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Clinical manifestationsPeripheral Arterial Disease (PAD) manifests through a range of symptoms, from the characteristic intermittent claudication to atypical presentations and severe complications in advanced stages. Intermittent claudication, a hallmark symptom of PAD, presents as exercise-induced muscle pain that typically resolves within minutes of rest. This pain is reproducible and stems from inadequate blood flow, leading to the accumulation of lactic acid produced during anaerobic...
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Related Experiment Video

Updated: Oct 31, 2025

Computerized Dynamic Posturography for Postural Control Assessment in Patients with Intermittent Claudication
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Cilostazol for intermittent claudication.

Tamara Brown1, Rachel B Forster2, Marcus Cleanthis3

  • 1Cochrane Vascular, University of Edinburgh, Edinburgh, UK.

The Cochrane Database of Systematic Reviews
|June 30, 2021
PubMed
Summary
This summary is machine-generated.

Cilostazol improves walking distance for peripheral arterial disease patients with intermittent claudication. However, it increases headache risk and lacks evidence for severe vascular events.

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Area of Science:

  • Vascular Medicine
  • Pharmacology
  • Clinical Trials

Background:

  • Peripheral arterial disease (PAD) affects a significant portion of older adults, leading to intermittent claudication and increased cardiovascular mortality.
  • Cilostazol is a licensed medication for improving claudication distance, with potential benefits for cardiovascular risk reduction.

Purpose of the Study:

  • To evaluate the efficacy of cilostazol in improving initial and absolute claudication distances.
  • To assess the impact of cilostazol on mortality, vascular events, and quality of life in patients with stable intermittent claudication.

Main Methods:

  • A systematic review and meta-analysis of double-blind, randomized controlled trials (RCTs) comparing cilostazol with placebo or pentoxifylline.
  • Searched multiple databases including Cochrane Vascular, CENTRAL, MEDLINE, Embase, CINAHL, and AMED up to November 2020.
  • Assessed risk of bias using the Cochrane tool and certainty of evidence with GRADE, pooling data using fixed-effect or random-effects models.

Main Results:

  • Cilostazol significantly improved initial claudication distance (ICD) by 26.49 meters and absolute claudication distance (ACD) by 39.57 meters compared to placebo (low to very-low certainty evidence).
  • Headache was a common adverse event, occurring more frequently in the cilostazol group (moderate-certainty evidence).
  • Insufficient evidence exists regarding cilostazol's effect on revascularization, amputation, or cardiovascular events; quality of life improvements were suggested but not statistically pooled.

Conclusions:

  • Cilostazol effectively improves walking distances for patients with intermittent claudication secondary to PAD.
  • The drug is associated with an increased incidence of headaches, and evidence for its impact on major vascular events remains limited.
  • No significant difference in walking distance improvement was found between cilostazol and pentoxifylline, with limited data on other outcomes.