Cilostazol for treatment of cerebral infarction

Abstract

Stroke not only causes critical disability and death but is also a cause of anxiety with the possibility of secondary cardiovascular events including secondary ischemic stroke. Indeed, patients with a history of previous stroke have a high rate of stroke recurrence, indicating the clinical importance of secondary stroke prevention. Area of covered: This review provides an overview of the pooled evidence for cilostazol's use in the management of secondary stroke prevention. Among the various antiplatelet agents that are available, aspirin is the most frequently used agent worldwide for the prevention of secondary stroke. Cilostazol, a selective phosphodiesterase (PDE) 3A inhibitor, is used worldwide for the treatment of patients with intermittent claudication. However, in Asia, cilostazol is recommended and used in practice for secondary stroke prevention. Expert opinion: The authors believe that cilostazol could be used for secondary stroke prevention not only in Asia but worldwide. However, further randomized trials on cilostazol are needed, especially in the US and Europe to better support its case.

The use of cilostazol for secondary stroke prevention: isn’t it time it’s evaluated in Western countries?

“…These concerns have opened new avenues to design studies to find genetic variations related to drug response without dragging social issues of race into the equation. Accordingly, cilostazol may have a high potential for secondary stroke prevention even in non-Asian populations, as highlighted by Dr. Noma and colleague in their updated systematic review published in a recent issue of Expert Opinion on Pharmacotherapy [5]. In particular, patients with bleeding prone conditions such as those with small vessel disease and multiple microbleeds or patients who experience hemorrhagic strokes are likely to benefit from cilostazol.…”

“…The clinical utility of cilostazol for the prevention of secondary stroke [2], intracranial arterial stenosis [3], recurrent stroke in small vessel disease, and bleeding complications and hemorrhagic events (subarachnoid and intracerebral hemorrhage) [4] has been suggested. Its use for ischemic stroke prevention is also suggested in a review recently published in Expert Opinion On Pharmacotherapy [5]. In this review, pooling beneficial evidence reported from South-East Asia, the authors recommend that cilostazol use for secondary stroke prevention should not be confined to Asia, and it should be used worldwide for secondary stroke prevention.…”

“…However, it is worth noticing that all trials were conducted among Asian patients. Conversely, the benefits of cilostazol have been poorly explored in Europe and the United States, while there is no definitive evidence that the clinical response may be different in non-Asian populations [5]. The existing gap between the East and West merits a profound scrutiny to assess the presence of any genetic differences across ethnicities or other involved unforeseen, though comprehensible, factors that have prevented the use of cilostazol in Western countries.…”

Model Difference in the Effect of Cilostazol on the Development of Experimental Pulmonary Hypertension in Rats

“…Cilostazol (CLZ) is a selective phosphodiesterase-3 inhibitor that increases intracellular cyclic AMP, which inhibits platelet aggregation and induces peripheral vasodilation. The antiplatelet agent CLZ is indicated in intermittent claudication in peripheral arterial disease [37], thrombotic complications of coronary angioplasty [38] and secondary stroke prevention [39]. Through cAMP-dependent and cAMP-independent mechanisms, CLZ also causes phosphorylation of eNOS, which increases NO production in the aortas of diabetic rats [40], human aortic endothelial cells [41], and rat cultured smooth muscle cells [42].…”

Cilostazol restores autophagy flux in bafilomycin A1-treated, cultured cortical astrocytes through lysosomal reacidification: roles of PKA, zinc and metallothionein 3

“…Cilostazol is a phosphodiesterase (PDE)-3 inhibitor that can increase intracellular cAMP levels [32][33][34][35][36] . It is approved for the treatment of intermittent claudication and prevention of ischemic heart attack and stroke [37][38][39][40][41] . Cilostazol was shown to prevent cerebral hypoperfusion-induced cognitive impairment and white matter damage [42][43][44] .…”