When should dual antiplatelet therapy with Cilostazol be initiated for secondary prevention in high-risk ischemic stroke?

Print

CSPS.com trial
When should dual antiplatelet therapy
with Cilostazol be initiated for secondary
prevention in high-risk ischemic stroke?

According to the CSPS.com study, dual therapy with cilostazol is more effective in secondary stroke prevention than monotherapy when treatment is initiated after a waiting period of two weeks. Combination therapy with cilostazol and aspirin or clopidogrel is effective in secondary prevention in patients at high risk for stroke recurrence with a bleeding risk comparable to aspirin or clopidogrel alone.

A sub-analysis of the CSPS.com trial, which randomized 1,879 patients between 8 and 180 days after high-risk non-cardio embolic ischemic stroke to receive aspirin or clopidogrel alone or in combination with Cilostazol, was used to address the question of the optimal timing for initiation of long-term dual antiplatelet therapy with Cilostazol and aspirin or clopidogrel. Patients were divided into three groups according to the time of treatment initiation. The primary endpoint was a recurrent ischemic stroke. Safety endpoints included major bleeding events.

Dr. Kazunori Toyoda, deputy director of the National Cerebral and Cardiovascular Center in Osaka and coordinator of the study, concluded, “Long-term DAPT [dual antiplatelet therapy] using Cilostazol was more effective for secondary prevention of non-cardio embolic stroke than monotherapy in high-risk patients who started the medication at 15 days or later after stroke onset without increasing hemorrhage risk, but not in those starting medication between 8 and 14 days.”

7th European Stroke Organization Conference (virtual) held on 1-3 September 2021.