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Cilostazol for peripheral arterial disease.

Abstract

BACKGROUND

Peripheral arterial disease (PAD) affects 4% to 12% of people aged 55 to 70 years and 20% of people over 70 years. The most common complaint is intermittent claudication (IC) characterised by pain in the legs or buttocks that occurs with exercise and which subsides with rest. Compared with age-matched controls, people with IC have a three- to six-fold increase in cardiovascular mortality. Symptoms of IC, walking distance, and quality of life can be improved by risk factor modification, smoking cessation, and a structured exercise program. Antiplatelet treatment is beneficial in patients with IC for the reduction of vascular events but has not been shown to influence claudication distance.

OBJECTIVES

To determine the effect of cilostazol on improving walking distance and in reducing vascular mortality and cardiovascular events in patients with stable IC.

SEARCH STRATEGY

The Cochrane Peripheral Vascular Diseases Group searched their specialised register (last searched August 2007) and the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 3, 2007). We searched MEDLINE (1966 to November 2005), EMBASE (1980 to November 2005), several more specialised databases, and reference lists of articles.

SELECTION CRITERIA

Double-blind, randomised controlled trials of cilostazol versus placebo, or versus other antiplatelet agents in patients with stable IC or patients undergoing vascular surgical intervention for PAD.

DATA COLLECTION AND ANALYSIS

Two authors independently assessed trials for selection and all three authors independently extracted data.

MAIN RESULTS

Seven randomised controlled trials comparing cilostazol with placebo were included. The weighted mean difference (WMD) for the initial claudication distance (ICD) was improved following treatment with cilostazol 100 mg twice daily (WMD 31.1 m; 95% confidence interval (CI): 21.3 to 40.9 m) and 50 mg twice daily (WMD 41.3 m; 95% CI: -7.1 to 89.7 m) compared with placebo. Participants receiving cilostazol 150 mg twice daily had an increased ICD (WMD 15.7 m; 95% CI: -9.6 to 41.0 m) compared with those receiving placebo. One study also included a comparison with pentoxifylline. In this study, participants receiving cilostazol had significant improvement in ICD compared with placebo. There was no increase in major adverse events including cardiovascular events or mortality in patients receiving cilostazol compared with placebo.

AUTHORS' CONCLUSIONS

Patients with IC should receive secondary prevention for cardiovascular disease. Cilostazol has been shown to be of benefit in improving walking distance in people with IC. There are no data on whether it results in a reduction of adverse cardiovascular events.

Authors+Show Affiliations

Yong Loo Lin School of Medicine, National University of Singapore, Dept of Cardiac, Thoracic and Vascular Surgery, 5 Lower Kent Ridge Road, Singapore, Singapore, 119074. surrpa@nus.edu.sgNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

18254032

Citation

Robless, P, et al. "Cilostazol for Peripheral Arterial Disease." The Cochrane Database of Systematic Reviews, 2008, p. CD003748.
Robless P, Mikhailidis DP, Stansby GP. Cilostazol for peripheral arterial disease. Cochrane Database Syst Rev. 2008.
Robless, P., Mikhailidis, D. P., & Stansby, G. P. (2008). Cilostazol for peripheral arterial disease. The Cochrane Database of Systematic Reviews, (1), CD003748. https://doi.org/10.1002/14651858.CD003748.pub3
Robless P, Mikhailidis DP, Stansby GP. Cilostazol for Peripheral Arterial Disease. Cochrane Database Syst Rev. 2008 Jan 23;(1)CD003748. PubMed PMID: 18254032.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cilostazol for peripheral arterial disease. AU - Robless,P, AU - Mikhailidis,D P, AU - Stansby,G P, Y1 - 2008/01/23/ PY - 2008/2/7/pubmed PY - 2008/4/15/medline PY - 2008/2/7/entrez SP - CD003748 EP - CD003748 JF - The Cochrane database of systematic reviews JO - Cochrane Database Syst Rev IS - 1 N2 - BACKGROUND: Peripheral arterial disease (PAD) affects 4% to 12% of people aged 55 to 70 years and 20% of people over 70 years. The most common complaint is intermittent claudication (IC) characterised by pain in the legs or buttocks that occurs with exercise and which subsides with rest. Compared with age-matched controls, people with IC have a three- to six-fold increase in cardiovascular mortality. Symptoms of IC, walking distance, and quality of life can be improved by risk factor modification, smoking cessation, and a structured exercise program. Antiplatelet treatment is beneficial in patients with IC for the reduction of vascular events but has not been shown to influence claudication distance. OBJECTIVES: To determine the effect of cilostazol on improving walking distance and in reducing vascular mortality and cardiovascular events in patients with stable IC. SEARCH STRATEGY: The Cochrane Peripheral Vascular Diseases Group searched their specialised register (last searched August 2007) and the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 3, 2007). We searched MEDLINE (1966 to November 2005), EMBASE (1980 to November 2005), several more specialised databases, and reference lists of articles. SELECTION CRITERIA: Double-blind, randomised controlled trials of cilostazol versus placebo, or versus other antiplatelet agents in patients with stable IC or patients undergoing vascular surgical intervention for PAD. DATA COLLECTION AND ANALYSIS: Two authors independently assessed trials for selection and all three authors independently extracted data. MAIN RESULTS: Seven randomised controlled trials comparing cilostazol with placebo were included. The weighted mean difference (WMD) for the initial claudication distance (ICD) was improved following treatment with cilostazol 100 mg twice daily (WMD 31.1 m; 95% confidence interval (CI): 21.3 to 40.9 m) and 50 mg twice daily (WMD 41.3 m; 95% CI: -7.1 to 89.7 m) compared with placebo. Participants receiving cilostazol 150 mg twice daily had an increased ICD (WMD 15.7 m; 95% CI: -9.6 to 41.0 m) compared with those receiving placebo. One study also included a comparison with pentoxifylline. In this study, participants receiving cilostazol had significant improvement in ICD compared with placebo. There was no increase in major adverse events including cardiovascular events or mortality in patients receiving cilostazol compared with placebo. AUTHORS' CONCLUSIONS: Patients with IC should receive secondary prevention for cardiovascular disease. Cilostazol has been shown to be of benefit in improving walking distance in people with IC. There are no data on whether it results in a reduction of adverse cardiovascular events. SN - 1469-493X UR - https://www.unboundmedicine.com/medline/citation/18254032/Cilostazol_for_peripheral_arterial_disease_ L2 - https://doi.org/10.1002/14651858.CD003748.pub3 DB - PRIME DP - Unbound Medicine ER -