Outcomes with cilostazol after endovascular therapy of peripheral artery disease

Michael Megaly, Bishoy Abraham, Marwan Saad, Andrew Mekaiel, Peter Soukas, Subhash Banerjee, Mehdi H. Shishehbor

Research output: Contribution to journalArticle

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, I 2 = 24%), lower risk of TLR (OR 0.37, 95% CI (0.26, 0.52), p < 0.001, I 2 = 0%), and lower risk of major amputation (OR 0.15, 95% CI (0.04, 0.62), p = 0.008, I 2 = 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.

Original languageEnglish (US)
JournalVascular Medicine (United Kingdom)
DOIs
StatePublished - Jan 1 2019

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Peripheral Arterial Disease
Amputation
Warfarin
Therapeutics
Observational Studies
Randomized Controlled Trials
cilostazol
Anticoagulants
Meta-Analysis
Extremities
Outcome Assessment (Health Care)

Keywords

  • cilostazol
  • endovascular therapy
  • peripheral artery disease (PAD)
  • peripheral endovascular interventions
  • Pletal

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Outcomes with cilostazol after endovascular therapy of peripheral artery disease. / Megaly, Michael; Abraham, Bishoy; Saad, Marwan; Mekaiel, Andrew; Soukas, Peter; Banerjee, Subhash; Shishehbor, Mehdi H.

In: Vascular Medicine (United Kingdom), 01.01.2019.

Research output: Contribution to journalArticle

Megaly, Michael ; Abraham, Bishoy ; Saad, Marwan ; Mekaiel, Andrew ; Soukas, Peter ; Banerjee, Subhash ; Shishehbor, Mehdi H. / Outcomes with cilostazol after endovascular therapy of peripheral artery disease. In: Vascular Medicine (United Kingdom). 2019.
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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, I 2 = 24{\%}), lower risk of TLR (OR 0.37, 95{\%} CI (0.26, 0.52), p < 0.001, I 2 = 0{\%}), and lower risk of major amputation (OR 0.15, 95{\%} CI (0.04, 0.62), p = 0.008, I 2 = 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.",
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AB - 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, I 2 = 24%), lower risk of TLR (OR 0.37, 95% CI (0.26, 0.52), p < 0.001, I 2 = 0%), and lower risk of major amputation (OR 0.15, 95% CI (0.04, 0.62), p = 0.008, I 2 = 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.

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