The use of cilostazol in patients with peripheral arterial disease: results of a national physician survey

BACKGROUND: Although international guidelines recommend cilostazol as first-line therapy for peripheral arterial disease (PAD) because it improves the symptoms and quality of life, it remains an underused agent for amputation-free survival. The objective of this study was to evaluate the practice among Italian physicians of the use of cilostazol in patients suffering from peripheral arterial disease (PAD). METHODS: For the present study, a cross-sectional survey was carried out. Physicians specialized in the medical and/or surgical treatment of PAD and who prescribe cilostazol regularly were invited to a phone interview. A nationally-representative probability sample of hospital-based physicians who diagnose and treat patients with PAD was randomly selected among the members of the Italian Physicians' Association. RESULTS: Out of a total of 641 physicians contacted, 250 of them (39%) accepted to take part in this survey. Reasons of survey refusal were the non-attitude to prescribe cilostazol (45%), or unspecified motivations (16%). Among the 250 physicians participating the survey: 120 were vascular surgeons, 80 internal medicine doctors, 50 angiologists. Cilostazol was suggested in 79% of patients with symptomatic intermittent claudication, and in 30% of patients who had undergone revascularization. The majority of physicians stated to prescribe cilostazol at recommended dosage of 100 mg bid (46.4%). The principal reason to suggest a reduced drug dosage was to limit early side effect at the time of treatment onset, but the increase to the full dose of cilostazol is suggested by 91.3% of interviewed within 4 weeks. Sixty-three percent of physicians affirmed to prescribe cilostazol as a continuous treatment for a mean of 4 months, while a lifelong treatment was suggested by 17.6% of participants. CONCLUSIONS: Among physicians who habitually prescribe cilostazol adherence to the recommended drug dosage and length of treatment is high. The prescription of cilostazol is particularly appreciated in patients with symptomatic intermittent claudication, even before any noninvasive diagnosis of PAD, and before any invasive therapy. Finally a relevant number of physicians regularly prescribe cilostazol also after revascularization, advocating the anti-restenotic properties of the drug.