Subacute thrombosis can be a serious problem after stent implantation. Physicians often use ticlopidine to help prevent or treat subacute thrombosis after intracoronary stent placement. A newer agent physicians can use to prevent thrombosis is cilostazol, a quinolone derivative.

Both agents are potent antiplatelet agents, but few data show whether one is more effective than the other in preventing stent thrombosis or angiographic outcomes.

To evaluate the relative efficacy of these drugs, investigators randomized 286 consecutive patients to aspirin(81mg/day) plus ticlopidine(200mg/day) or aspirin(81mg/day) plus cilostazol(200mg/day). Patients received treatment starting two days before stenting, and continuing for six months after the procedure.

There was no statistical difference in rate of angiographic restenosis between the two arms (26.5% for ticlopidine and 30.3% for cilostazol.) Likewise, there was no statistical difference in rate of target lesion revascularization (18.4% for ticlopidine and 20.2% for cilostazol.)

However, there was significantly more subacute thrombosis after stent placement in the cilostazol group. None of the patients who received ticlopidine had subacute thrombosis after stent placement, compared with 4.2% of patients who received cilostazol.

Patient baseline characteristics were not different between groups, although the rate of acute myocardial infarction was significantly higher in the cilostazol group (43% versus 27% for ticlopidine.)

These investigators concluded that patients who receive coronary stents are more likely to benefit from ticlopidine prophylaxis. In particular, they said physicians should use ticlopidine prior to stenting to prevent subacute thrombosis.