Antiplatelet Therapy for Secondary Prevention of Noncardioembolic Ischemic Stroke

O’Donnell, Martin J.; Hankey, Graeme J.; Eikelboom, John W.

doi:10.1161/strokeaha.107.497271

Cited by 48 publications

(27 citation statements)

References 59 publications

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“…Actually, the benefits of aspirin in reducing recurrent stroke (–7/1,000) or death/dependency (–13/1,000) were negated by the increased intracranial (+2/1,000) or extracranial hemorrhages (+4/1,000) [3]. Characteristically, cilostazol does not prolong the bleeding time compared with aspirin or clopidogrel [20].…”

Section: Discussionmentioning

confidence: 99%

“…However, antiplatelet trials in acute stroke are rare, and the efficacy and safety have only been proven for aspirin. Aspirin reduced recurrent stroke or death; however, the net benefit was small because of symptomatic hemorrhages [1,2,3]. In addition, about 8–18% of patients suffer from recurrent vascular events including stroke while taking aspirin [4], and some patients are intolerant to or have contraindications for aspirin.…”

Section: Introductionmentioning

confidence: 99%

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Cilostazol in Acute Ischemic Stroke Treatment (CAIST Trial): A Randomized Double-Blind Non-Inferiority Trial

Lee¹,

Bae²,

Kang³

et al. 2011

Cerebrovasc Dis

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Background: Aspirin is a proven antiplatelet agent in acute ischemic stroke, and there are no current guidelines for other antiplatelet treatments. We aimed to compare the efficacy and safety of cilostazol with aspirin in acute stroke. Methods: Patients with measurable neurological deficits (NIHSS score ≤15) within 48 h of onset were randomly assigned to cilostazol (200 mg/day) or aspirin (300 mg/day) for 90 days. The primary endpoint was a modified Rankin Scale (mRS) score of 0–2 at 90 days. Cardiovascular events, bleeding complications, and other functional outcomes were also assessed. Statistical analysis was carried out by intention-to-treat and per-protocol bases. This trial is registered with ClinicalTrials.gov (NCT00272454). Results: In total, 458 patients were enrolled (mean age of 63 years, median NIHSS of 3), and mRS at 90 days was obtained in 447 patients. The primary endpoint was achieved in 76% (173/228) of those randomized to cilostazol and in 75% (165/219) assigned to aspirin, which supported the pre-specified non-inferiority of cilostazol to aspirin (95% CI of proportion difference: –6.15 to 7.22%, p = 0.0004). These results were also supported by per-protocol analysis (p = 0.045). Cardiovascular events occurred in 6 patients (3%) treated with cilostazol, and in 9 patients (4%) treated with aspirin (p = 0.41). Adverse events were more common in cilostazol-treated patients during the trial (91 vs. 85%, p = 0.055), while the frequencies of bleeding complications (cilostazol 11%, aspirin 13%, p = 0.43) or drug discontinuation (cilostazol 10%, aspirin 7%, p = 0.32) were not different. Conclusion: Cilostazol is feasible in acute ischemic stroke, and comparable to aspirin in its efficacy and safety.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cilostazol in Acute Ischemic Stroke Treatment (CAIST Trial): A Randomized Double-Blind Non-Inferiority Trial

Lee¹,

Bae²,

Kang³

et al. 2011

Cerebrovasc Dis

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“…6 An increased bleeding risk is particularly ominous when treating ischemic cerebrovascular disease because of the harmful consequences of intracranial hemorrhage; 7 therefore, ischemic cerebrovascular disorders represent a clinical setting in which an antiplatelet regimen with a lower bleeding risk would be of special value. 8,9 Antiplatelet therapy with aspirin, dypiridamole, clopidogrel, or their combination is the mainstay for secondary prevention of stroke, but its effectiveness for acute stroke is limited and is associated with increased intracranial bleeding. 10 Intravenous GPIIb/IIIa inhibitors, effective in acute coronary syndromes, 11 have given disappointing results in acute ischemic stroke: a recent phase 3 trial with abciximab was stopped prematurely because of increased intracranial hemorrhage and mortality and lack of efficacy.…”

Section: Introductionmentioning

confidence: 99%

Reperfusion of cerebral artery thrombosis by the GPIb–VWF blockade with the Nanobody ALX-0081 reduces brain infarct size in guinea pigs

Momi

Tantucci

Roy

et al. 2013

Blood

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“…1,2 Patients who participated in these trials may not have been representative of patients with a recent TIA or ischemic stroke in general. We and others [3][4][5] showed that patients in antiplatelet trials are generally younger, have less comorbidity, and less severe strokes than patients in hospital and population surveys. This may raise concerns about extrapolation of trial results to all patients with a recent TIA or minor ischemic stroke.…”

mentioning

confidence: 89%

Prevention With Low-Dose Aspirin Plus Dipyridamole in Patients With Disabling Stroke

Dippel

Maasland

Halkes

et al. 2010

Stroke

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on behalf of the ESPRIT Study Group and the ESPS-2 InvestigatorsBackground and Purpose-The combination of low-dose aspirin and dipyridamole is more effective than aspirin alone in reducing the risk of recurrent stroke and other major cardiovascular events in patients with a recent transient ischemic attack or minor stroke. It is unknown whether this also applies to patients with a disabling stroke. Methods-We reanalyzed the data of 5700 patients from ESPRIT and ESPS-2 to study the effect of aspirin and dipyridamole according to modified Rankin scale (mRS) score at baseline. Primary outcome was vascular events (stroke, myocardial infarction, or vascular death). We used proportional hazards regression to estimate the treatment effect across mRS strata at baseline, and we tested for interactions with treatment. Results-In total, 426 patients (7.5%) had mRS score of 4 or 5 at baseline. The risk of an outcome event increased with mRS score. The relative risk associated with the combination of aspirin and dipyridamole compared to aspirin alone in patients with mRS score 0 to 5 was 0.79 (95% confidence interval, 0.69 -0.91). The relative risk according to mRS subcategory score 0 to 4 at baseline varied between 0.73 and 0.96 for vascular events and between 0.62 and 0.96 for stroke. The number of patients with mRS score 5 was too small for reliable estimates, but the data suggest a beneficial effect. There was no evidence of interaction between treatment effect and mRS score at baseline. Conclusion-The

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Antiplatelet Therapy for Secondary Prevention of Noncardioembolic Ischemic Stroke

Abstract: Abstract-For

Cited by 48 publications

References 59 publications

Cilostazol in Acute Ischemic Stroke Treatment (CAIST Trial): A Randomized Double-Blind Non-Inferiority Trial

Cilostazol in Acute Ischemic Stroke Treatment (CAIST Trial): A Randomized Double-Blind Non-Inferiority Trial

Reperfusion of cerebral artery thrombosis by the GPIb–VWF blockade with the Nanobody ALX-0081 reduces brain infarct size in guinea pigs

Prevention With Low-Dose Aspirin Plus Dipyridamole in Patients With Disabling Stroke

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