Abstract Number: Esoc2026a325 Cilo-Clop Trial: Cilostazol Versus Clopidogrel in Acute Moderate and Moderate-to-Severe Ischemic Stroke: A Randomized Controlled Multicenter Trial

Abstract Background and aims All the large studies that evaluated the role of cilosatzol versus other antiplatelet agents in stroke prevention have been conducted in Asia and included patients with minor stroke or transient ischemic attack (TIA). We evaluated the efficacy and safety of cilostazol versus clopidogrel to assess the role of cilostazol as an alternative to clopidogrel in Egyptian patients with first-ever non-cardioembolic moderate or moderate to severe ischemic stroke. Methods 870 patients with moderate and moderate-to-severe acute ischemic stroke (AIS) were randomly assigned to administer loading and maintenance doses of cilostazol or clopidogrel. Results Our trial included 870 patients. 37 (8.7%) patients in cilostazol arm and 59 (13.6%) in clopidogrel arm experienced a new stroke (HR 0.53; 95% CI, 0.33-0.84; P-value= 0.007). Twelve participants (2.8%) in cilostazol group and 25 patients (5.7%) in clopidogrel group experienced drug-related hemorrhagic complications (HR 0.25; 95% CI, 0.12-0.53; P-value= 0.001). Patients with hypertensive who received cilostazol had significantly lower rates of recurrent hemorrhagic and ischemic stroke. Conclusions Egyptian patients with non-cardioembolic moderate and moderate-to-severe ischemic stroke who received cilostazol within the first 24 hours of symptoms had significantly lower rates of hemorrhagic transformation of brain infarction and peripheral hemorrhagic complications compared to those who received clopidogrel; patients with hypertension achieved the best benefit from cilostazol as they experienced significant reduction in the recurrent ischemic and hemorrhagic infarctions, there were no significant differences between the two groups regarding mRS after three months and the non-hemorrhagic side effects. Conflict of interest all authors declare no conflict of interest