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Do Patients With Arterial Occlusive Disease of Different Etiologies Benefit Equally From Cilostazol?
Burak Can Depboylu1, Serkan Yazman1, Bugra Harmandar1
1Department of Cardiovascular Surgery, Mugla Sitki Kocman University Faculty of Medicine, Mugla, Turkey.
Insights
Cilostazol improves walking distance and oxygen saturation in peripheral arterial disease patients. However, those with Buerger disease or diabetic angiopathy may benefit less, suggesting tailored treatment approaches.
Area of Science:
- Vascular Medicine
- Pharmacology
- Clinical Outcomes Research
Background:
- Cilostazol is recommended for chronic atherosclerotic peripheral arterial disease (PAD) to improve intermittent claudication and quality of life.
- The drug's efficacy across diverse etiologies of arterial occlusive diseases is not fully understood.
- This study investigates differential patient responses to cilostazol based on disease cause.
Purpose of the Study:
- To evaluate the efficacy of cilostazol in patients with peripheral arterial disease (PAD) across various etiologies.
- To compare patient outcomes, including walking distance and tissue oxygenation, based on the underlying cause of arterial occlusion.
- To identify potential differences in cilostazol benefit among atherosclerosis, diabetic angiopathy, embolism/thrombosis, and Buerger disease.
Main Methods:
- A cohort of 194 patients with PAD was divided into four etiological groups: atherosclerosis, diabetic angiopathy, embolism/thrombosis, and Buerger disease.
- Key outcome measures including maximum walking distance, ankle-brachial index (ABI), and distal tissue oxygen saturation (Sto2) were assessed before and after 12 months of cilostazol treatment.
- Comparisons were made for clinical improvement onset, time to maximum benefit, vascular surgeries, and wound healing.
Main Results:
- Cilostazol significantly improved maximum walking distance, ABI, and Sto2 in all patient groups (P < .001).
- Patients with diabetic angiopathy and Buerger disease exhibited significantly lower distal Sto2 compared to the atherosclerosis group (P < .001).
- Vascular surgery rates decreased significantly in the atherosclerosis and embolism/thrombosis groups, but not significantly in others.
Conclusions:
- While cilostazol benefits patients with nonatherosclerotic PAD, those with Buerger disease or diabetic angiopathy may experience reduced efficacy.
- Optimizing cilostazol therapy might involve combination with anticoagulant or antiaggregant agents.
- Closer patient monitoring is recommended for those with Buerger disease and diabetic angiopathy to maximize cilostazol benefits.
Background:
Cilostazol is a guideline-recommended drug that improves intermittent claudication and quality of life in patients with chronic atherosclerotic peripheral arterial disease. The drug is used for most etiologies of arterial occlusive diseases in clinical practice. This study aimed to evaluate whether patients benefit equally from cilostazol regardless of etiology.
Methods:
Patients on cilostazol were divided into 4 groups according to arterial occlusive disease etiology: (1) atherosclerosis, (2) diabetic angiopathy, (3) embolism/thrombosis, and (4) Buerger disease. Patients' maximum walking distance, ankle-brachial index score and distal tissue oxygen saturation (Sto2), clinical improvement onset time, ability to reach maximum benefit time, vascular surgeries, and wounds were compared before they started cilostazol and after 12 months. Results were evaluated at a statistical significance of P < .05.
Results:
In 194 patients, 307 target extremities were evaluated in the 4 disease groups. After cilostazol use, maximum walking distance, ankle-brachial index score, and distal Sto2 increased significantly in all groups (P < .001), but distal Sto2 in the diabetic angiopathy and Buerger disease groups was significantly lower than in the atherosclerosis group (P < .001). Ankle-brachial index and distal Sto2 differences in the Buerger disease group were significantly lower (both P < .001). The vascular surgery counts decreased significantly in the atherosclerosis and embolism/thrombosis groups (P = .019 and P = .004, respectively).
Conclusion:
Patients with nonatherosclerotic arterial occlusive disease also benefit from cilostazol, but patients with Buerger disease or diabetic angiopathy seem to benefit less. Combining cilostazol with anticoagulant or antiaggregant agents and closer monitoring of these patients may produce better results.
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