Which antiplatelet drug is best for stroke prevention, cilostazol or aspirin?

This study compared two antiplatelet medications that are used to prevent strokes, cilostazol (Pletal) and aspirin. They found that patients treated with cilostazol were less likely to have a second stroke, or a brain bleed compared to aspirin.

An ischaemic stroke results from a blockage in a blood vessel in the brain. Patients who have had an ischaemic stroke are at high risk of having a second stroke. They are therefore usually given an antiplatelet medication which reduces the blood's ability to clot and block vessels. 

Cilostazol and aspirin are examples of antiplatelet medications. Cilostazol also helps blood vessels to dilate (become wider) which improves blood flow. It is therefore possible that cilostazol could be more effective than aspirin at preventing stroke. However, but this has not been clearly shown.

This study looked at 5 previous studies comparing cilostazol and aspirin for stroke prevention.  A total of 7,240 patients, all from Asian populations, were involved in these studies.  All patients had suffered an ischaemic stroke or transient ischaemic attack (mini-stroke). 3615 patients had received cilostazol and 3625 had received aspirin.

Compared to patients treated with aspirin, those treated with cilostazol were 32% less likely to suffer a second stroke. Patients treated with cilostazol were also 58% less likely to suffer a brain bleed and 29% less likely to suffer any kind of bleed.

This study showed that in an Asian population, patients treated with cilostazol were less likely to suffer a second stroke and a bleeding event than patients treated with aspirin.  

This study looked at an Asian population. Further studies are needed to see if these findings apply to other ethnicities.