The role of cilostazol (Pletal) in the management of intermittent claudication.

Intermittent claudication affects 5% of the middle-aged population in developed countries and is associated with a significant reduction in health-related quality of life and cardiovascular morbidity and mortality The mainstay of treatment is best medical therapy (BMT) comprising smoking cessation, antiplatelet agents, lipid-lowering, advice to exercise, and correction of other modifiable vascular risk factors. Although BMT is highly effective in reducing cardiovascular risk and may also improve walking distance, many patients remain unacceptably symptomatic despite it. Until recently, the only available adjuvant therapies were supervised exercise programmes, angioplasty and surgery. Many patients are unable to comply with the first, and the last two are associated with limited durability and risk. The advent of cilostazol (Pletal) adds evidence-based pharmacotherapy to the vascular specialist's armamentarium for the first time. Here cilostazol and its role in the management of intermittent claudication are discussed.