Cilostazol may prevent cardioembolic stroke in patients undergoing antiplatelet therapy

• Published in: Neurological research (New York) 2015-07, Vol.37 (7), p.619-623
• Main Authors: Horie, Nobutaka, Kaminogo, Makio, Izumo, Tsuyoshi, Hayashi, Kentaro, Tsujino, Akira, Nagata, Izumi
• Format: Article
• Language: English
• Subjects: Aged; Antiplatelet therapy; Aspirin - therapeutic use; Atrial fibrillation; Atrial Fibrillation - drug therapy; Atrial Fibrillation - epidemiology; Atrial Fibrillation - physiopathology; Cardioembolic stroke; Cilostazol; Databases, Factual; Female; Fibrinolytic Agents - therapeutic use; Humans; Incidence; Intracranial Embolism - epidemiology; Intracranial Embolism - physiopathology; Intracranial Embolism - prevention & control; Male; Multivariate Analysis; Platelet Aggregation Inhibitors - therapeutic use; Recurrence; Retrospective Studies; Stroke - epidemiology; Stroke - physiopathology; Stroke - prevention & control; Tetrazoles - therapeutic use; Ticlopidine - analogs & derivatives; Ticlopidine - therapeutic use
• ISSN: 0161-6412; 1743-1328
• DOI: 10.1179/1743132815Y.0000000021

Objectives: Randomised trials have shown the efficacy of antiplatelet therapy with cilostazol to prevent secondary ischaemic stroke. Recently, cilostazol has been reported to prevent the development and/or recurrence of atrial fibrillation (AF), which can potentially prevent cardioembolic stroke in patients undergoing antiplatelet therapy. Herein, we examined the impact of prior antiplatelet therapy with cilostazol on the incidence of cardioembolic stroke, which had not been fully investigated. Methods: Using the multicenter retrospective study of stroke risk in antithrombotic therapy (RESTATE) database, we analysed consecutive patients with primary or secondary stroke under single antiplatelet therapy. We evaluated the characteristics of ischaemic stroke based on the type of antiplatelet agent used: aspirin, ticlopidine/clopidogrel or cilostazol. Results: Of 1069 consecutive patients with primary or secondary stroke during antithrombotic therapy from January to December 2012, 615 patients received single antiplatelet therapy (293 and 322 cases of primary and secondary strokes, respectively). Interestingly, the percentage of cardioembolic infarction was significantly lower in patients taking cilostazol compared with other agents. Multivariate regression analysis found that age (OR: 1.03, 95% CI: 1.01-1.06, P = 0.0029), serum creatinine (OR: 1.17, 95% CI: 1.03-1.34, P = 0.0198), aspirin (OR: 1.75, 95% CI: 1.00-3.22, P = 0.0486), cilostazol (OR: 0.19, 95% CI: 0.03-0.73, P = 0.0125), and smoking (OR: 1.86, 95% CI: 1.16-2.94, P = 0.0102) were independently associated with cardioembolic stroke. Conclusions: Cilostazol may prevent cardioembolic stroke in patients undergoing antiplatelet therapy. This could be a novel strategy for cardioembolic stroke prevention potentially by affecting cardiac remodelling, in contrast to secondary anticoagulant therapy.