+ ticlopidine or aspirin+ticlopidine+cilostazol, and the clinical observation and follow-up angiography was completed for 6 months. There were 111 (66 males) and 87 (male:57) in the aspirin+ticlopidine and aspirin+ ticlopidine+cilostazol groups, respectively. The rates of major adverse cardiovascular events (MACE) and restenosis were compared during the follow-up period.

RESULTS: The frequency of MACE was similar, without a significant increase in the side effects during the follow-up period. The restenosis and target lesion revascularization (TLR) rates were significantly decreased in the triple combination therapy group (37.2% vs. 21.9%, p=0.006, 29.8% vs. 14.1%, p=0.008).

CONCLUSION: This study showed that this triple combination of platelet aggregation inhibitors is a good combination therapy for the reduction of restenosis. It is suggested that these effects were probably due to more potent platelet inhibition by the multi-directional mechanism in addition to coronary vasodilation effect.