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Cilostazol May Be Safe, Effective for Long-Term Use

Long-term use of dual antiplatelet therapy with cilostazol reduces the risk for recurrent ischemic strokes in high-risk patients and is just as safe as monotherapy for major bleeding, according to new research presented at the International Stroke Conference.1

 

Aspirin and clopidogrel are known to reduce early recurrence of stroke, but the benefits do not last and are offset by a high risk for major bleeding in the long term. Therefore, the researchers in this new study aimed to determine the efficacy and safety of cilostazol dual therapy for long-term use.

 

To conduct their study, lead author Kazunori Toyoda, MD, and colleagues from the National Cerebral and Cardiovascular Center in Japan conducted a multicenter open-label, parallel-group trial of 1839 patients at high risk for stroke.

 

High-risk patients had to meet one or more of the following factors to be included in the study:

  • More than or equal to 50% stenosis of a major intracranial artery,
  • More than or equal to 50% stenosis of an extracranial artery, and
  • Two or more vascular risk factors.

At baseline, participants were randomly assigned to either a monotherapy group (aspirin alone or clopidogrel alone) or to a dual antiplatelet therapy group (aspirin + cilostazol or clopidogrel + cilostazol) from December 2013 to March 2017.

 

The first recurrence of ischemic stroke as well as severe of life-threatening bleeding were tracked as primary end points.

 

Of the 1839 participants recruited at baseline, 756 were taking aspirin and 1083 were taking clopidogrel.

 

Over a median follow-up of 17 months, 3.2% of participants in the dual therapy group and 6.9% of participants in the monotherapy group had experienced a recurrent ischemic stroke. About 0.9% of the dual therapy group and 1.4% of the monotherapy group had experienced severe or life-threatening bleeding.

 

“Addition of cilostazol to aspirin or clopidogrel is recommendable for the long-term use in the chronic stage of high-risk non-cardioembolic stroke for patients who are tolerable to headache and palpitation,” Toyoda and colleagues concluded.

 

—Amanda Balbi

 

Reference:

Cilostazol-combo antiplatelet therapy reduced risk for recurrent stroke [press release]. Honolulu, HI: American Heart Association; February 6, 2019. https://newsroom.heart.org/news/cilostazol-combo-antiplatelet-therapy-reduced-risk-for-recurrent-stroke.