Dual antiplatelet therapy with cilostazol in stroke patients with extracranial arterial stenosis or without arterial stenosis: a subgroup analysis of the CSPS.com trial

Can you at least write up a provisional protocol on this  and get it delivered to all stroke hospitals? YOUR RESPONSIBILITY  since we have fucking failures of stroke associations that do nothing for survivors.

Dual antiplatelet therapy with cilostazol in stroke patients with extracranial arterial stenosis or without arterial stenosis: a subgroup analysis of the CSPS.com trial

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Shinichiro Uchiyama, Kazunori Toyoda, Satomi Okamura, ...

First Published June 28, 2022 Research Article 

https://doi.org/10.1177/17474930221112343

Article information

Abstract

Background: 

We previously reported that dual antiplatelet therapy (DAPT) with cilostazol was superior to aspirin or clopidogrel for the prevention of recurrent stroke and vascular events in a subgroup analysis of intracranial arterial stenosis in the Cilostazol Stroke Prevention Study for Antiplatelet Combination (CSPS.com), a randomized controlled trial.

Aims: 

We conducted another subgroup analysis to investigate the benefit of DAPT with cilostazol in patients with extracranial arterial stenosis (ECAS) and those without arterial stenosis.

Methods: 

We compared the risk of recurrent ischemic stroke, vascular events, and major bleeding between DAPT with cilostazol plus aspirin or clopidogrel and aspirin or clopidogrel alone in patients with ischemic stroke between 8 and 180 days before starting trial treatment and extracranial arterial stenosis (ECAS) or without arterial stenosis.

Results: 

The median follow-up period was 1.4 years. The risk of recurrent ischemic stroke (hazard ratio [HR]; 1.04, 95% confidence interval [CI]; 0.42-2.57) and vascular events (HR; 0.97, 95% CI; 0.42-2.24) did not differ between the both groups for the 253 patients with ECAS, whereas they were lower (HR; 0.36, 95% CI; 0.18-0.74 and HR; 0.47, 95% CI; 0.26-0.85, respectively) in the DAPT group for the 944 patients without arterial stenosis. The risk of major bleeding did not differ between the groups in patients with ECAS (HR; 0.58, 95% CI; 0.05-6.39) or without arterial stenosis (HR; 0.79, 95% CI; 0.27-2.26).

Conclusions: 

DAPT with cilostazol might be beneficial for prevention of recurrent stroke and vascular events in patients without arterial stenosis but not in those with ECAS.

Keywords

Antiplatelet therapy, Clinical trial, Ischaemic stroke, Stenosis, Asia, Prevention

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