Cilostazol

Zeller, Thomas; Trenk, Dietmar

doi:10.1161/circulationaha.113.003284

Circulation

2013

DOI: 10.1161/circulationaha.113.003284

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Cilostazol

Thomas Zeller

Dietmar Trenk

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2021

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Cited by 1 publication

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References 25 publications

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“…[40][41][42] Additional pleiotropic effects that have been proposed include a decrease in systemic inflammation, improved stroke recovery, reduction of amyloid-related neurotoxicity, prevention of restenosis of cardiac stents, and prevention of diabetic nephropathy. 37,[43][44][45][46][47][48][49][50][51][52][53] Another potential role for cilostazol is in the prevention of dementia or cognitive decline, 21,27,[54][55][56] particularly in patients with chronic microvascular disease who may benefit from the effects of cilostazol on myelin repair and astrocyte-to-neuron energy supply. 13,26,27…”

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confidence: 99%

Cilostazol for Secondary Stroke Prevention

Havenon

Sheth

Madsen

et al. 2021

Stroke

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Cilostazol is a PDE3 (phosphodiesterase III) inhibitor with a long track record of safety that is Food and Drug Administration and European Medicines Agency approved for the treatment of claudication in patients with peripheral arterial disease. In addition, cilostazol has been approved for secondary stroke prevention in several Asian countries based on trials that have demonstrated a reduction in stroke recurrence among patients with noncardioembolic stroke. The onset of benefit appears after 60 to 90 days of treatment, which is consistent with cilostazol’s pleiotropic effects on platelet aggregation, vascular remodeling, blood flow, and plasma lipids. Cilostazol appears safe and does not increase the risk of major bleeding when given alone or in combination with aspirin or clopidogrel. Adverse effects such as headache, gastrointestinal symptoms, and palpitations, however, contributed to a 6% increase in drug discontinuation among patients randomized to cilostazol in a large secondary stroke prevention trial (CSPS.com [Cilostazol Stroke Prevention Study for Antiplatelet Combination]). Due to limitations of prior trials, such as open-label design, premature trial termination, large loss to follow-up, lack of functional or cognitive outcome data, and exclusive enrollment in Asia, the existing trials have not led to a change in clinical practice or guidelines in Western countries. These limitations could be addressed by a double-blind placebo-controlled randomized trial conducted in a broader population. If positive, it would increase the evidence in support of long-term treatment with cilostazol for secondary prevention in the millions of patients worldwide who have experienced a noncardioembolic ischemic stroke.

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confidence: 99%

Cilostazol for Secondary Stroke Prevention

Havenon

Sheth

Madsen

et al. 2021

Stroke

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Cilostazol

Cited by 1 publication

References 25 publications

Cilostazol for Secondary Stroke Prevention

Cilostazol for Secondary Stroke Prevention

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