Cilostazol reduces the risk of hemorrhagic infarction after administration of tissue-type plasminogen activator in a murine stroke model.
OBJECTIVE
Prior use of antiplatelet agents improves stroke outcome in patients undergoing thrombolytic therapy as shown by reduced arterial reocclusion, although the risk of cerebral hemorrhage can be increased.


METHODS
The effect of cilostazol, an antiplatelet drug that improves endothelial function through upregulation of intracellular cAMP, on cerebral hemorrhage after thrombolytic therapy was investigated using a highly reproducible transient ischemia model.


RESULTS
Treatment with cilostazol for 7 days before ischemia significantly suppressed the risk and severity of cerebral hemorrhage after injection of tissue-type plasminogen activator, although treatment with aspirin had no such protective effect compared with nontreated mice. Immunohistological analysis revealed that treatment with cilostazol suppressed disruption of the microvasculature in the ischemic area associated with reduced matrix metalloproteinase-9 activity.


CONCLUSIONS
Our results suggest that patients treated with cilostazol before onset of stroke could have a lower risk of cerebral hemorrhage after thrombolytic therapy and might also have a longer therapeutic time window for thrombolysis. Furthermore, the risk of cerebral hemorrhage can be significantly altered by prestroke therapies, and analysis of the effects of multiple drugs on tissue-type plasminogen activator-induced cerebral hemorrhage in animal models is essential for the extending safe and effective thrombolytic therapy to a wider group of patients.
Department of Cerebrovascular Disease, National Cerebral and Cardiovascular Center, Osaka, Japan.
Yukiko
Y
Kasahara
Takayuki
T
Nakagomi
Tomohiro
T
Matsuyama
David
D
Stern
Akihiko
A
Taguchi
D000818:Animals; D001241:Aspirin / Q000627:therapeutic use; D001921:Brain / Q000473:pathology; D002543:Cerebral Hemorrhage / Q000139:chemically induced / Q000473:pathology / Q000517:prevention & control*; D002544:Cerebral Infarction / Q000139:chemically induced / Q000473:pathology / Q000517:prevention & control*; D000077407:Cilostazol; D007150:Immunohistochemistry; D002546:Ischemic Attack, Transient / Q000517:prevention & control; D008297:Male; D020780:Matrix Metalloproteinase 9 / Q000096:biosynthesis; D051379:Mice; D008813:Mice, Inbred ICR; D018696:Neuroprotective Agents / Q000627:therapeutic use*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D015427:Reperfusion Injury / Q000517:prevention & control; D020521:Stroke / Q000139:chemically induced / Q000517:prevention & control*; D013777:Tetrazoles / Q000627:therapeutic use*; D010959:Tissue Plasminogen Activator
D018696:Neuroprotective Agents; D010975:Platelet Aggregation Inhibitors; D013777:Tetrazoles; D010959:Tissue Plasminogen Activator; D020780:Matrix Metalloproteinase 9; D000077407:Cilostazol; D001241:Aspirin