Addition of cilostazol to aspirin and a thienopyridine for prevention of restenosis after coronary artery stenting: a meta-analysis

J Clin Pharmacol. 2010 Apr;50(4):415-21. doi: 10.1177/0091270009338940. Epub 2010 Jan 16.


The purpose of this study is to evaluate the effect of adding cilostazol to dual antiplatelet therapy (aspirin and thienopyridine) on rates of restenosis after coronary artery stenting. A meta-analysis is conducted of randomized, controlled trials comparing 3 drug regimens (cilostazol, thienopyridine, aspirin [triple therapy]) with dual antiplatelet therapy to reduce restenosis after coronary stenting. A total of 5 studies are included for analysis. The analysis reveals that triple therapy is used in 796 patients, whereas dual therapy is used in 801 patients. Approximately 56% of patients receive a drug-eluting stent. The 6-month restenosis rates are significantly lower with triple versus dual antiplatelet therapy (12.7% vs 21.9%; odds ratio 0.5; 95% confidence interval, 0.38-0.66; P < .001). This benefit is seen regardless of whether a bare-metal or drug-eluting stent is used. Rates of major adverse cardiac events and bleeding are reported for 3 of the 5 studies (n = 1426); analysis of these outcomes shows no difference between treatment groups (P = .21 and .48, respectively). The addition of cilostazol to standard dual antiplatelet therapy reduces angiographic restenosis and increases MLD at 6 months without significantly affecting rates of major adverse cardiac events or bleeding.

Publication types

  • Comparative Study
  • Meta-Analysis
  • Review

MeSH terms

  • Aspirin / administration & dosage*
  • Cilostazol
  • Coronary Restenosis / etiology
  • Coronary Restenosis / prevention & control*
  • Coronary Vessels / drug effects
  • Coronary Vessels / pathology
  • Drug Therapy, Combination
  • Drug-Eluting Stents*
  • Humans
  • Pyridines / administration & dosage*
  • Pyridines / therapeutic use
  • Randomized Controlled Trials as Topic / methods
  • Tetrazoles / administration & dosage*
  • Tetrazoles / therapeutic use


  • Pyridines
  • Tetrazoles
  • thienopyridine
  • Cilostazol
  • Aspirin