Cilostazol versus aspirin for prevention of additional vascular events after stroke

This review article examined the safety and efficacy of a drug called cilostazol (pletal), compared to the commnly used aspirin, in patients who had an ischemic stroke or a transient ischemic attack (TIA). Efficacy was judged by the prevention of another stroke or other serious vascular events (e.g. heart attack).

Ischemic strokes occur due to a blot clot blocking an artery that supply blood to the brain. TIA refers to a temporary stroke that does not result in any disability. After a stroke, patients are at a high risk for similar vascular events, such as strokes and heart attacks. For this reason, drugs that prevent clot formation, such as aspirin, are commonly prescribed to patients after a stroke. Aspirin prevents the formation of blood clots by inhibiting the action of platelets (cells in the blood responsible for forming blood clots). However, treatments that inhibit platelets may also increase the risk of bleeding, including intra-cranial hemorrhages, or ICH (bleeding within the skull, also referred to as a hemorrhagic strokes).

Cilostazol is a drug with a similar mode of action to that of aspirin, and is used mainly in the treatment of peripheral vascular disease (narrowing or obstruction of the arteries supplying the limbs). Whether cilostazol might benefit patients after a stroke is currently under investigation.

This review included two trials, involving a total of 3477 patients. Both trials randomly assigned patients after a stroke to receive either aspirin or cilostazol.

6.77% of patients treated with cilostazol experienced additional vascular events (such as strokes or heart attacks). This compared to 9.39% of patients treated with aspirin. In addition, use of cilostazol reduced the risk of ICH by 74% compared to aspirin.

This review concluded that cilostazol is more effective than aspirin in the prevention of additional vascular events after an initial stroke. Cilostazol also showed a reduced risk of serious bleeding events compared to aspirin.

Both trials reviewed in this article were conducted in Asia (one in China and the other in Japan). In these countries the incidence of stroke is much higher than in the United States, but the distribution of stroke subtypes (ischemic versus heomrrhagic) is slightly different.

Consult with your physician regarding cilostazol treatment in the prevention of further adverse events after ischemic strokes.