Antiplatelet Therapy with Cilostazol and Clopidogrel

Introduction to Combination Therapy

• The American College of Chest Physicians guidelines support the use of both cilostazol and clopidogrel in specific clinical scenarios, including patients with noncardioembolic ischemic stroke or TIA, and patients with peripheral arterial disease (PAD) and intermittent claudication 1

Patient Selection and Dosage

• For patients with noncardioembolic ischemic stroke or TIA, cilostazol (100 mg twice daily) and clopidogrel (75 mg once daily) are individually recommended as antiplatelet options 1
• For patients with peripheral arterial disease (PAD) and intermittent claudication, cilostazol can be added to standard antiplatelet therapy, which includes clopidogrel 2

Mechanism of Action and Safety

• Clopidogrel inhibits platelet aggregation by blocking the P2Y12 ADP receptor, while cilostazol works as a phosphodiesterase-3 inhibitor, increasing intracellular cAMP levels 3
• The combination of cilostazol and clopidogrel is generally safe, but precautions should be observed, including monitoring for bleeding signs and symptoms, as recommended for all antiplatelet therapies 4

Precautions and Contraindications

• The combination should be avoided in patients with heart failure, as cilostazol is contraindicated in heart failure due to potential for tachyarrhythmias 3, 4
• Use caution in elderly patients (≥75 years) who may have higher risk of bleeding with antiplatelet therapies 4
• Consider renal function, as cilostazol should be used with caution in patients with severe renal impairment 3

Benefits and Potential Applications

• The combination may be particularly beneficial in patients with high-risk noncardioembolic stroke, patients with PAD and intermittent claudication, and patients with clopidogrel resistance 2