Question

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

Answer 1

Background- In patients with intracranial artery stenosis, a long-term advantage of dual antiplatelet therapy (DAPT) over single antiplatelet therapy (SAPT) for the prevention of recurrent stroke has not been proven. We studied patients with intracranial arterial stenosis who were enrolled in the Cilostazol Stroke Prevention Study for Antiplatelet Combination trial, a randomized controlled trial in high-risk Japanese patients with ischemic stroke, to compare the efficacy and safety of DAPT with cilostazol and clopidogrel or aspirin to those of SAPT with clopidogrel or aspirin. Techniques and Outcomes In patients with ischemic stroke with symptomatic or asymptomatic intracranial arterial stenosis of at least 50% in a major intracranial artery, we compared the vascular and hemorrhagic events between DAPT and SAPT.

Patients were divided into two groups: 275 were given DAPT, while 272 were given SAPT. In contrast to SAPT, which had a higher risk of serious or life-threatening bleeding, DAPT had a lower risk of ischemic stroke (hazard ratio [HR], 0.47; 95% CI, 0.23-0.95); and a composite of stroke, myocardial infarction, and vascular mortality (HR, 0.48; 95% CI, 0.26-0.91). Conclusions In patients with intracranial artery stenosis following stroke, DAPT using cilostazol was superior than SAPT using clopidogrel or aspirin for the prevention of recurrent stroke and vascular events without raising bleeding risk.

What is stroke?

When anything prevents blood flow to a portion of the brain or when a blood artery in the brain bursts, a stroke, also known as a brain attack, happens. The brain either ages or suffers harm in both scenarios. A stroke may result in permanent brain damage, chronic disability, or even fatality.

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