Pharmacodynamic effect of cilostazol plus standard clopidogrel versus double-dose clopidogrel in patients with type 2 diabetes undergoing percutaneous coronary intervention.

Abstract

OBJECTIVE:

To determine the effect of adding cilostazol (100 mg b.i.d.) to standard-dose clopidogrel (75 mg/d) (TRIPLE) compared with double-dose clopidogrel (150 mg/d) (DOUBLE) and the influence of the cytochrome P450 (CYP2C19*2/*3, CYP3A5*3)and ATP-binding cassette subfamily B1(ABCB1 C3435T) genetic polymorphisms in type 2 diabetes (T2DM) patients.

RESEARCH DESIGN AND METHODS:

T2DM patients were treated with TRIPLE (n = 41) or DOUBLE (n = 39) after percutaneous coronary intervention. Conventional aggregometry and VerifyNow were performed at baseline and at 30 days. The primary end point was absolute change in 20-μM ADP-induced maximal platelet aggregation (ΔMPA(20)) between baseline and switching values.

RESULTS:

TRIPLE versus DOUBLE showed greater ΔMPA(20) (22.9 ± 11.6 vs.12.7 ± 15.5%; difference, 10.2% [95% CI 4.2-16.3]; P < 0.001). Carriage of one (β coefficient, -5.4%; P = 0.162) and two CYP2C19 loss-of-function allele(s) (-8.3%; P = 0.007) were associated with lower ΔMPA(20) in DOUBLE-treated patients, but not in TRIPLE-treated patients.

CONCLUSIONS:

Among T2DM patients, adding cilostazol achieves greater platelet inhibition compared with clopidogrel (150 mg/d), which is not influenced by genetic polymorphisms.

• Authors: Young-Hoon Jeong, Udaya S Tantry, Yongwhi Park, Tae Jung Kwon, Jeong Rang Park, Seok-Jae Hwang, Kevin P Bliden, Eun-Ha Koh, Choong Hwan Kwak, Jin-Yong Hwang, Sunjoo Kim, Paul A Gurbel
• Journal: Diabetes care (Diabetes Care) Vol. 35 Issue 11 Pg. 2194-7 (Nov 2012) ISSN: 1935-5548 [Electronic] United States
• PMID: 22837373 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Platelet Aggregation Inhibitors
• Tetrazoles
• Clopidogrel
• Cilostazol
• Ticlopidine

Topics

• Cilostazol
• Clopidogrel
• Diabetes Mellitus, Type 2 (drug therapy, genetics, metabolism)
• Female
• Humans
• Male
• Percutaneous Coronary Intervention (methods)
• Platelet Aggregation (drug effects)
• Platelet Aggregation Inhibitors (administration & dosage, therapeutic use)
• Polymorphism, Genetic (genetics)
• Tetrazoles (administration & dosage, therapeutic use)
• Ticlopidine (administration & dosage, analogs & derivatives, therapeutic use)