WSO - April 2023 - 426

1112343
WSO
International Journal of StrokeUchiyama et al.
Research
Dual antiplatelet therapy with cilostazol
in stroke patients with extracranial
arterial stenosis or without arterial
stenosis: A subgroup analysis of the
CSPS.com trial
Shinichiro Uchiyama1 , Kazunori Toyoda2 , Satomi Okamura3,
Katsuhiro Omae3, Haruhiko Hoshino4 , Kazumi Kimura5
,
Kazuo Kitagawa6 , Kazuo Minematsu7 and Takenori Yamaguchi2
Abstract
Background: We previously reported that dual antiplatelet therapy (DAPT) with cilostazol was superior to aspirin or
clopidogrel for the prevention of recurrent stroke and vascular events in a subgroup analysis of intracranial arterial stenosis
in the Cilostazol Stroke Prevention Study for Antiplatelet Combination (CSPS.com), a randomized controlled trial.
Aims: We conducted another subgroup analysis to investigate the benefit of DAPT with cilostazol in patients with
extracranial arterial stenosis (ECAS) and those without arterial stenosis.
Methods: We compared the risk of recurrent ischemic stroke, vascular events, and major bleeding between DAPT with
cilostazol plus aspirin or clopidogrel and aspirin or clopidogrel alone in patients with ischemic stroke between 8 and
180 days before starting trial treatment and ECAS or without arterial stenosis.
Results: The median follow-up period was 1.4 years. The risk of recurrent ischemic stroke (hazard ratio (HR): 1.04, 95% confidence
interval (CI): 0.42-2.57) and vascular events (HR: 0.97, 95% CI: 0.42-2.24) did not differ between the two groups for the
253 patients with ECAS, whereas they were lower (HR: 0.36, 95% CI: 0.18-0.74 and HR: 0.47, 95% CI: 0.26-0.85, respectively)
in the DAPT group for the 944 patients without arterial stenosis. The risk of major bleeding did not differ between the groups
in patients with ECAS (HR: 0.58, 95% CI: 0.05-6.39) or without arterial stenosis (HR: 0.79, 95% CI: 0.27-2.26).
Conclusion: DAPT with cilostazol might be beneficial for prevention of recurrent stroke and vascular events in patients
without arterial stenosis but not in those with ECAS.
Data access statement: We will make the deidentified participant data from this research available to the scientific
community with as few restrictions as feasible, while retaining exclusive use until the publication of major output.
Keywords
Dual antiplatelet therapy, cilostazol, arterial stenosis, stroke prevention
Received: 6 April 2022; accepted: 19 June 2022
1Clinical Research Center for Medicine, International University of Health and Welfare, Center for Brain and Cerebral Vessels, Sanno Medical
Center, Tokyo, Japan
2Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
3Department of Data Science, National Cerebral and Cardiovascular Center, Suita, Japan
4Department of Neurology, Tokyo Saiseikai Central Hospital, Tokyo, Japan
5Department of Neurology, Nippon Medical School, Tokyo, Japan
6Department of Neurology, Tokyo Women's Medical University, Tokyo, Japan
7Medical Corporation Iseikai, Osaka, Japan
Corresponding author:
Shinichiro Uchiyama, Clinical Research Center for Medicine, International University of Health and Welfare, Center for Brain and Cerebral Vessels,
Sanno Medical Center, 8-5-35 Akasaka, Minato-ku, Tokyo 107-8332, Japan.
Email: suchiyama@iuhw.ac.jp
International Journal of Stroke, 18(4)
International Journal of Stroke
2023, Vol. 18(4) 426 -432
© 2022 World Stroke Organization
Article reuse guidelines:
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DOI: 10.1177/17474930221112343
journals.sagepub.com/home/wso
https://doi.org/10.1177/17474930221112343
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