The Efficacy and Safety of Cilostazol as an Alternative Antiplatelet Therapy After Coronary Stent Implantation in Patients With Aspirin Intolerance

Aspirin (ASA) is commonly used in dual antiplatelet therapy (DAPT) of patients undergoing percutaneous coronary intervention. The pharmacologic management in the patient demographic with an ASA intolerance is poorly defined. This study aims to determine the efficacy and safety of the phosphodiesterase-3 inhibitor, cilostazol, as an alternative DAPT for ASA-intolerant patients. We used PubMed, Google Scholar, and Cochrane until January 2024 to identify all related prospective and retrospective studies evaluating cilostazol antiplatelet therapy in ASA-intolerant patients. Studies that did not include the target population were excluded. Fixed and random effect models with the Mantel-Haenszel statistical method were used to calculate P values, risk ratios, Z scores, and a 95% confidence interval on RevMan 7.14.0 software. Cilostazol use demonstrates a significant decrease in the incidence of major adverse cardiac events (P = 0.02) (relative risk [RR] = 0.71 [0.53, 0.94]). A nonsignificant trend for benefit was identified for incidence of myocardial infarction (P = 0.34) (RR = 0.42 [0.07, 2.46]) and major bleeding event (P = 0.71) (RR = 0.65 [0.07, 6.37]). The findings of this study suggest a potential benefit for the use of cilostazol in patients after percutaneous coronary intervention with aspirin intolerance.