Antiplatelet cilostazol is beneficial in diabetic and/or hypertensive ischemic stroke patients. Subgroup analysis of the cilostazol stroke prevention study.
OBJECTIVE
Although antiplatelets are known to be effective for secondary prevention of cerebral infarction, the number needed to treat is rather large and the effects in stroke patients with complications such as hypertension or diabetes are inadequately defined. This study was conducted to examine the effect of such complications on recurrence of cerebral infarction, and to assess the effect of cilostazol, an antiplatelet agent, in these high-risk subjects.


METHODS
A post hoc subgroup analysis of the already reported Cilostazol Stroke Prevention Study, which was a placebo-controlled double-blind trial, has been carried out to clarify the influence of various complications on recurrence in the placebo group and the effects of cilostazol in 1,095 patients with noncardioembolic ischemic cerebrovascular disease. Treatment continued for an average of 1.8 +/- 1.3 years (maximum 4.8 years).


RESULTS
The recurrence rate of the diabetic stroke patients was significantly higher compared with the nondiabetics in the placebo group (9.4 vs. 4.7%/year, p = 0.01). Furthermore, our study showed that the relative risk reduction (RRR) for recurrence of infarction was 41.7% with cilostazol. This treatment provided a significant benefit in patients with lacunar infarction (RRR 43.4%, p = 0.04), with diabetes (RRR 64.4%, p = 0.008), or with hypertension (RRR 58.0%, p = 0.003).


CONCLUSIONS
Diabetic patients are particularly at risk for recurrence of cerebral infarction. Cilostazol is useful for the prevention of the recurrence of vascular events in patients with lacunar infarction, and is probably effective in high-risk patients with diabetes and/or hypertension.
Federation of National Personnel Mutual Aid Associations, Tachikawa Hospital, Tachikawa, Japan. yshinoha@tachikawa-hosp.gr.jp
Yukito
Y
Shinohara
Fumio
F
Gotoh
Hideo
H
Tohgi
Shunsaku
S
Hirai
Akiro
A
Terashi
Yasuo
Y
Fukuuchi
Eiichi
E
Otomo
Eiichi
E
Itoh
Tamotsu
T
Matsuda
Tohru
T
Sawada
Takenori
T
Yamaguchi
Katsuya
K
Nishimaru
Yasuo
Y
Ohashi
D000368:Aged; D002545:Brain Ischemia / Q000150:complications / Q000517:prevention & control*; D002544:Cerebral Infarction / Q000209:etiology / Q000517:prevention & control*; D000077407:Cilostazol; D048909:Diabetes Complications / Q000188:drug therapy*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D007564:Japan; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D018570:Risk Assessment; D012307:Risk Factors; D055502:Secondary Prevention; D013777:Tetrazoles / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
D010975:Platelet Aggregation Inhibitors; D013777:Tetrazoles; D000077407:Cilostazol