In a nutshell
This study compared cilostazol (Pletal) with aspirin for the prevention of further strokes (secondary prevention).
Some background
A stroke occurs when blood flow is interrupted to part of the brain. Without blood to supply oxygen, brain cells quickly begin to die. Depending on the region of the brain affected, a stroke may cause paralysis, speech impairment, loss of memory and reasoning ability. After one stroke, patients have a high risk of heart attacks and other strokes, leading to greater consequences such as dementia or death. Antiplatelet medications (drugs that prevent the formation of blood clots), such as aspirin, are routinely prescribed for patients with stroke, for the secondary prevention. However, because of the side effects of aspirin (gastrointestinal bleeding), its prescription is limited. Cilostazol is an antiplatelet drug that also has vasodilation (widening of the blood vessels) properties, by relaxing the smooth muscle in the wall of the blood vessels.
Methods & findings
This research evaluated four trials, involving a total of 3,917 patients, comparing cilostazol with aspirin for the secondary prevention of strokes. Compared with aspirin, cilostazol was associated with a 19% reduction in ischemic stroke (reduced blood flow to the brain) and a 73% reduction in hemorrhagic stroke (ruptured blood vessel in the brain). Cilostazol was associated with a 28% reduction in stroke, heart attack, or vascular death, and a 48% reduction in total hemorrhagic events. Also, cilostazol resulted in 40% fewer gastrointestinal bleeds compared to aspirin.
The bottom line
In summary, cilostazol was associated with a significant reduction in hemorrhagic stroke, heart attack, vascular death and total hemorrhagic events compared to aspirin.
The fine print
All trials were performed in patients of Asian descent, limiting the potential application of these results to other populations. Also, there was no mentioning of the potential side effects of cilostazol.
What’s next?
Consult with your physician regarding cilostazol for the prevention of further events.
Published By :
The American journal of cardiology
Date :
Jul 19, 2013
