Protocol for Cilostazol Stroke Prevention Study for Antiplatelet Combination (CSPS.com): A Randomized, Open-Label, Parallel-Group Trial

Toyoda, Kazunori; Uchiyama, Shinichiro; Hoshino, Haruhiko; Kimura, Kazumi; Origasa, Hideki; Minematsu, Kazuo; Yamaguchi, Takenori

doi:10.1111/ijs.12420

Cited by 28 publications

(24 citation statements)

References 40 publications

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“…The onset of MCI could always be along with the occurrence of lacunar strokes. The phosphodiesterase III inhibitor cilostazol, which is often used in the prevention of stroke23 and peripheral artery disease,24 may delay cognitive decline 25. There is one more method that should be touched on; once they are diagnosed as MCI, cognitive enhancers, including cholinesterase inhibitors26 and memantine,27 are recommended to treat the disease.…”

Section: Discussionmentioning

confidence: 99%

Mild cognitive impairment in maintenance hemodialysis patients: a cross-sectional survey and cohort study

Pei¹,

Lai²,

He³

et al. 2018

CIA

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IntroductionFew studies focused on mild cognitive impairment (MCI) in maintenance hemodialysis (MHD) patients. This study was conducted to survey the prevalence, the potent risk factors of MCI in MHD patients, and further observe the progress of MCI in a period of 6 months.MethodologyMini-Mental State Examination, and Montreal Cognitive Assessment were used to assess cognitive condition. MHD patients were enrolled from The First Affiliated Hospital of Nanjing Medical University, who had a stable hemodialysis history for more than 3 months.ResultsSixty-four MHD patients and 54 general subjects were finally included. The average age of both groups was more than 60 years. The prevalence of MCI in the MHD group was significantly higher than that in general population (60.9% vs 29.6%, P<0.05). Spearman correlation analysis indicated that MCI was related to age, comorbidities, education years, uric acid, serum albumin, and blood pressure. The prevalence and severity of MCI in the MHD group remained unchanged during the 6 months (prevalence: 59.5%–66.6%, MoCA scores: 22.9–22.5).ConclusionMHD patients sustain a fairly high prevalence of MCI. Multiple risk factors influence the incidence and progression of MCI in MHD patients. More attention should be paid to this special population.

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Section: Discussionmentioning

confidence: 99%

Mild cognitive impairment in maintenance hemodialysis patients: a cross-sectional survey and cohort study

Pei¹,

Lai²,

He³

et al. 2018

CIA

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“…ICH is more common in Asians than in whites, while taking a single antiplatelet agent, dual antiplatelet agents, and vitamin K antagonists. 12,[56][57][58] The Cilostazol Stroke Prevention Study for Antiplatelet Combination (CSPS.com) has been recruiting patients from Japan to determine the efficacy and safety of dual antiplatelet therapy involving cilostazol 59 because the bleeding risk with cilostazol is relatively low. 60 Early initiation of oral anticoagulation after stroke is not strongly recommended globally in current guidelines.…”

Section: Other Problems Of Acute Stroke Care Awaiting Solutionmentioning

confidence: 99%

Acute Reperfusion Therapy and Stroke Care in Asia After Successful Endovascular Trials

Toyoda

Koga

Hayakawa

et al. 2015

Stroke

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Abstract-The current status of and prospects for acute stroke care in Asia in the situation where both intravenous thrombolysis and endovascular therapies have been recognized as established strategies for acute stroke are reviewed. Of 15 million people annually having stroke worldwide, ≈9 million are Asians. The burdens of both ischemic and hemorrhagic strokes are severe in Asia. The unique features of stroke in Asia include susceptibility to intracranial atherosclerosis, high prevalence of intracerebral hemorrhage, effects of dietary and lifestyle habits, and several disorders with genetic causes. These features affect acute stroke care, such as the dosage of alteplase for thrombolysis and consideration of bleeding complications during antithrombotic therapy. Acute endovascular thrombectomy, as well as intravenous thrombolysis, is relatively prevalent in East Asia, but most of the other Asian countries need to develop their human resources and fundamental medical infrastructure for stroke care. A limitation of endovascular therapy in East Asia is the high prevalence of intracranial atherosclerosis that can cause recanalization failure and require additional angioplasty or permanent stent insertion although intracranial stenting is not an established strategy. Multinational collaboration on stroke research among Asian countries is infrequent. Asians should collaborate to perform their own thrombolytic and endovascular trials and seek the optimal strategy for stroke care specific

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“…In addition, the CSPS.com trial (Cilostazol Stroke Prevention Study for Antiplatelet Combination), a multicentre, open-label RCT, is evaluating the efficacy and safety of dual antiplatelet therapy involving cilostazol for secondary stroke prevention. 34 A total of 4000 high-risk patients with non-cardioembolic IS will be randomised 8–180 days after onset to dual therapy with cilostazol plus aspirin or clopidogrel, or to aspirin or clopidogrel monotherapy for at least 1 year (ClinicalTrials.gov identifier: NCT01995370). However, CSPS.com excluded patients within 3 days of ictus.…”

Section: Discussionmentioning

confidence: 99%

Dual versus mono antiplatelet therapy for acute non-cardioembolic ischaemic stroke or transient ischaemic attack: a systematic review and meta-analysis

et al. 2018

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ObjectiveRecent years have seen new evidence on the efficacy and safety of dual antiplatelet therapy for secondary stroke prevention. We updated a meta-analysis of randomised controlled trials evaluating dual antiplatelet versus monotherapy for patients with acute non-cardioembolic ischaemic stroke (IS) or transient ischaemic attack (TIA).MethodsWe searched PubMed and identified randomised controlled trials evaluating dual antiplatelet versus monotherapy for acute non-cardioembolic IS or TIA within 3 days of ictus up to May 2018. Risk ratio (RR) with 95% CI were calculated using random effects models. Clinical endpoints included stroke recurrence, composite vascular events and major bleeding.Results18 randomised controlled trials including 15 515 patients were pooled in the meta-analysis. When compared with monotherapy among patients with acute IS or TIA, dual antiplatelet therapy reduced the risk of stroke recurrence (RR 0.69; 95% CI 0.61 to 0.78; p<0.001) and composite vascular events (RR 0.72; 95% CI 0.64 to 0.80; p<0.001). Dual therapy was associated with a significant increase in the risk of major bleeding (RR 1.77; 95% CI 1.09 to 2.87; p=0.02) when all trial data were combined. However, when all previous trials before the completion of the POINT trial were analysed, dual antiplatelet versus monotherapy was not associated with a significant increase in the risk of major bleeding (RR 1.46; 95% CI 0.77 to 2.75; p=0.25).ConclusionsAmong patients with acute non-cardioembolic IS or TIA within 3 days of ictus, dual antiplatelet therapy was associated with a reduction in stroke recurrence, and composite vascular events, when compared with monotherapy. However, a significant increase in the risk of major bleeding was observed.

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Protocol for Cilostazol Stroke Prevention Study for Antiplatelet Combination (CSPS.com): A Randomized, Open-Label, Parallel-Group Trial

Cited by 28 publications

References 40 publications

Mild cognitive impairment in maintenance hemodialysis patients: a cross-sectional survey and cohort study

Mild cognitive impairment in maintenance hemodialysis patients: a cross-sectional survey and cohort study

Acute Reperfusion Therapy and Stroke Care in Asia After Successful Endovascular Trials

Dual versus mono antiplatelet therapy for acute non-cardioembolic ischaemic stroke or transient ischaemic attack: a systematic review and meta-analysis

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