12 RESEARCH &: DEVELOPMENT

Reocdusion prevented by ciIostazoI Despite the huge advances that have been made

in the management of acute MI with the introduction of thrombolytics, reocc1usion remains a significant clinical problem. A novel antiplatelet drug, cilostazol, may improve the situation.

Japanese researchers report that cilostazol dose-dependently prevented reocclusion following thrombolysis with alteplase in a heparinised canine model of coronary artery thrombosis in the presence of flow-limiting critical stenosis. Reocc1usion occurred in 6n dogs control dogs (who received alteplase and heparin only), and in 4/5 dogs who received low-dose cilostazol. In contrast, reocclusion occurred briefly in 2/12 dogs only who received higher doses of cilostazol. Reocclusion was prevented at doses that did not cause any serious haemodynamic disturbances.

There was also a trend towards the administration of cilostazol decreasing the time to reperfusion.

Previous studies in this model showed that aspirin, with or without heparin, was not able to completely prevent reocclusion after thrombolysis. Saitoh S, Saito T, Otake A. Owada T, MitIugi M. et al. CilOSlaZOI, a DOVel cyclic AMP phospbodiesrtru inhibitor, prevents reocclusion after coronary aneriaI tbromboIYlis with m:ombinant tissue-type plasminogen activator. Arteriosclerosis and Thrombosis 13: S63-S70, Apr 1993 1001937<09

~ Editorial comment: Cilostazol is a cyclic-AMP phosphodiesterase inhibitor that has been developed by Otsuka. It was launched in Japan in 1988 and in South Korea in 1990. It is undergoing clinical investigation in the US and Europe.

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