DAPT Duration
Original Research2020 Jun 1;9(6):E1678.
JOURNAL:J Clin Med. Article Link
Y Park, JH Kim, TH Kim et al. Keywords: cilostazol; endothelial progenitor cell; MI; platelet.
BACKGROUND - Endothelial progenitor cells (EPCs) have the potential to
protect against atherothrombotic event occurrences. There are no data to
evaluate the impact of cilostazol on EPC levels in high-risk patients.
METHODS - We conducted a randomized, double-blind, placebo-controlled
trial to assess the effect of adjunctive cilostazol on EPC mobilization
and platelet reactivity in patients with acute myocardial infarction
(AMI). Before discharge, patients undergoing percutaneous coronary
intervention (PCI) were randomly assigned to receive cilostazol SR
capsule (200-mg) a day (n = 30) or placebo (n = 30) on top of dual antiplatelet therapy (DAPT) with clopidogrel and
aspirin. Before randomization (baseline) and at 30-day follow-up,
circulating EPC levels were analyzed using flow cytometry and hemostatic
measurements were evaluated by VerifyNow and thromboelastography
assays. The primary endpoint was the relative change in EPC levels
between baseline and 30-day.
RESULTS - At baseline, there were similar
levels of EPC counts between treatments, whereas patients with
cilostazol showed higher levels of EPC counts compared with placebo
after 30 days. Cilostazol versus placebo treatment displayed
significantly higher changes in EPC levels between baseline and
follow-up (ΔCD133+/KDR+: difference 216%, 95% confidence interval (CI) 44~388%, p = 0.015; ΔCD34+/KDR+: difference 183%, 95% CI 25~342%, p =
0.024). At 30-day follow-up, platelet reactivity was lower in the
cilostazol group compared with the placebo group (130 ± 45 versus 169 ±
62 P2Y12 Reaction Unit, p = 0.009).
However, there were no significant correlations between the changes of
EPC levels and platelet reactivity.
CONCLUSIONS - Adjunctive cilostazol on top of clopidogrel and aspirin versus DAPT alone is associated with increased EPC mobilization and decreased platelet reactivity in AMI patients, suggesting its pleiotropic effects against atherothrombotic events (NCT04407312).