Efficacy and safety of triple-antiplatelet therapy after percutaneous coronary intervention: a meta-analysis

Background The combination of cilostazol, aspirin and clopidogrel (triple antiplatelet therapy, TAT) after a percutaneous coronary intervention has been used as an alternative therapy. We performed a meta-analysis to evaluate the efficacy and safety of TAT for patients after percutaneous coronary intervention (PCI). Methods We systematically searched Pubmed, Embase and Web of Science databases to identify all randomized controlled trials (RCTs) that compared dual antiplatelet therapy (DAT) with and without cilostazol after PCI. All analyses were conducted using Review Manager 5.0. Results The final analysis consisted of 4474 patients from ten studies. The combined results suggested that there was a lower risk of cardiac death (relative risk (RR)=0.55, 95% confidence interval (CI): 0.31-0.98, P<0.05) and major adverse cardiac events (MACEs) (RR=0.63, 95% CI: 0.54-0.74, P<0.05) in patients treated with TAT as compared to those with DAT follow-ups after six months to one year; no significant difference was observed in bleeding and non-fatal myocardial infarction (MI) (RR=1.14, 95% CI: 0.80-1.64, P>0.05; RR=0.87, 95% CI: 0.42-1.83, P>0.05). However, the rate of adverse drug reaction was higher in patients receiving TAT than in patients receiving DAT (RR=2.21, 95% CI: 1.84-2.66, P<0.05). Moreover, there was a lower risk of stent thrombosis in patients treated with TAT as compared to those treated with DAT (RR=0.44, 95% CI: 0.21-0.94, P<0.05). The TAT group had a reduced risk of target lesion revascularilation (TLR) (RR=0.60, 95% CI: 0.43-0.82, P=0.001) and target vessel revascularization (TVR) than the DAT group (RR=0.56, 95% CI: 0.45-0.71, P<0.05). The number of MACEs was lower for patients in the TAT group than in the DAT group with diabetes mellitus sub-analysis (RR=0.41, 95% CI: 0.28-0.61, P<0.05). But no significant difference was observed between the two groups regarding MACEs in patients with drug-eluting stent implantations (RR=0.82, 95% CI: 0.65-1.03, P>0.05). Conclusion TAT could significantly reduce the rates of MACEs and cardiac death in comparison to DAT, but more attention should be paid to adverse side effects of the drugs.