Adding cilostazol to antiplatelet therapy reduces recurrent ischemic stroke risk

How long before your stroke hospital puts together a stroke protocol on this? Or starting at the top with the board of directors, does everyone need to be fired?  Your choice, allow incompetency to flourish or start over?  I would think you would want competency, but that is just my stroke-addled brain rubbing two neurons together and producing a fleeting thought.

Adding cilostazol to antiplatelet therapy reduces recurrent ischemic stroke risk

February 6, 2019

 

 

Kazunori Toyoda

Stroke survivors who had cilostazol added to aspirin or clopidogrel had reduced risk for recurrent ischemic stroke compared with patients taking aspirin or clopidogrel alone, according to results from the CSPS.com study presented at the International Stroke Conference.
Dual antiplatelet therapy with aspirin and clopidogrel has been shown to reduce short-term risk for recurrent stroke, but in the long term, has not been effective and has increased bleeding risk, Kazunori Toyoda, MD, PhD, deputy director general at the National Cerebral and Cardiovascular Center in Suita, Osaka, Japan, said during a presentation.

See Also

• Having an abortion may increase risk for blood clots
• Recurrent stroke risk steady after TIA, minor stroke
• Some antipsychotics may increase gestational diabetes risk

“Cilostazol, a phosphodiesterase [type] 3 inhibitor, prevents stroke recurrence with relatively low incidence of serious bleeding,” he said. “Dual antiplatelet therapy involving cilostazol may be safe and appropriate for long-term use.”
Previous studies found that cilostazol (Pletal, Otsuka) reduced risk for recurrent stroke compared with placebo, reduced risk for any stroke or major bleeding compared with aspirin, he said.
For the present study, Toyoda and colleagues evaluated whether cilostazol plus aspirin or clopidogrel reduced recurrent ischemic stroke risk in the chronic phase compared with aspirin or clopidogrel alone. The researchers enrolled 1,879 Japanese patients with ischemic stroke 8 to 180 days before enrollment; in the dual-therapy group, the mean age was 70 years and 32% were women; in the monotherapy group, the mean age was 70 years and 28% were women.
The primary efficacy outcome was recurrent ischemic stroke. Safety outcomes included severe or life-threatening bleeding according to GUSTO classification, intracranial hemorrhage, any adverse events, serious adverse events and bleeding adverse events.
At 4 years, the primary efficacy outcome occurred in 29 patients (annualized rate, 2.2%) of the dual-therapy group and 64 patients (annualized rate, 4.5%) of the monotherapy group (HR = 0.49; 95% CI, 0.31-0.76), Toyoda said.
The composite of stroke, MI and vascular death at 4 years occurred in 38 patients (annualized rate, 2.9%) of the dual-therapy group and 78 patients (annualized rate, 5.5%) of the monotherapy group (HR = 0.52; 95% CI, 0.35-0.77).
The dual-therapy group compared with the monotherapy group at 4 years also had lower rates of any stroke (HR = 0.51; 95% CI, 0.34-0.77), ischemic stroke or transient ischemic attack (HR = 0.5; 95% CI, 0.33-0.76) and any vascular event (HR = 0.56; 95% CI, 0.39-0.8), although there were no differences in hemorrhagic stroke or all-cause mortality, Toyoda said.
The results did not vary across subgroups.

 

Perspective

Larry B. Goldstein

Issues are that a very high proportion (nearly 25%) of participants discontinued study medications, the overall follow up was relatively short, and the trial was open-label. In addition, it enrolled less than half (47%) of the intended sample size and it was limited to Japanese, so generalizability is unknown. The approach will need to be confirmed in other studies if it is to be pursued further.

• Larry B. Goldstein, MD, FAAN, FANA, FAHA
• Cardiology Today Editorial Board Member
  University of Kentucky

Disclosures: Goldstein reports no relevant financial disclosures.

See more from International Stroke Conference