Cilostazol 100 mg bid resolved platelet clumping and prevented further transient ischemic attacks in a patient with sticky platelet syndrome who had failed aspirin therapy.
Case Report (n=1)
Sticky platelet syndrome should be considered as a risk factor for cryptogenic ischemic stroke, and cilostazol may be effective in preventing recurring TIAs in these patients.
Abstract Background and aims While ischemic stroke (IS) caused by sticky platelet syndrome syndrome (SPS) is rare, SPS was actually first described in a group of young-aged IS patients.1 We report a case of IS and recurring transient ischemic attack (TIA) caused by SPS to raise awareness of the effect of SPS to the cerebrovascular system. Methods A 57-year-old male came with slurred speech and right sided weakness. He had no history of hypertension and diabetes mellitus; was diagnosed with coronary artery disease a month before and currently taking antiplatelet and statin. The brain MRI showed hyperacute-acute infarction in left corona-radiata and basal-ganglia. The deficits lasted no more than 24 hours. MR, CT, and digital subtraction angiography were done with no remarkable result. The D-dimer, fibrinogen, protein C and S level were within normal limits. The peripheral blood smear demonstrated massive platelet clumping (Figure 1), while platelet antibody test was negative. The patient was discharged with additional acetyl-salicylic-acid (ASA) 80 mg. He then underwent less-than-24-hour right-sided weakness nine times, before benefiting from cilostazol 100 mg bid. The platelet clumping resolved, and the platelet aggregation test demonstrates hypoaggregation. Results Since there is no other significant risk factor, the unusual clumping condition of platelets suggests SPS as the cause of the recurrence TIA. Although low-dose ASA is reported to be effective to reverse hyperaggregability,2 the patient took better benefit from cilostazol. Conclusions While the diagnostic procedure of it is yet to be standardized, SPS should be considered as a risk factor for cryptogenic IS. Conflict of interest Anthonius Kurniadi: nothing to disclose. Linny Luciana: nothing to disclose. Figure 1 - belongs to Methods
Kurniadi et al. (Fri,) conducted a case report in Ischemic stroke and recurring transient ischemic attack (n=1). Cilostazol was evaluated on Resolution of platelet clumping and TIA recurrence. Cilostazol 100 mg bid resolved platelet clumping and prevented further transient ischemic attacks in a patient with sticky platelet syndrome who had failed aspirin therapy.