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Antiplatelet Cilostazol Is Beneficial in Diabetic and/or Hypertensive Ischemic Stroke Patients
Subgroup Analysis of the Cilostazol Stroke Prevention StudyShinohara Y.a · Gotoh F.b · Tohgi H.f · Hirai S.g · Terashi A.c · Fukuuchi Y.h · Otomo E.d · Itoh E.i · Matsuda T.j · Sawada T.k · Yamaguchi T.l · Nishimaru K.m · Ohashi Y.e
aFederation of National Personnel Mutual Aid Associations, Tachikawa Hospital, Tachikawa, bDepartment of Neurology, School of Medicine, Keio University, cNippon Medical School, dDepartment of Internal Medicine, Yokufukai Geriatric Hospital, and eDepartment of Biostatistics, School of Public Health, University of Tokyo, Tokyo, fDepartment of Neurology, Iwate Medical University School of Medicine, Morioka, gDepartment of Neurology, Gunma University School of Medicine, Maebashi, hAshikaga Red Cross Hospital, Tochigi, iDepartment of Neurology, National Higashi-Nagoya Hospital, Nagoya, jThird Department of Internal Medicine, Kanazawa University School of Medicine, Kanazawa, kDepartment of Rehabilitation, Aino Hospital, and lNational Cardiovascular Center, Osaka, and mYoshizuka Hayashi Hospital, Fukuoka, Japan
Background and Purpose: Although antiplatelets are known to be effective for secondary prevention of cerebral infarction, the number needed to treat is rather large and the effects in stroke patients with complications such as hypertension or diabetes are inadequately defined. This study was conducted to examine the effect of such complications on recurrence of cerebral infarction, and to assess the effect of cilostazol, an antiplatelet agent, in these high-risk subjects. Methods: A post hoc subgroup analysis of the already reported Cilostazol Stroke Prevention Study, which was a placebo-controlled double-blind trial, has been carried out to clarify the influence of various complications on recurrence in the placebo group and the effects of cilostazol in 1,095 patients with noncardioembolic ischemic cerebrovascular disease. Treatment continued for an average of 1.8 ± 1.3 years (maximum 4.8 years). Results: The recurrence rate of the diabetic stroke patients was significantly higher compared with the nondiabetics in the placebo group (9.4 vs. 4.7%/year, p = 0.01). Furthermore, our study showed that the relative risk reduction (RRR) for recurrence of infarction was 41.7% with cilostazol. This treatment provided a significant benefit in patients with lacunar infarction (RRR 43.4%, p = 0.04), with diabetes (RRR 64.4%, p = 0.008), or with hypertension (RRR 58.0%, p = 0.003). Conclusions: Diabetic patients are particularly at risk for recurrence of cerebral infarction. Cilostazol is useful for the prevention of the recurrence of vascular events in patients with lacunar infarction, and is probably effective in high-risk patients with diabetes and/or hypertension.
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