In this large industry-sponsored randomized non-inferiority trial, 2757 Japanese patients who had a (non-cardioembolic) cerebral infarction in the past 6 months were randomized to cilostazol 100mg BID or ASA 81mg a day. After a follow up of about 2 years, the primary endpoint (cerebral infarction, cerebral hemorrhage, or subarachnoid hemorrhage) occurred in significantly fewer cilostazol patients than ASA patients (2.8% vs 3.7%). Cilostazol patients also had fewer hemorrhagic events (0.8% vs 1.8%), but more side effects (headache, diarrhea, tachycardia). If proven effective in a more generalized patient population, and if tolerable from side effects, cilostazol may become an alternative agent to ASA for secondary stroke prevention (non-cardioembolic) (abstract).
Dr. Scheurer is a clinical hospitalist and the Medical Director of Quality and Safety at the Medical University of South Carolina in Charleston, South Carolina, and is Assistant Professor of Medicine. She is a graduate of the University of Tennessee College of Medicine, completed her residency at Duke University, and completed her Masters in Clinical Research at the Medical University of South Carolina. She also serves as the Web Editor and Physician Advisor for the Society of Hospital Medicine.