Outcomes with cilostazol after endovascular therapy of peripheral artery disease
Michael Megaly1,2, Bishoy Abraham3, Marwan Saad4,5
11 Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA.
Insights
Cilostazol improves outcomes after endovascular therapy for peripheral artery disease (PAD). This medication enhances primary patency and reduces risks of target lesion revascularization and major amputation, independent of warfarin use.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Pharmacology
Background:
- Peripheral artery disease (PAD) management often involves endovascular therapy (EVT).
- The role of pharmacotherapy, specifically cilostazol, post-EVT for PAD requires clarification.
- Optimizing outcomes after EVT is crucial for limb salvage and patient quality of life.
Purpose of the Study:
- To perform a meta-analysis evaluating cilostazol's efficacy after EVT in PAD patients.
- To assess the impact of cilostazol on primary patency, major adverse limb events (MALE), target lesion revascularization (TLR), and major amputation.
- To investigate potential interactions between cilostazol and anticoagulant use (warfarin).
Main Methods:
- Meta-analysis of studies published from January 2000 to November 2018.
- Inclusion of randomized controlled trials (RCTs) and observational studies.
- Analysis of outcomes including primary patency, MALE, TLR, and major amputation from 3846 patients across eight studies.
Main Results:
- Cilostazol use was associated with significantly higher primary patency (OR 2.28, p < 0.001).
- Lower risks of target lesion revascularization (OR 0.37, p < 0.001) and major amputation (OR 0.15, p = 0.008) were observed.
- Improved patency was noted in RCTs and was independent of warfarin use.
Conclusions:
- Cilostazol use following EVT for femoropopliteal and iliac lesions improves primary patency.
- Cilostazol significantly reduces the risk of major amputation and target lesion revascularization.
- The benefits of cilostazol are consistent, irrespective of concurrent warfarin administration.
Abstract:
The role of cilostazol after endovascular therapy (EVT) of peripheral artery disease (PAD) remains unclear. We conducted a meta-analysis for all studies reporting the outcomes of cilostazol after EVT of PAD from January 2000 through November 2018 with the outcomes of interest including primary patency, major adverse limb events (MALE), target lesion revascularization (TLR), and major amputation. We included eight studies (three randomized controlled trials (RCTs) and five observational studies) with a total of 3846 patients (4713 lesions). During a mean follow-up duration of 12.5 ± 5 months, the use of cilostazol was associated with higher primary patency (OR 2.28, 95% CI (1.77, 2.94), p < 0.001, I2 = 24%), lower risk of TLR (OR 0.37, 95% CI (0.26, 0.52), p < 0.001, I2 = 0%), and lower risk of major amputation (OR 0.15, 95% CI (0.04, 0.62), p = 0.008, I2 = 0%). The use of cilostazol in RCTs was associated with significantly higher odds of primary patency compared with observational studies (OR 3.37 vs 2.28, p-interaction = 0.03). After further subgroup analysis, cilostazol remained associated with higher primary patency regardless of the use of anticoagulants (warfarin) (p-interaction = 0.49). We conclude that the use of cilostazol after EVT of femoropopliteal and iliac lesions is associated with improved primary patency and lower risk of major amputation and TLR. The favorable impact of cilostazol is independent of the use of warfarin. PROSPERO identifier: CRD42018092715.
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