Cilostazol for Secondary Prevention of Stroke?

Aspirin alone, aspirin plus dipyridamole, and clopidogrel are often prescribed for secondary prevention of stroke. Now, cilostazol (Pletal and generics) — a drug with antiplatelet and vasodilating properties that is FDA-approved only for treating intermittent claudication — enters the picture.

In a manufacturer-sponsored double-blind randomized trial conducted in Japan, 2757 people with recent noncardioembolic strokes received cilostazol (100 mg twice daily) or aspirin (81 mg daily). During mean follow-up of 29 months, the primary endpoint (recurrent cerebral infarction, cerebral hemorrhage, or subarachnoid hemorrhage) occurred less commonly in the cilostazol group than in the aspirin group (6.1% vs. 8.9%; P=0.04). Bleeding events (intracranial hemorrhage or other hemorrhage that required hospitalization) also were less common with cilostazol (1.7% vs. 4.3%; P<0.001). Numerous adverse effects were more common with cilostazol than with aspirin (e.g., headache, diarrhea, palpitations, dizziness), which resulted in more cilostazol recipients than aspirin recipients withdrawing from the trial (20% vs. 12%).