Aspirin, Cilostazol Combination Best After Angioplasty for Critical Limb Ischemia

Following angioplasty, patients with critical limb ischemia (CLI) due to pure isolated infrapopliteal disease assigned antiplatelet therapy with a combination of aspirin and cilostazol experienced better outcomes than those patients treated with any of three other antiplatelet regimens, according to study results presented at TCT 2012.

Junichi Tazaki, MD, of Kyoto University, Kyoto, Japan, and colleagues, conducted a retrospective study evaluating the efficacy of four antiplatelet therapies in 884 patients (1,057 limbs) with CLI due to isolated infrapopliteal lesions:

• Aspirin and cilostazol
• Triple antiplatelet therapy (aspirin, cilostazol, and a thienopyridine)
• Aspirin alone
• Aspirin and a thienopyridine

Patients were selected from a Japanese multicenter registry. The primary endpoint was freedom from major adverse limb events, defined as a major amputation or any reintervention, at 2 years.

A clear winner

Those patients assigned to aspirin and cilostazol had an increased rate of freedom from major adverse limb events and a lower cumulative incidence of major amputation compared with the three other treatment groups (see Table).

Table. Antiplatelet Therapy Outcomes in Patients with CLI

Abbreviations: MALE – major adverse limb event (major amputation or any reintervention).

Surprising result

Although it is standard practice to use antiplatelet therapy to improve clinical outcomes in patients with atherosclerosis, no optimal antiplatelet therapy following angioplasty has been identified for those with CLI due to pure isolated infrapopliteal lesions.

“The results of this study indicate that the combination of aspirin and cilostazol is associated with better outcomes than aspirin alone or aspirin and thienopyridine,” Tazaki told TCT Daily. He added that the results are surprising because they offer the first useful data to guide antiplatelet treatment in this patient group.

“If the patient with [critical] limb ischemia is able to tolerate the treatment, we should begin to use cilostazol in addition to aspirin,” Tazaki said.

In the future, Tazaki and colleagues hope to conduct a prospective study to evaluate the optimal antiplatelet regimen for patients with CLI to more effectively avoid the need for major amputations. In addition, examining the treatment options in patients with femoropopliteal lesions and those with milder limb ischemia is also needed.

Disclosure:
Dr. Tazaki reports no relevant conflicts of interest.