Safety, Efficacy of Long-Term Use of Cilostazol

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.