title: Comparison of antiplatelet and antithrombotic therapy for secondary prevention of ischemic stroke in patients with peripheral artery disease: population-based follow-up study in Taiwan.
abstract: BACKGROUND
  A limited number of studies have assessed the benefit and risk among the different antiplatelet and antithrombotic therapies in patient with stroke and peripheral artery disease (PAD). We compared the efficacy and safety of clopidogrel, cilostazol, warfarin, and aspirin.
  
  
  RESULTS
  A retrospective cohort study analyzing the Taiwan National Health Insurance Research Dataset identified patients with stroke and PAD from 2002 to 2008. Patients were stratified according to their use of aspirin, clopidogrel, cilostazol, warfarin or combination therapy. A total of 1,686 patients were enrolled: aspirin (n=862), clopidogrel (n=92), warfarin (n=136), cilostazol only (n=515), and cilostazol-based combination therapy (n=81). Compared with aspirin, cilostazol could reduce the risk of ischemic stroke [hazard ratio (HR) 0.79, 95% confidence interval (CI) 0.63-0.98, P=0.0349) and no increase in hemorrhagic events (HR 0.98, 95% CI 0.74-1.32, P=0.9122). Clopidogrel decreased the risk of ischemic stroke (HR 0.47, 95% CI 0.29-0.78, P=0.0033) and hemorrhagic events (HR 0.64, 95% CI 0.31-0.96, P=0.034) more than aspirin. There was no statistical difference regarding the risk of stroke and hemorrhagic events among warfarin, cilostazol-based combination therapy and aspirin.
  
  
  CONCLUSIONS
  Cilostazol and clopidogrel were more effective in preventing recurrent ischemic stroke without increased hemorrhagic events than aspirin in patients with PAD.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
authors.forename: Wen-Hsien
authors.initials: WH
authors.lastname: Lee
authors.forename: Chun-Yuan
authors.initials: CY
authors.lastname: Chu
authors.forename: Po-Chao
authors.initials: PC
authors.lastname: Hsu
authors.forename: Ho-Ming
authors.initials: HM
authors.lastname: Su
authors.forename: Tsung-Hsien
authors.initials: TH
authors.lastname: Lin
authors.forename: Wen-Chol
authors.initials: WC
authors.lastname: Voon
authors.forename: Wen-Ter
authors.initials: WT
authors.lastname: Lai
authors.forename: Sheng-Hsiung
authors.initials: SH
authors.lastname: Sheu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000209:etiology / Q000517:prevention & control*; D016208:Databases, Factual; D004359:Drug Therapy, Combination; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000150:complications / Q000188:drug therapy*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D012189:Retrospective Studies; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D013624:Taiwan
chemical_list: D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors