Stent thrombosis associated with drug eluting stents on addition of cilostazol to the standard dual antiplatelet therapy following percutaneous coronary intervention: a systematic review and meta-analysis of published randomized controlled trials

BACKGROUND: In this analysis, we aimed to systematically compare stent thrombosis (ST) and its different subtypes following treatment with DAPT (aspirin + clopidogrel) versus TAPT (aspirin + clopidogrel + cilostazol). METHODS: Studies were included if: they were randomized controlled trials (RCTs) comparing TAPT (cilostazol + aspirin + clopidogrel) with DAPT (aspirin + clopidogrel); they reported ST or its subtype including definite, probable, acute, sub-acute and late ST as their clinical outcomes. RevMan software (version 5.3) was used to carry out this analysis whereby odds ratios (OR) and 95% confidence intervals (CI) were generated. RESULTS: Statistical analysis of the data showed no significant difference in total ST with the addition of cilostazol to the standard DAPT with OR: 0.65, 95% CI: 0.38–1.10; P = 0.11, I(2) = 6%. Moreover, when ST was further subdivided and analyzed, still, no significant difference was observed in acute, sub-acute, late, definite and probable ST with OR: 0.48, 95% CI: 0.13–1.74; P = 0.27, I(2) = 0%, OR: 0.56, 95% CI: 0.22–1.40; P = 0.21, I(2) = 0%, OR: 0.72, 95% CI: 0.23–2.28; P = 0.58, I(2) = 0%, OR: 1.18, 95% CI: 0.38–3.69; P = 0.77, I(2) = 3% and OR: 0.75, 95% CI: 0.17–3.55; P = 0.70, I(2) = 0% respectively. No change was observed during a short term (≤ 6 months) and a longer (≥ 1 year) follow-up time period. CONCLUSIONS: This current analysis showed no significant difference in stent thrombosis with the addition of cilostazol to the standard dual antiplatelet therapy during any follow-up time period after PCI.