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Cilostazol As Good As Aspirin for Stroke Prevention

Study assesses secondary prevention in Asians; fewer hemorrhagic events found with cilostazol

TUESDAY, Sept. 14 (HealthDay News) -- The antiplatelet drug cilostazol is non-inferior, and possibly superior, to aspirin for secondary stroke prevention, and is associated with fewer hemorrhagic events, according to research from the second Cilostazol Stroke Prevention Study (CSPS 2) published online Sept. 11 in The Lancet Neurology.

Yukito Shinohara, M.D., of the Federation of National Public Service Personnel Mutual Aid Associations Tachikawa Hospital in Tokyo, and colleagues conducted a randomized, double-blind, clinical multi-site trial of patients in Japan who had experienced a cerebral infarction within the previous 26 weeks, with patients receiving either 100 mg cilostazol twice daily or 81 mg aspirin once daily for one to five years. The measured end point was the first occurrence of stroke (cerebral infarction, cerebral hemorrhage, or subarachnoid hemorrhage). The predefined margin of non-inferiority was a hazard ratio of 1.33.

The researchers found that stroke occurred at a yearly rate of 2.76 percent in the cilostazol group and 3.71 percent in the aspirin group (hazard ratio, 0.743). Bleeding events, including cerebral hemorrhage, subarachnoid hemorrhage, or hemorrhage requiring hospital admission occurred in significantly fewer patients on cilostazol than on aspirin (0.77 versus 1.78 percent). The patients in the cilostazol group had more non-bleeding side effects, including headache, diarrhea, palpitation, dizziness, and tachycardia.

"The results of CSPS 2 suggest that cilostazol can be recommended as an option for the prevention of stroke in Asian patients with non-cardioembolic stroke who can tolerate long-term treatment with this drug. However, cilostazol also seems to be effective for patients of different ethnic origin who have peripheral artery disease -- for example, in a study in the U.S.A., cilostazol reduced cerebrovascular events versus placebo," the authors write.

The study was funded by Otsuka Pharmaceutical. Several study authors disclosed financial ties to pharmaceutical companies, including Otsuka.

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