Comparative effectiveness of dual antiplatelet therapy after revascularization in diabetes and chronic limb-threatening ischemia: a target trial emulation study
Authors' conclusion
Among patients with diabetes and CLTI undergoing lower-extremity revascularization, aspirin plus cilostazol was associated with lower risks of LEA and MACE compared with aspirin plus clopidogrel, whereas clopidogrel plus cilostazol was associated with lower MACE but not with significant limb-related benefit.
Study context
- Population
- Adults with T2D who underwent lower-extremity revascularization for new-onset chronic limb-threatening ischemia, 2016–2019, Taiwan
- Participants
- 1,849 adults
- Exposure
- Aspirin plus cilostazol and clopidogrel plus cilostazol vs aspirin plus clopidogrel (standard dual antiplatelet therapy (DAPT))
- Aspirin plus clopidogreln = 439reference
- Aspirin plus cilostazoln = 753
- Clopidogrel plus cilostazoln = 657
- Outcome
- Lower-extremity amputation (LEA) and major adverse cardiovascular events (MACE)
- Follow-up
- Median 2.79 (1.62-3.96) years for LEA, 2.55 (1.24-3.70) for MACE
Methodological detailsnationwide, 90-day landmark, healthcare claims data, inverse probability of treatment weighting
- Nationwide
- 90-day landmark
- Healthcare claims data
- Inverse probability of treatment weighting
Main finding
As reported in the abstract
median follow-up 2.79 (1.62-3.96) years for LEA, 2.55 (1.24-3.70) for MACE
Each group vs aspirin plus clopidogrelSubdistribution hazard ratio (95% CI)
Aspirin plus cilostazolLEA
0.672(0.460–0.981)
Aspirin plus cilostazolMACE
0.799(0.641–0.995)
Clopidogrel plus cilostazolMACE
0.790(0.631–0.989)
Observational data: associations, not effects.
Further findings
All-cause mortality · median follow-up 2.94 (1.97-4.11) years
- All-cause mortality was comparable across all three regimens
Subgroup: patients receiving dialysis
- Benefits of cilostazol-based therapies attenuated and statistically non-significant among patients receiving dialysis
- Stratified analyses
Original publication
Comparative effectiveness of dual antiplatelet therapy after revascularization in diabetes and chronic limb-threatening ischemia: a target trial emulation study. Cardiovasc Diabetol. Published 9 July 2026. doi:10.
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