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Jakarta, 28 Dec 2009
Pletaal in cerebrovascular disease
Pletaal in cerebrovascular disease
The risk of cerebrovascular events in patients with mild to moderate peripheral vascular disease is significant. A post hoc analysis of the CASTLE (The Cilostazol: A Study in Long-Term Effects) trial was undertaken to evaluate Pletaal use on cerebrovascular events in 1435 patients with mild to moderate peripheral arterial occlusive disease. Blinded adjudication of all cerebrovascular events (stroke, transient ischemic attack, and carotid revascularization) in this trial was performed. Kaplan-Meier analysis was used for statistical evaluation. The overall rate of cerebrovascular events was 4.6% (67 of 1435 patients) with a mean follow-up of 515 days. Ischemic vascular events were more common (2.5%) than hemorrhagic events (0.3%; P < .05). The placebo group demonstrated a greater risk for events (6.1%; 43 of 718 patients) versus the Pletaal treated group (3.2%; 24 of 717 patients; P < .05) In this trial Cerebrovascular risk factors were similar in both groups (1).
In a meta-analysis of Pletaal in patients with atherothrombosis demonstrated a significant risk reduction for cerebrovascular events.
Data from 12 randomized controlled trials, involving 5674 patients, were analyzed for end points of cerebrovascular, cardiac, and major bleeding events.
Data were available in 3782, 1187, and 705 patients with peripheral arterial disease, cerebrovascular disease, and coronary stenting, respectively. Incidence of total vascular events was significantly lower in the Pletaal group compared with the placebo group (relative risk [RR], 0.86; 95% confidence interval [CI], 0.74-0.99; P=.038). This was particularly influenced by a significant decrease of incidence of cerebrovascular events in the Pletaal group (RR, 0.58; 95% CI, 0.43-0.78; P < .001). There was no significant intergroup difference in incidence of cardiac events (RR, 0.99; 95% CI, 0.83-1.17; P=.908) and serious bleeding complications (RR, 1.00; 95% CI, 0.66-1.51; P=.996) (2).
Treatment with PDE3 inhibitors (Pletaal) may reduce this risk of cerebrovascular events in patients with atherothrombosis with no associated increase of bleeding risk.
References :
- Stone WM et al. Type 3 phosphodiesterase inhibitors may be protective against cerebrovascular events in patients with claudication. J stroke cerebrovasc dis 2008 May-Jun;17(3):129-33.
- Uchiyama S et al. Stroke prevention by cilostazol in patients with atherothrombosis: meta-analysis of placebo-controlled randomized trials. J Stroke Cerebrovasc2009 Nov-Dec;18(6):482-90.
Elizabeth Jonosewojo, MD
Ass. Medical Director
elizabet@ho.otsuka.co.id
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