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Alternative to aspirin


A study in China has shown that the antiplatelet drug cilostazol is as effective as aspirin at preventing recurrent stroke, but causes fewer bleeding events.

The results suggest cilostazol could be a safer alternative to aspirin post-stroke for Chinese patients, and warrant both phase III trials and studies in other populations. These are the conclusions of authors of an article published early online and in the June edition of The Lancet Neurology.

Stroke is the second leading cause of death in China, with about seven million people affected countrywide.

Aspirin is effective for preventing secondary stroke, and has been used in up to 89% of stroke patients.

However, Asian populations are at higher risk of brain bleeding from aspirin use than other populations, and the incidence of such bleeds is higher in China than in high-income countries.

Cilostazol is an alternative antiplatelet drug to aspirin that works through a different mechanism, and Dr Yining Huang, Department of Neurology, Peking University First Hospital, Beijing, China, and colleagues did a randomised trial to compare the efficacy and safety of the two drugs at preventing recurrent stroke.

The researchers found that 12 patients in a group of 360 receiving cilostazol had a recurrence of stroke, compared with 20 in the aspirin group of 359 patients.

These findings were not statistically significant and thus can only be described as a trend. However, brain bleeding events were also much lower in the cilostazol group (just one patient) versus the aspirin group (seven patients), and this was statistically significant.

The authors conclude: “The lower rates of ischaemic and haemorrhagic stroke in the cilostazol group suggest that cilostazol might be a more effective and safer alternative to aspirin for Chinese patients with ischaemic stroke; however, a larger phase III trial is required to confirm this.”

The Lancet Neurology

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