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Antiplatelet drugs have an established role in secondary stroke prevention. Several attempts have been made to boost the clinical effectiveness of these treatments by enhancing antithrombotic effects or lowering hemorrhagic risks. Cilostazol, a drug that primarily acts by inhibiting phosphodiesterase and, thus, platelet aggregation, is more effective than placebo at preventing stroke recurrence but has not been tested against routinely prescribed antiplatelet agents.
The manufacturer-funded second Cilostazol Stroke Prevention Study (CSPS 2) was designed to establish clinical noninferiority of cilostazol versus aspirin for the prevention of recurrent stroke in patients with noncardioembolic stroke. At multiple sites in Japan, the investigator…