Cilostazol Bridging Effective in Transitioning Off DAPT Post-Op

Cilostazol given prior to a surgical procedure resulted in a safer transition off dual antiplatelet therapy (DAPT) by reducing the risk the risk of bleeding during the operation in patients with a high-risk paclitaxel drug-eluting stent, a study has shown. This late-breaking clinical trial was presented at the Society for Cardiovascular Angiography and Interventions (SCAI) 2015 Scientific Sessions.

In the OUTSIDE START (OUTpatient peri-Surgical Interruption of Drug Eluting STent’s Antiplatelet Regimen Trial using Cilostazol Bridging) study, patients stopped DAPT 8 days prior to their operation. They were given cilostazol 100mg twice daily (or 50mg if undergoing high-bleeding-risk surgery or if intolerant of full dose) 7 days before their operation. Patients who were lower-risk discontinued cilostazol 24–30 hours prior to their surgery and resumed DAPT 12–24 hours post-surgery. Higher-risk patients discontinued cilostazol 54–60 hours prior to their surgery and resumed DAPT 24–36 hours post-surgery. “Fully bridged” patients were defined as those receiving at least 600mg of cilostazol prior to surgery and resuming DAPT by at least 48 hours post-surgery.

A total of 108 patients with a paclitaxel-eluting stent underwent 183 operations with a cilostazol bridge from 2005–2012. Overall, 171 patients who were fully bridged had no adverse events. Of 12 patients in the study that did not receive the full cilostazol bridge/DAPT resumption protocol, four experienced an adverse cardiac event.

Researchers concluded cilostazol bridging was effective without the risk of adverse events or bleeding within 30 days of a surgical procedure. Larger studies are needed to confirm whether bridging is effective for more patients with other types of drug-eluting and bare metal stents.

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