What question did this study set out to answer?

To evaluate the efficacy and safety of dual antiplatelet therapy combining cilostazol with aspirin or clopidogrel compared to single antiplatelet therapy in patients with ischemic stroke and intracranial arterial stenosis.

October 8, 2021Journal of the American Heart AssociationOpen Access

Dual Antiplatelet Therapy Using Cilostazol in Patients With Stroke and Intracranial Arterial Stenosis

View Full Paper

Ask AI

Bookmark

Why the study?

The long-term benefit of dual antiplatelet therapy over single antiplatelet therapy for preventing recurrent stroke has not been established in patients with intracranial arterial stenosis.

Does dual antiplatelet therapy with cilostazol reduce the risk of recurrent stroke and vascular events in patients with ischemic stroke and intracranial arterial stenosis compared to single antiplatelet therapy?

Comparison

DAPT with cilostazol and clopidogrel or aspirin vs SAPT with clopidogrel or aspirin

Design

Randomized controlled trial subanalysis

Authors

SUShinichiro UchiyamaUniversité Claude Bernard Lyon 1 ḰTḰazunori ToyodaUniversity of Fukui KOKatsuhiro OmaeNational Cerebral and Cardiovascular Center

Discussion

Member takes

Implication

Supports cilostazol DAPT in ischemic stroke with intracranial stenosis; extends RCT evidence for secondary prevention in this population.

Key Points

To evaluate the efficacy and safety of dual antiplatelet therapy combining cilostazol with aspirin or clopidogrel compared to single antiplatelet therapy in patients with ischemic stroke and intracranial arterial stenosis.
Randomized controlled trial (Cilostazol Stroke Prevention Study for Antiplatelet Combination, NCT01995370) in high-risk Japanese patients with ischemic stroke and ≥50% symptomatic or asymptomatic intracranial arterial stenosis.
Assigned 547 patients to receive either dual antiplatelet therapy with cilostazol plus aspirin or clopidogrel (N=275) or single antiplatelet therapy with aspirin or clopidogrel (N=272).
Dual antiplatelet therapy significantly reduced the risk of recurrent ischemic stroke compared with single antiplatelet therapy (HR, 0.47; 95% CI, 0.23–0.95).
Dual antiplatelet therapy significantly decreased the composite endpoint of stroke, myocardial infarction, and vascular death (HR, 0.48; 95% CI, 0.26–0.91).
Severe or life-threatening bleeding risks did not differ significantly between dual and single antiplatelet therapy groups (HR, 0.72; 95% CI, 0.12–4.30).

Structured PICO

Population

547 high-risk Japanese patients with ischemic stroke and symptomatic or asymptomatic intracranial arterial stenosis of at least 50% in a major intracranial artery.

Intervention

Dual antiplatelet therapy (DAPT) with cilostazol and clopidogrel or aspirin.

Comparator

Single antiplatelet therapy (SAPT) with clopidogrel or aspirin.

Outcome

Ischemic strokehard clinical

DAPT with cilostazol is superior to SAPT for preventing recurrent stroke and vascular events in patients with ischemic stroke and intracranial arterial stenosis, without increasing bleeding risk.

Cite This Study

Uchiyama et al. (2021) studied this question.

synapsesocial.com/papers/6a7de90d33dcb27c99cb601c https://doi.org/10.1161/jaha.121.022575

Topics

Dual antiplatelet therapy

View Full Paper

Ask AI

Bookmark

Dual Antiplatelet Therapy Using Cilostazol in Patients With Stroke and Intracranial Arterial Stenosis

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Topics

Dual Antiplatelet Therapy Using Cilostazol in Patients With Stroke and Intracranial Arterial Stenosis

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Also Consider

Topics

Also Consider