Cilostazol may cut repeat stroke rate

Cardiology Japanese researchers compare antiplatelet agents in non-inferiority study.

Cerebral infarction rates were lower in cilostazol than aspirin patients (Photograph:SPL)
Cerebral infarction rates were lower in cilostazol than aspirin patients (Photograph:SPL)

Using cilostazol rather than aspirin to prevent repeat stroke is associated with fewer bleeding events and may be more effective, a study has found.

Japanese researchers used a non-inferiority study to examine whether cilostazol was at least as good as aspirin at preventing secondary stroke. They gave 2,757 cerebral infarction patients either 100mg cilostazol twice daily or 81mg of aspirin daily.

Over 29 months, the yearly rate of cerebral infarction, cerebral haemorrhage or subarachnoid haemorrhage was 26 per cent lower with cilostazol than with aspirin.

In addition, the number of patients who suffered a major bleeding event was 54 per cent lower among patients given cilostazol.

However, rates of some non-serious side-effects, such as headache, diarrhoea, palpitation and dizziness, were more common among cilostazol patients.

The researchers said: 'Cilostazol seems to be non-inferior, and might be superior, to aspirin for prevention of stroke after an ischaemic stroke, and was associated with fewer haemorrhagic events.

'Therefore, cilostazol could be used for prevention of stroke in patients with non-cardioembolic stroke.'

In an editorial published alongside the study, Dr Deepak Bhatt and Dr Dharam Kumbhani from Harvard Medical School, Boston, US said the results were interesting and warranted further investigation.

But they pointed out that the study included only east Asian patients and patients with non-severe strokes, so the results might not be generalisable.

'The choice of the best antiplatelet drug for the secondary prevention of ischaemic stroke remains challenging, but (this study) shows that there might be another promising pathway for secondary stroke prevention beyond the protection provided by aspirin.'

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