Controlled trials of cilostazol for claudication demonstrate improvements in walking distance and quality of life. Without the structure of a study environment, it is not certain that cilostazol has similar efficacy.
Method:
Retrospective review of patients prescribed cilostazol for claudication was undertaken. Patients were advised to stop smoking and increase exercise but no formal programs were instituted. The primary outcome measure was patient-reported improvement in claudication symptoms. Secondary outcomes were smoking cessation and participation in regular exercise.
Results:
Over a 2-year period, 77 patients were prescribed cilostazol as initial treatment for claudication. Follow-up for 3 months was available for 69 (90%) patients. Noncompliance was reported in 20% of patients. Of the overall group, 58% (73% of compliant patients) of patients reported improvement in claudication symptoms, 4% of patients reported smoking cessation, and 7% reported regular exercise.
Conclusion:
Despite minimal behavior modification, up to 70% of patients taking cilostazol report an improvement in claudication symptoms with few side effects.
SelvinEErlingerTP. Prevalence of and risk factors for peripheral arterial disease in the United States: results from the national health and nutrition examination survey, 1999-2000. Circulation. 2004;110(6):738–743.
2.
HirschATHaskalZJHertzerNR. ACC/AHA 2005 Practice guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American association for vascular surgery/society for vascular surgery, society for cardiovascular angiography and interventions, society for vascular medicine and biology, society of interventional radiology, and the ACC/AHA task force on practice guidelines (writing committee to develop guidelines for the management of patients with peripheral arterial disease): endorsed by the American association of cardiovascular and pulmonary rehabilitation; national heart, lung, and blood institute; society for vascular nursing; TransAtlantic inter-society consensus; and vascular disease foundation. Circulation. 2006;113(11):e463–e654.
3.
ComerotaAJ. Endovascular and surgical revascularization for patients with intermittent claudication. Am J Cardiol. 2001;87(12A):34D–43D.
4.
NorgrenLHiattWRDormandyJANehlerMRHarrisKAFowkesFG. Inter-Society consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg. 2007;45suppl S:S5–S67.
5.
QuickCRCottonLT. The measured effect of stopping smoking on intermittent claudication. Br J Surg. 1982;69suppl:S24–S26.
6.
JonasonTBergstromR. Cessation of smoking in patients with intermittent claudication. Effects on the risk of peripheral vascular complications, myocardial infarction and mortality. Acta Med Scand. 1987;221(3):253–260.
7.
AnthonisenNRSkeansMAWiseRAManfredaJKannerREConnettJE. The effects of a smoking cessation intervention on 14.5-year mortality: a randomized clinical trial. Ann Intern Med. 2005;142(4):233–239.
8.
GardnerAWPoehlmanET. Exercise rehabilitation programs for the treatment of claudication pain. a meta-analysis. JAMA. 1995;274(12):975–980.
9.
BendermacherBLWilligendaelEMTeijinkJAPrinsMH. Supervised exercise therapy versus non-supervised exercise therapy for intermittent claudication. Cochrane Database Syst Rev. 2006(2):CD005263.
10.
O'DonnellMEBadgerSASharifMAYoungISLeeBSoongCV. The vascular and biochemical effects of cilostazol in patients with peripheral arterial disease. J Vasc Surg. 2009;49(5):1226–1234.
11.
HiattWR. Medical treatment of peripheral arterial disease and claudication. N Engl J Med. 2001;344(21):1608–1621.
12.
DobeshPPStacyZAPerssonEL. Pharmacologic therapy for intermittent claudication. Pharmacotherapy. 2009;29(5):526–553.
13.
PrattCM. Analysis of the cilostazol safety database. Am J Cardiol. 2001;87(12A):28D–33D.
14.
PackerMCarverJRRodehefferRJ. Effect of oral milrinone on mortality in severe chronic heart failure. the PROMISE study research group. N Engl J Med. 1991;325(21):1468–1475.
15.
BeebeHGDawsonDLCutlerBS. A new pharmacological treatment for intermittent claudication: results of a randomized, multicenter trial. Arch Intern Med. 1999;159(17):2041–2050.
16.
DawsonDLCutlerBSHiattWR. A comparison of cilostazol and pentoxifylline for treating intermittent claudication. Am J Med. 2000;109(7):523–530.
17.
StrandnessDEJrDalmanRLPanianS. Effect of cilostazol in patients with intermittent claudication: a randomized, double-blind, placebo-controlled study. Vasc Endovascular Surg. 2002;36(2):83–91.
18.
MarshallCLinPHHuynhTTKougiasP. How optimal is the medical management of patients prior to major reconstructive vascular surgery? the results of a cross-sectional study. Vasc Endovascular Surg. 2009;43(3):238–243.
19.
McDermottMMLiuK. Functional decline in peripheral arterial disease: associations with the ankle brachial index and leg symptoms. JAMA. 2004;292(4):453–461.
20.
BarakSStopkaCBArcher MartinezCCarmeliE. Benefits of low-intensity pain-free treadmill exercise on functional capacity of individuals presenting with intermittent claudication due to peripheral arterial disease. Angiology. 2009;60(4):477–486.
21.
NicolaiSPKruidenierLMRouwetEVGraffiusKPrinsMHTeijinkJA. The walking impairment questionnaire: an effective tool to assess the effect of treatment in patients with intermittent claudication. J Vasc Surg. 2009;50(1):89–94.
22.
WareJEKosinskiMKellerSD. A 12-Item short-form health survey: construction of scales and preliminary tests of reliability and validity. Medical Care. 1996;34(3):220–233.
