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).
In this large multicenter trial, patients with minor stroke or TIA were randomized to clopidogrel+ASA or ASA alone; 90-day stroke occurred in 8% vs 12% respectively, and rates of hemorrhage or hemorrhagic stroke were the same (abstract).
These guidelines provide an evidence based for the use of periprocedural antithrombotics in patients with cerebrovascular disease. They recommend continuing ASA-warfarin for dental procedures, and most other minor procedures. There is little evidence to support the use of procedural bridging with heparin, and it does increase the risk of bleeding. Cessation of therapy for 7 […]
A large analysis from a stroke registry found better outcomes with earlier thrombolytics for acute ischemic stroke; every 15 minutes earlier was associated with an odds ratio of 0.96 for in-hospital death or intracranial hemorrhage, and an odds ratio of 1.03 for being discharged home and 1.04 for walking independently at discharge (abstract).