Pharmacodynamic effect of clopidogrel therapy and switching to cilostazol in patients with the CYP2C19 loss-of-function allele (ACCEL-SWITCH) study

摘要

Restenosis and stent thrombosis (ST) are catastrophic events that can occur in stented patients. In spite of the development of the drug-eluting stent (DES) platform, selected DES-treated patients still suffer from these clinical events [1]. Early events (within post-stent 30 days) are more likely as a result of mechanical issues, inadequate platelet inhibition or the pro-thrombotic profile, whereas late events may be attributed to biological issues such as delayed re-endothelialization, inflammation, and impaired vascular function and remodeling [2]. In addition to use of new generation DES, optimal pharmacologic regimens may reduce DES-related complications [2]. Adjunctive medications such as statin and thiazolid-inedione may reduce the risk of restenosis through stem cell homing balancing the re-endothelialization and neointimal proliferation, whereas antiplatelet therapy may decrease the risk of DES-mediated ST. Cilostazol is a reversible dual inhibitor of adenosine uptake and phosphodiesterase 3 (PDE3) [3].