Randomized Comparisons of Double-Dose Clopidogrel or Adjunctive Cilostazol versus Standard Dual Anti-platelet in Patients with High Post-Treatment Platelet Reactivity: Results of the CREATIVE Trial (Clopidogrel Response Evaluation and AnTi-platelet InterV -

Randomized Comparisons of Double-Dose Clopidogrel or Adjunctive Cilostazol versus Standard Dual Anti-platelet in Patients with High Post-Treatment Platelet Reactivity: Results of the CREATIVE Trial (Clopidogrel Response Evaluation and AnTi-platelet InterV
Information type: Randomised controlled trials
Source: Circulation Research
Specialities: Cardiovascular system disorders | Haematological disorders
Summary
RCT (n=1078) found that in patients with low responsiveness to clopidogrel, as measured by thromboelastography, intensified antiplatelet strategies with adjunctive use of cilostazol improved clinical outcomes without increasing the risk of major bleeding.
UKMi comment

In the study, participants received different anti-platelet therapies: standard antiplatelet therapy (clopidogrel 75mg daily plus aspirin 100mg daily (STANDARD group), double-dose clopidogrel (clopidogrel 150mg daily plus aspirin 100mg daily (DOUBLE group) and adjunctive use of cilostazol (cilostazol 100mg twice per day plus dual antiplatelet therapy (TRIPLE group).

The primary outcome (incidence of major adverse cardiac and cerebrovascular events at 18 months post-PCI, defined as a composite of all-cause death, myocardial infarction, target vessel revascularisation or stroke occurred in 52 patients (14.4%) in STANDARD group, 38 patients (10.6%) in DOUBLE group and 30 patients (8.5%) in TRIPLE group (HR: 0.720, 95%CI: 0.474-1.094, DOUBLE vs. STANDARD; HR: 0.550, 95%CI: 0.349-0.866, TRIPLE vs. STANDARD).

In the UK, cilostazol is only licensed for the improvement of the maximal and pain-free walking distances in patients with intermittent claudication, who do not have rest pain and who do not have evidence of peripheral tissue necrosis (peripheral arterial disease Fontaine stage II).
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