Triple Antiplatelet Therapy Reduced Thrombosis, MI Rates After DES       
 
Key Points:

DECREASE registry found cilostazol safe when added to aspirin and clopidogrel.

By TCT Daily Staff

Data from the DECREASE registry show that triple antiplatelet therapy adding cilostazol to aspirin and clopidogrel resulted in lower one-year rates of stent thrombosis and MI after DES implantation than standard dual antiplatelet therapy.

Seong-Wook Park, MD, PhD, of the Asan Medical Center in Seoul, South Korea, reported one-year clinical outcome data Tuesday, which showed no difference in major or minor bleeding rates between the triple- and dual-therapy groups.

In a landmark analysis, triple antiplatelet therapy for more than one month was found to reduce the 12-month risk of stent thrombosis (HR=0.108; 95% CI, 0.013-0.918; P=.0415). Triple therapy beyond three or six months had no such effect.

Both inverse-probability-of-treatment-weighted and propensity-score-matched data for one year clinical outcomes showed a reduction in MI risk and stent thrombosis with triple therapy, although mortality risk was similar between the two groups (see Figure). The cumulative incidence of stent thrombosis in propensity-score matched pairs was significantly lower in the triple therapy group than in the dual therapy group (0.1% vs. 0.8%; log-rank P=.0192).

"These results may provide the rationale for using triple antiplatelet therapy in a broad range of patients undergoing DES implantation," Park said.

DECREASE, a single-center registry, included 1,443 patients assigned to triple antiplatelet therapy and 1,656 assigned to standard dual therapy after DES implantation.

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Jeffrey J. Popma, MD, of Tufts University School of Medicine, in Boston, said that even though there is no long-term information from the registry about TLR rates, "we can certainly say that in complex patients, triple drug therapy with cilostazol has a lower event rate than with dual therapy alone."

Popma said that cilostazol "might be useful where clopidogrel resistance has been demonstrated in patients undergoing DES implantation, which cannot be overcome with increased clopidogrel dosing. It might also be useful in patients who have stent thrombosis or MI while on dual antiplatelet therapy, as well as in aspirin-resistant or hypersensitive patients. It may also be useful in high-risk anatomy," he said.

"But [clinicians] must make certain that their triple therapy patients do not have congestive heart failure, because there is an FDA-labeled contraindication for cilostazol," he said.

Disclosures:

Dr. Park reports no relevant conflicts of interest.
Dr. Popma reports having received research grants from or having served on advisory boards or speaker’s bureaus for the following: Cordis, Boston Scientific, Medtronic, Abbott-Guidant, Biosensors, Radiant, eV3, Sanofi, BMS, Pfizer.

（source：www.tctmd.com）