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Tanaka K. [111th Scientific Meeting of the Japanese Society of Internal Medicine: Educational Lecture: 5. Secondary prevention of cerebral infarction--Most useful antithrombotic therapy for Japanese patients]. NIHON NAIKA GAKKAI ZASSHI. THE JOURNAL OF THE JAPANESE SOCIETY OF INTERNAL MEDICINE 2014; 103:2252-2260. [PMID: 27522787 DOI: 10.2169/naika.103.2252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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102
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Yoneyama M, Tanaka M, Hasebe S, Yamaguchi T, Shiba T, Ogita K. Beneficial effect of cilostazol-mediated neuronal repair following trimethyltin-induced neuronal loss in the dentate gyrus. J Neurosci Res 2014; 93:56-66. [PMID: 25139675 DOI: 10.1002/jnr.23472] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 07/05/2014] [Accepted: 07/24/2014] [Indexed: 01/16/2023]
Abstract
Cilostazol acts as an antiplatelet agent and has other pleiotropic effects based on phosphodiesterase-3-dependent mechanisms. We evaluated whether cilostazol would have a beneficial effect on neuronal repair following hippocampal neuronal damage by using a mouse model of trimethyltin (TMT)-induced neuronal loss/self-repair in the hippocampal dentate gyrus [Ogita et al. (2005) J Neurosci Res 82:609-621]; these mice will hereafter be referred to as impaired animals. A single treatment with cilostazol (10 mg/kg, i.p.) produced no significant change in the number of 5-bromo-2'-deoxyuridine (BrdU)-incorporating cells in the dentate granule cell layer (GCL) or subgranular zone on day 3 after TMT treatment. However, chronic treatment with cilostazol on days 3-15 posttreatment resulted in an increase in the number of BrdU-incorporating cells in the dentate GCL of the impaired animals, and these cells were positive for neuronal nuclear antigen or doublecortin. Cilostazol was effective in elevating the level of phosphorylated cyclic adrenosine monophosphate response element-binding protein (pCREB) in the dentate gyrus of impaired animals. The results of a forced swimming test revealed that the chronic treatment with cilostazol improved the depression-like behavior seen in the impaired animals. In the cultures of hippocampal neural stem/progenitor cells, exposure to cilostazol produced not only enhancement of proliferation activity but also elevation of pCREB levels. Taken together, our data suggest that cilostazol has a beneficial effect on neuronal repair following neuronal loss in the dentate gyrus through promotion of proliferation and/or neuronal differentiation of neural progenitor cells in the subgranular zone.
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Affiliation(s)
- Masanori Yoneyama
- Laboratory of Pharmacology, Faculty of Pharmaceutical Sciences, Setsunan University, Hirakata, Osaka, Japan
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103
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Uchiyama S, Shinohara Y, Katayama Y, Yamaguchi T, Handa S, Matsuoka K, Ohashi Y, Tanahashi N, Yamamoto H, Genka C, Kitagawa Y, Kusuoka H, Nishimaru K, Tsushima M, Koretsune Y, Sawada T, Hamada C. Benefit of Cilostazol in Patients with High Risk of Bleeding: Subanalysis of Cilostazol Stroke Prevention Study 2. Cerebrovasc Dis 2014; 37:296-303. [DOI: 10.1159/000360811] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 02/24/2014] [Indexed: 11/19/2022] Open
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104
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Alvarez-Sabín J, Quintana M, Santamarina E, Maisterra O. Triflusal and Aspirin in the Secondary Prevention of Atherothrombotic Ischemic Stroke: A Very Long-Term Follow-Up. Cerebrovasc Dis 2014; 37:181-7. [DOI: 10.1159/000357662] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 12/02/2013] [Indexed: 11/19/2022] Open
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105
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Arboix A, Blanco-Rojas L, Martí-Vilalta JL. Advancements in understanding the mechanisms of symptomatic lacunar ischemic stroke: translation of knowledge to prevention strategies. Expert Rev Neurother 2014; 14:261-76. [PMID: 24490992 DOI: 10.1586/14737175.2014.884926] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Symptomatic lacunar ischemic stroke (25% of all brain infarctions) results from occlusion of a single penetrating artery by microatheromas or lipohyalinosis and rarely from an intracranial atheromatous branch disease. Recurrent lacunar stroke may be associated with more severe clinical features and has been involved in producing lacunar state and vascular subcortical dementia. In the first multicenter randomized clinical trial (SPS3) focused on stroke prevention among patients with recent lacunar stroke, the addition of clopidogrel to aspirin not only did not reduced significantly the risk of recurrent stroke, but also increased significantly the likelihood of hemorrhage and fatal outcome. If lacunar stroke is primarily non-atherothromboembolic, secondary prevention aimed at preventing atheroma progression may not be very effective. The efficacy of drugs that improve endothelial function in lacunar stroke patients remains to be studied in the future.
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Affiliation(s)
- Adrià Arboix
- Department of Neurology, Cerebrovascular Division, Hospital Universitari del Sagrat Cor, Universitat de Barcelona, C/Viladomat 288, E-08029 Barcelona, Catalonia, Spain
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106
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Collinson DJ, Donnelly R. Cilostazol: improving walking distance in patients with intermittent claudication. Expert Rev Cardiovasc Ther 2014; 2:503-9. [PMID: 15225110 DOI: 10.1586/14779072.2.4.503] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Intermittent claudication is a common, disabling symptom of peripheral arterial disease that limits walking distance and is associated with an increased cardiovascular risk of acute limb- or life-threatening complications. Very few patients with intermittent claudication (<7%) are suitable candidates for surgical revascularization, yet in contrast to the treatment of stable angina, few effective medical therapies (apart from exercise) are available for the symptomatic relief of intermittent claudication. The phosphodiesterase-3 inhibitor, cilostazol (Pletal, Otsuka Pharmaceuticals Ltd), is the first symptom-relieving treatment for intermittent claudication that has been evaluated successfully in large multicenter placebo-controlled, double-blind clinical trials (involving >2000 patients). A meta-analysis of the eight major efficacy studies with cilostazol has shown significant improvements in pain-free and maximum walking distance, and a good overall safety and tolerability profile. Thus, in the UK, USA and Japan, cilostazol administered at 100 mg twice daily is licensed for symptom relief in patients with stable, moderate-to-severe intermittent claudication, as an adjunct to nonpharmacological approaches such as exercise.
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Affiliation(s)
- Deborah J Collinson
- University of Nottinham Medical School, Derby City General Hospital, Uttoxeter Road, Derby, DE22 3DT, UK
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107
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Qian Y, Bi Q. Systematic study of cilostazol on secondary stroke prevention: a meta-analysis. Eur J Med Res 2013; 18:53. [PMID: 24313983 PMCID: PMC4029517 DOI: 10.1186/2047-783x-18-53] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 11/12/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To study the efficacy and safety of cilostazol on ischemic stroke prevention and treatment, systematic reviews of related clinical randomized controlled trials were analyzed. METHODS We searched the main databases for eligible trials including literature from January 1966 to November 2012 in MEDLINE, reports from 1980 to November 2012 in EMBASE, and all the studies published in EBSCO, Springer, Ovid, and Cochrane library citations. We also searched for keywords, including cilostazol and aspirin. RewMan 5.0 software was used to conduct the meta-analysis. RESULTS Our search yielded five eligible trials. The effects of cilostazol and aspirin on ischemic stroke prevention and treatment were almost equal (combined odds ratio (OR) 0.78, 95% confidence interval (CI) (0.59, 1.04)). Additionally, both magnetic resonance angiography (MRA) and transcranial Doppler (TCD) examination showed that cilostazol could significantly decrease the incidence of intracranial artery stenosis exacerbation (MRA: combined OR 0.22, 95% CI (0.07, 0.68); TCD: combined OR 0.17, 95% CI (0.05, 0.51)). In terms of adverse reactions, there were slightly fewer incidences of major bleeding with cilostazol than with aspirin (combined OR 0.38, 95% CI (0.24, 0.60)), and there was no difference in the number of heart palpitations between cilostazol and aspirin. However, the incidence of gastrointestinal disorders, dizziness, and headaches caused by cilostazol was greater. CONCLUSIONS Cilostazol might be a more effective and safer alternative to aspirin for patients with ischemic stroke. Further studies are required to confirm whether cilostazol is a suitable therapeutic option for secondary stroke prevention in larger cohorts of patients with ischemic stroke.
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Affiliation(s)
| | - Qi Bi
- Department of Neurology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
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108
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DiNicolantonio JJ, Lavie CJ, Fares H, Menezes AR, O'Keefe JH, Bangalore S, Messerli FH. Meta-analysis of cilostazol versus aspirin for the secondary prevention of stroke. Am J Cardiol 2013; 112:1230-4. [PMID: 23827403 DOI: 10.1016/j.amjcard.2013.05.067] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 05/17/2013] [Accepted: 05/17/2013] [Indexed: 12/20/2022]
Abstract
Aspirin is the most widely prescribed antiplatelet agent for the secondary prevention of stroke. Cilostazol, an antiplatelet and vasodilating agent, has shown promise for the secondary prevention of stroke. A systematic review and meta-analysis of randomized controlled trials using Ovid MEDLINE, PubMed, and Excerpta Medica (EMBASE) was searched up to October 2012. Four trials, in 3,917 patients, comparing cilostazol with aspirin were identified. Compared with aspirin, cilostazol was associated with a 73% reduction in hemorrhagic stroke (relative risk [RR] 0.27, 95% confidence interval [CI] 0.13 to 0.54, p = 0.0002), 28% reduction in the composite end point of stroke, myocardial infarction, or vascular death (RR 0.72, 95% CI 0.57 to 0.89, p = 0.003), and 48% reduction in total hemorrhagic events (RR 0.52, 95% CI 0.34 to 0.79, p = 0.002), with trend for lesser gastrointestinal bleeds (RR 0.60, 95% CI 0.34 to 1.06, p = 0.08). In conclusion, compared with aspirin, cilostazol is associated with significantly less hemorrhagic stroke, the combined end point of stroke, myocardial infarction, and vascular death, and total hemorrhagic events, with numerically fewer gastrointestinal bleeds when used for the secondary prevention of stroke.
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109
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Affiliation(s)
- Mark J Fisher
- From the Departments of Neurology, Anatomy & Neurobiology, and Pathology & Laboratory Medicine, UC Irvine School of Medicine, Irvine, CA
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110
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Watson A, Mikhailidis D, Stansby G. Cilostazol for peripheral arterial disease could reduce stroke risk? Thromb Res 2013; 132:149-50. [DOI: 10.1016/j.thromres.2013.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 03/12/2013] [Accepted: 03/12/2013] [Indexed: 10/26/2022]
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111
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Fujita K, Komatsu Y, Sato N, Higuchi O, Kujiraoka Y, Kamezaki T, Suzuki K, Matsumura A. Pilot study of the safety of starting administration of low-dose aspirin and cilostazol in acute ischemic stroke. Neurol Med Chir (Tokyo) 2013; 51:819-24. [PMID: 22198102 DOI: 10.2176/nmc.51.819] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Progressive stroke is a serious problem due to the associated morbidity and mortality. Aspirin is recommended for acute ischemic stroke, but does not reduce the frequency of stroke progression. No standard treatment has been approved for the prevention of stroke progression. Cilostazol, which reduces platelet aggregation about 3 hours after single administration, does not increase the frequency of bleeding events when compared with aspirin or a placebo. Moreover, the combination of 100 mg aspirin and 200 mg cilostazol does not increase the frequency of bleeding events compared with only 100 mg aspirin, and thus is expected to prevent stroke progression with a high degree of safety. The present study investigated the safety of this combination of two drugs administered at the above concentrations in 54 patients with acute ischemic stroke within 48 hours of stroke onset. Modified National Institutes of Health Stroke Scale (NIHSS) measurements were performed at baseline and again on day 4 to 7. Progressive stroke was defined as an increase greater than or equal to 1 point on NIHSS. Patient scores on the modified Rankin Scale (mRS) were evaluated at baseline and 3 months after enrollment. Stroke progression occurred in 11.1% of the patients. The percentages of patients with mRS score from 0 to 2 were 42.6% and 75% at baseline and 3 months, respectively. No symptomatic intracranial hemorrhage or major extracranial hemorrhage occurred. These results suggest that administration of aspirin and cilostazol is safe for acute ischemic stroke.
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Affiliation(s)
- Keishi Fujita
- Department of Neurosurgery, Ibaraki Seinan Medical Center Hospital, Sashima, Ibaraki, Japan.
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112
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Abstract
Antiplatelet agents are one of the main interventions for recurrent ischemic stroke prevention. Their time of use, dosage, and combination of therapy have different effects in terms of stroke risk reduction and adverse effects. This review provides an evidence-based update of the latest on antiplatelet therapy for stroke prevention.
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Affiliation(s)
- Sarkis G Morales Vidal
- Neurology Department, Stritch School of Medicine, Loyola University Chicago, 2160 South 1st Avenue, Building 105, Room 2700, Maywood, IL 60153, USA.
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113
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Shimizu H, Tominaga T, Ogawa A, Kayama T, Mizoi K, Saito K, Terayama Y, Ogasawara K, Mori E. Cilostazol for the prevention of acute progressing stroke: a multicenter, randomized controlled trial. J Stroke Cerebrovasc Dis 2013; 22:449-56. [PMID: 23541423 DOI: 10.1016/j.jstrokecerebrovasdis.2013.02.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2012] [Revised: 01/22/2013] [Accepted: 02/05/2013] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Progressing stroke is one of the major determinants of outcome after acute ischemic stroke. A pilot randomized controlled trial was conducted to investigate the effect of cilostazol on progressing stroke. METHODS Adult patients with noncardioembolic ischemic stroke within 24 hours after onset were randomized to receive cilostazol 200 mg/day (cilostazol group) or no medication (control group) in addition to the optimum medical treatments (a free radical scavenger plus an antiplatelet agent or an antithrombin agent). The primary endpoints were the rate of progressing stroke, defined as aggravation of the National Institutes of Health Stroke Scale (NIHSS) score by ≥ 4 points on days 3 and/or 5 and a modified Rankin Scale score of 0 to 1 at 3 months after enrollment. Aggravation caused by systemic complications, edema, hemorrhagic infarction, or recurrent stroke was not considered as progressing stroke. This trial was registered as UMIN000001630. RESULTS A total of 510 patients were enrolled from 55 institutions in Japan between February 2009 and July 2010. The rate of progressing stroke was 3.2% and 6.3% in the cilostazol and control groups, respectively (P = .143). The modified Rankin Scale score of 0 to 1 at 3 months did not differ between the groups. CONCLUSIONS Cilostazol failed to show a preventive effect against acute progressing stroke. However, the tendency to reduce progressing stroke and the results of stratified analyses may encourage additional studies to clarify the effect of cilostazol in the treatment of acute ischemic stroke.
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Affiliation(s)
- Hiroaki Shimizu
- Department of Neurosurgery at Kohnan Hospital, Sendai, Japan.
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114
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Abe A, Nishiyama Y, Hagiwara H, Okubo S, Ueda M, Katsura KI, Katayama Y. Administration of cilostazol, an antiplatelet, to patients with acute-stage cerebral infarction and its effects on plasma substance P level and latent time of swallowing reflex. J NIPPON MED SCH 2013; 80:50-6. [PMID: 23470806 DOI: 10.1272/jnms.80.50] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVE It has been reported that medical treatment with cilostazol (cilo) as an antiplatelet may increase a substance P level in the striatum to shorten the latent time of swallowing reflex (LTSR). We undertook a pilot study to confirm whether cilo administration to patients with cerebral infarction is effective in increasing their plasma substance P level and then in ameliorating the status of LTSR. METHODS AND SUBJECTS Eligible subjects were recruited, after informed consents, from 20 hospitalized patients with acute-phase cerebral infarction within 72 hours from the onset. At the start of treatment, the subjects were assigned at random to those given aspirin alone (non-cilo group) and those given aspirin plus cilo (cilo group). Plasma substance P levels and LTSR values were measured at the starting point (baseline), 28 days after, and 180 days after. RESULTS AND DISCUSSION No significant time-dependent change in plasma substance P level was found probably because of large individual differences but, 28 days after the start of treatment, this value tended to become higher in cilo group than in non-cilo group (P<0.10). Whereas, in terms of fold changes of LTSR in cilo group, there was a significant between-term difference at P<0.05, indicating that this medication is effective in ameliorating the swallowing function is improved in the long run. CONCLUSION The LTSR values was significantly shortened within 180 days after the start of cilo treatment, but the result was not well explained by substance P levels as far as these were measured using the plasma, probably because this substance had diluted during blood circulation. However, it will become clinically usable as a single swallowing index, if in the future some ingeneus method of its measurement is developed. A larger-scale study would also be needed to confirm our conclusion from this pilot study.
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Affiliation(s)
- Arata Abe
- Divisions of Neurology, Nephrology, and Rheumatology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan.
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115
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Lee WH, Chu CY, Hsu PC, Su HM, Lin TH, Voon WC, Lai WT, Sheu SH. Cilostazol for primary prevention of stroke in peripheral artery disease: a population-based longitudinal study in Taiwan. Thromb Res 2013; 132:190-5. [PMID: 23433530 DOI: 10.1016/j.thromres.2013.01.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2012] [Revised: 01/09/2013] [Accepted: 01/28/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND Clopidogrel, cilostazol, and aspirin were compared in terms of efficacy and safety for primary prevention of stroke in peripheral artery disease (PAD) patients. METHODS This retrospective cohort study analyzed data contained in the Taiwan National Health Insurance Bureau database for patients treated for PAD but not for stroke during 2002-2008. Patients were stratified according to treatment with aspirin, clopidogrel, cilostazol, or combined therapy. The primary efficacy and safety endpoints were stroke and hemorrhage. RESULTS Of the 931 patients enrolled in this study, 479 had received aspirin, 39 had received clopidogrel, 294 had received cilostazol alone, and 33 had received a cilostazol-based combined therapy. Compared to patients treated with aspirin, the patients treated with cilostazol had significantly lower all-stroke risk not only in the overall group (HR=0.66, 95% CI=0.48-0.90, p=0.0086), but also in the subgroup of patients with diabetes (HR=0.64, 95% CI=0.42-0.98, p=0.0394) and in the subgroup of patients with high cardiovascular risk (HR=0.66, 95% CI=0.46-0.95, p=0.0254). Additionally, compared to patients treated with aspirin, those treated with cilostazol did not have significantly more hemorrhagic events in the overall group, in the diabetes subgroup, or in the high cardiovascular risk subgroup. Clopidogrel, cilostazol-based combined therapy and aspirin did not significantly differ in terms of efficacy and hemorrhagic events. CONCLUSION Although this database study indicated that cilostazol therapy is an effective alternative treatment for primary prevention of stroke in PAD, further confirmation is needed in large, prospective, and randomized trials.
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Affiliation(s)
- Wen-Hsien Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Taiwan, ROC; Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan, ROC
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116
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Ikeda Y, Sudo T, Kimura Y. Cilostazol. Platelets 2013. [DOI: 10.1016/b978-0-12-387837-3.00057-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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117
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Niazi AK, DiNicolantonio JJ, Lavie CJ, O'Keefe JH, Meier P, Bangalore S. Triple versus Dual Antiplatelet Therapy in Acute Coronary Syndromes: Adding Cilostazol to Aspirin and Clopidogrel. Cardiology 2013; 126:233-43. [DOI: 10.1159/000353674] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 06/11/2013] [Indexed: 11/19/2022]
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118
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Senbokuya N, Kinouchi H, Kanemaru K, Ohashi Y, Fukamachi A, Yagi S, Shimizu T, Furuya K, Uchida M, Takeuchi N, Nakano S, Koizumi H, Kobayashi C, Fukasawa I, Takahashi T, Kuroda K, Nishiyama Y, Yoshioka H, Horikoshi T. Effects of cilostazol on cerebral vasospasm after aneurysmal subarachnoid hemorrhage: a multicenter prospective, randomized, open-label blinded end point trial. J Neurosurg 2013; 118:121-30. [DOI: 10.3171/2012.9.jns12492] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Cerebral vasospasm following aneurysmal subarachnoid hemorrhage (SAH) is a major cause of subsequent morbidity and mortality. Cilostazol, a selective inhibitor of phosphodiesterase 3, may attenuate cerebral vasospasm because of its antiplatelet and vasodilatory effects. A multicenter prospective randomized trial was conducted to investigate the effect of cilostazol on cerebral vasospasm.
Methods
Patients admitted with SAH caused by a ruptured anterior circulation aneurysm who were in Hunt and Kosnik Grades I to IV and were treated by clipping within 72 hours of SAH onset were enrolled at 7 neurosurgical sites in Japan. These patients were assigned to one of 2 groups: the usual therapy group (control group) or the add-on 100 mg cilostazol twice daily group (cilostazol group). The group assignments were done by a computer-generated randomization sequence. The primary study end point was the onset of symptomatic vasospasm. Secondary end points were the onset of angiographic vasospasm and new cerebral infarctions related to cerebral vasospasm, clinical outcome as assessed by the modified Rankin scale, and length of hospitalization. All end points were assessed for the intention-to-treat population.
Results
Between November 2009 and December 2010, 114 patients with SAH were treated by clipping within 72 hours from the onset of SAH and were screened. Five patients were excluded because no consent was given. Thus, 109 patients were randomly assigned to the cilostazol group (n = 54) or the control group (n = 55). Symptomatic vasospasm occurred in 13% (n = 7) of the cilostazol group and in 40% (n = 22) of the control group (p = 0.0021, Fisher exact test). The incidence of angiographic vasospasm was significantly lower in the cilostazol group than in the control group (50% vs 77%; p = 0.0055, Fisher exact test). Multiple logistic analyses demonstrated that nonuse of cilostazol is an independent factor for symptomatic and angiographic vasospasm. The incidence of new cerebral infarctions was also significantly lower in the cilostazol group than in the control group (11% vs 29%; p = 0.0304, Fisher exact test). Clinical outcomes at 1, 3, and 6 months after SAH in the cilostazol group were better than those in the control group, although a significant difference was not shown. There was also no significant difference in the length of hospitalization between the groups. No severe adverse event occurred during the study period.
Conclusions
Oral administration of cilostazol is effective in preventing cerebral vasospasm with a low risk of severe adverse events. Clinical trial registration no. UMIN000004347, University Hospital Medical Information Network Clinical Trials Registry.
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Affiliation(s)
- Nobuo Senbokuya
- 1Department of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Yamanashi
| | - Hiroyuki Kinouchi
- 1Department of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Yamanashi
| | - Kazuya Kanemaru
- 1Department of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Yamanashi
| | - Yasuhiro Ohashi
- 2Department of Neurosurgery and Radiology, Nasu Neurosurgical Center, Nasushiobara, Tochigi
| | - Akira Fukamachi
- 2Department of Neurosurgery and Radiology, Nasu Neurosurgical Center, Nasushiobara, Tochigi
| | - Shinichi Yagi
- 3Department of Neurosurgery, Kanto Neurosurgical Hospital, Kumagaya, Saitama
| | - Tsuneo Shimizu
- 3Department of Neurosurgery, Kanto Neurosurgical Hospital, Kumagaya, Saitama
| | - Koro Furuya
- 4Department of Neurosurgery, Suwa Central Hospital, Chino, Nagano; and
| | - Mikito Uchida
- 4Department of Neurosurgery, Suwa Central Hospital, Chino, Nagano; and
| | - Nobuyasu Takeuchi
- 5Department of Neurosurgery, Yamanashi Prefectural Central Hospital, Kofu, Yamanashi
| | - Shin Nakano
- 5Department of Neurosurgery, Yamanashi Prefectural Central Hospital, Kofu, Yamanashi
| | - Hidehito Koizumi
- 5Department of Neurosurgery, Yamanashi Prefectural Central Hospital, Kofu, Yamanashi
| | | | - Isao Fukasawa
- 6Department of Neurosurgery, Kofu Johnan Hospital, Kofu, Yamanashi
| | - Teruo Takahashi
- 7Department of Neurosurgery, Shizuoka Medical Center, Shizuoka, Japan
| | - Katsuhiro Kuroda
- 7Department of Neurosurgery, Shizuoka Medical Center, Shizuoka, Japan
| | - Yoshihisa Nishiyama
- 1Department of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Yamanashi
| | - Hideyuki Yoshioka
- 1Department of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Yamanashi
| | - Toru Horikoshi
- 1Department of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Yamanashi
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119
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Kondo R, Matsumoto Y, Furui E, Itabashi R, Sato S, Yazawa Y, Shimizu H, Fujiwara S, Takahashi A, Tominaga T. Effect of cilostazol in the treatment of acute ischemic stroke in the lenticulostriate artery territory. Eur Neurol 2012. [PMID: 23207729 DOI: 10.1159/000343799] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cilostazol, an inhibitor of phosphodiesterase 3, has various pleiotropic effects besides its antiplatelet activity. This study examined the efficacy of cilostazol for the treatment of acute perforating artery infarction. METHODS In this prospective, randomized, open-label, blinded-end point trial, 100 patients with cerebral infarction in the territory of the lenticulostriate arteries were enrolled within 48 h of onset. Patients were randomly treated with both cilostazol and ozagrel for 14 days (n = 50, cilostazol group) or ozagrel alone for 14 days (n = 50, control group). The primary end point was the proportion of favorable outcomes 30 days after randomization as defined by a modified Rankin Scale (mRS) score of 0-2. Secondary end points included the incidence of neurological deterioration (an increase of ≥ 2 on the National Institutes of Health Stroke Scale within 7 days). RESULTS Favorable outcomes (mRS scores 0-2) were similar in both groups (81.3 and 82.0% in the cilostazol and control groups, respectively). The incidence of neurological deterioration was lower in the cilostazol group than the control group (12.5 and 16.0%, respectively) with a 21.9% relative risk reduction, although the difference was not statistically significant. CONCLUSIONS Cilostazol did not prevent the neurological deterioration of perforating artery infarction.
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Affiliation(s)
- Ryushi Kondo
- Department of Neuroendovascular Therapy, Kohnan Hospital, Sendai, Japan. rkondoh @ kohnan-sendai.or.jp
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Han SW, Lee SS, Kim SH, Lee JH, Kim GS, Kim OJ, Koh IS, Lee JY, Suk SH, Lee SI, Nam HS, Kim WJ, Yong SW, Lee KY, Park JH. Effect of cilostazol in acute lacunar infarction based on pulsatility index of transcranial Doppler (ECLIPse): a multicenter, randomized, double-blind, placebo-controlled trial. Eur Neurol 2012; 69:33-40. [PMID: 23128968 DOI: 10.1159/000338247] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2011] [Accepted: 03/11/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND This study is intended to evaluate the propensities of cilostazol to reduce the pulsatility index (PI) in patients with acute lacunar infarction using the serial transcranial Doppler (TCD) examinations. METHODS In a multicenter, randomized, double-blind, placebo-controlled trial, patients were randomly assigned to receive either placebo or 100 mg cilostazol twice a day as well as aspirin 100 mg a day. The primary outcomes were the changes of middle cerebral artery (MCA) and basilar artery (BA) PIs at 14 and 90 days from the baseline TCD study. This study is registered with ClinicalTrials.gov (NCT00741286). RESULTS Trial medication was given to 203 patients, with 100 receiving cilostazol and 103 receiving placebo, and 164 were included in the per-protocol analysis of the primary outcome. Results from the linear mixed model showed that significant effects were obtained for time-by-group interactions (p = 0.008 in right MCA, p = 0.015 in left MCA, p = 0.002 in BA), suggesting that changes of PIs from the baseline to the 90-day study were different across the groups. CONCLUSIONS Cilostazol further decreased TCD PIs at 90 days from baseline compared to placebo in acute lacunar infarction. This result may be related to pleiotropic effects, such as vasodilation, beyond its antiplatelet activity.
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Affiliation(s)
- Sang Won Han
- Department of Neurology at Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
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Uchiyama S. [Results of the Cilostazol Stroke Prevention Study II (CSPS II): a randomized controlled trial for the comparison of cilostazol and aspirin in stroke patients]. Rinsho Shinkeigaku 2012; 50:832-4. [PMID: 21921460 DOI: 10.5692/clinicalneurol.50.832] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We compared the efficacy and safety of cilostazol and aspirin in 2,672 Japanese patients with non-cardioembolic ischemic stroke. The patients were randomized to be allocated either on cilostazol (200 mg/day) group or aspirin (81 mg/day) group, and were followed up for one to five years (average 29 months). The primary endpoint was any stroke, and safety endpoint was hemorrhagic stroke or hemorrhage requiring hospitalization. Annual incidence of stroke was significantly lower in the cilostazol group (2.76%) than in the aspirin group (3.71%) (relative risk reduction [RRR] 25.7%, p=0.0357) and annual incidence of hemorrhagic stroke or hemorrhage requiring hospitalization was 0.77% in the cilostazol group and 1.77% in the aspirin group (RRR 54.2%, p=0.0004). The sub-analyses between subtypes of ischemic stroke showed that annual incidence of hemorrhagic stroke was much lower in the cilostazol group (0.36%) than in the aspirin group (1.20%) among patients with lacunar stroke (p=0.003). The results suggest that cilostazol has a favorable risk-benefit profile alternative to aspirin for secondary stroke prevention in patients with non-cardioembolic ischemic stroke, particularly in patients with lacunar stroke, who are at high risk of hemorrhagic stroke.
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Cilostazol suppresses LPS-stimulated maturation of DC2.4 cells through inhibition of NF-κB pathway. J Appl Biomed 2012. [DOI: 10.2478/v10136-012-0012-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Satoh K, Fukasawa I, Kanemaru K, Yoda S, Kimura Y, Inoue O, Ohta M, Kinouchi H, Ozaki Y. Platelet aggregometry in the presence of PGE(1) provides a reliable method for cilostazol monitoring. Thromb Res 2012; 130:616-21. [PMID: 22728022 DOI: 10.1016/j.thromres.2012.05.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Revised: 05/24/2012] [Accepted: 05/25/2012] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Cilostazol has been shown to be effective for prevention and treatment of cerebral infarction. However, there appears to be no widely accepted method appropriate for monitoring cilostazol. We attempted to establish an assay system for cilostazol monitoring, using platelet aggregation induced by arachidonic acid (AA) in the presence of PGE(1) which upregulates intracellular cyclic AMP. METHODS Blood was drawn from stroke patients before and after cilostazol intake. AA-induced platelet aggregation after pretreatment with 0~30nM PGE(1) for 2minutes was measured by light transmittance aggregometry. RESULTS AA-induced platelet aggregation was 73.1±2.2% in the absence of PGE(1), and pretreatment with 30nM PGE(1) had virtually no inhibitory effect on platelet aggregation prior to cilostazol intake. In contrast, after cilostazol intake, 30nM PGE(1) significantly inhibited platelet aggregation to 12.7±4.5% (p=7.8×10(-11)) , while in the absence of PGE(1) platelet aggregation remained similar to that of prior-to-cilostazol value (70.6±3.5%). The plasma concentration of cilostazol ranged from 0.55 to 3.51μM. In the presence of 30nM PGE(1), all the patients with cilostazol concentrations exceeding 1μM had their platelet aggregation inhibited almost completely. ROC analysis suggests that AA-induced platelet aggregation in the presence of 30nM PGE(1) had the excellent sensitivity (90.5%) and specificity (88.4%) for monitoring cilostazol. CONCLUSIONS AA-induced platelet aggregation in the presence of 30nM PGE(1) could give good estimate on plasma concentrations of cilostazol. It is suggested that this system is a good tool for monitoring cilostazol.
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Affiliation(s)
- Kaneo Satoh
- Department of Clinical and Laboratory Medicine, Faculty of Medicine, University of Yamanashi, Shimokato 1110, Chuo, Yamanashi, Japan
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Fisher M, Vasilevko V, Cribbs DH. Mixed cerebrovascular disease and the future of stroke prevention. Transl Stroke Res 2012; 3:39-51. [PMID: 22707990 PMCID: PMC3372772 DOI: 10.1007/s12975-012-0185-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 04/17/2012] [Accepted: 04/19/2012] [Indexed: 12/16/2022]
Abstract
Stroke prevention efforts typically focus on either ischemic or hemorrhagic stroke. This approach is overly simplistic due to the frequent coexistence of ischemic and hemorrhagic cerebrovascular disease. This coexistence, termed “mixed cerebrovascular disease”, offers a conceptual framework that appears useful for stroke prevention strategies. Mixed cerebrovascular disease incorporates clinical and subclinical syndromes, including ischemic stroke, subclinical infarct, white matter disease of aging (leukoaraiosis), intracerebral hemorrhage, and cerebral microbleeds. Reliance on mixed cerebrovascular disease as a diagnostic entity may assist in stratifying risk of hemorrhagic stroke associated with platelet therapy and anticoagulants. Animal models of hemorrhagic cerebrovascular disease, particularly models of cerebral amyloid angiopathy and hypertension, offer novel means for identifying underlying mechanisms and developing focused therapy. Phosphodiesterase (PDE) inhibitors represent a class of agents that, by targeting both platelets and vessel wall, provide the kind of dual actions necessary for stroke prevention, given the spectrum of disorders that characterizes mixed cerebrovascular disease.
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Affiliation(s)
- Mark Fisher
- Department of Neurology, University of California at Irvine, Irvine, CA USA
- Department of Anatomy & Neurobiology, University of California at Irvine, Irvine, CA USA
- Department of Pathology & Laboratory Medicine, University of California at Irvine, Irvine, CA USA
- UC Irvine Medical Center, 101 The City Drive South, Shanbrom Hall Room 121, Orange, CA 92868 USA
| | | | - David H. Cribbs
- Department of Neurology, University of California at Irvine, Irvine, CA USA
- UCI MIND, University of California at Irvine, Irvine, CA USA
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Cheng FC, Chen WL, Wei JW, Huang KS, Yarbrough GG. The Neuroprotective Effects of BNG-1: A New Formulation of Traditional Chinese Medicines for Stroke. THE AMERICAN JOURNAL OF CHINESE MEDICINE 2012; 33:61-71. [PMID: 15844834 DOI: 10.1142/s0192415x05002667] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BNG-1, a novel mixture of traditional Chinese medicines with a long history in the treatment of stroke, exhibited acute neuroprotection effect on rats with middle cerebral artery occlusion (MCAO). Anti-ischemic effects were seen in both animals receiving BNG-1 before the ischemic insult as well as in animals receiving the drug formulation after surgical occlusion of the artery. Anti-thrombic activity was seen in vitro to inhibit arachidonic acid-induced platelet aggregation and in vivo to prolong bleeding time in mice. BNG-1 was also found to inhibit several phosphodiesterase (PDE) isoforms with potency order of the following rank: PDE 1>PDE 3>PDE 6>PDE 2>PDE 4>PDE 5. Other pre-clinical results and emerging clinical data coupled with the present findings suggest that BNG-1 may be a safe and effective therapy for both the prevention and treatment of cerebral stroke. Moreover, the fundamental cellular mechanism underlying its therapeutic effects may result from phosphodiesterase inhibition.
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Del Bene A, Palumbo V, Lamassa M, Saia V, Piccardi B, Inzitari D. Progressive lacunar stroke: review of mechanisms, prognostic features, and putative treatments. Int J Stroke 2012; 7:321-9. [PMID: 22463492 DOI: 10.1111/j.1747-4949.2012.00789.x] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Lacunar stroke is generally considered to have a fair outcome. However 20-30% of patients with lacunar stroke worsen neurologically in hours or days after onset, reaching eventually an unexpectedly severe disability status. In the field of acute stroke, progressive lacunar stroke remains an important unresolved practice problem, because as yet no treatment does exist proven to prevent or halt progression. Pathophysiology of progression is yet incompletely understood. Hemodynamic factors, extension of thrombosis, excitotoxicity, and inflammation, have been proposed as possible mechanisms of progression. A few clinical studies also aimed at establishing presentation features that may help identifying patients at risk of deterioration. In this paper, we review hypothesized mechanisms of lacunar stroke progression and possible markers of early deterioration. Moreover, based on putative mechanisms and suggestions from reported evidence, we propose a few treatments that seem worthy to be tested by randomized clinical trials.
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Affiliation(s)
- Alessandra Del Bene
- Department of Neurological and Psychiatric Sciences, University of Florence, Viale Morgagni, 85, 50134 Florence, Italy.
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Ansara AJ, Shiltz DL, Slavens JB. Use of Cilostazol for Secondary Stroke Prevention: An Old Dog with New Tricks? Ann Pharmacother 2012; 46:394-402. [DOI: 10.1345/aph.1q420] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objective: To evaluate the safety and efficacy of cilostazol for secondary prevention of non-cardioembolic ischemic stroke. Data Sources: PubMed and MEDLINE searches were performed (January 1970-September 2011) using the key words cilostazol, antiplatelet, aspirin, acetylsalicylic acid, secondary stroke prevention, ischemic stroke, intracerebral hemorrhage, intracranial, cerebrovascular accident, and transient ischemic attack. Additionally, reference citations from publications identified were reviewed. Study Selection and Data Extraction: Articles published in English and relevant primary literature evaluating the efficacy and safety of cilostazol in the secondary prevention of atherosclerotic ischemic stroke were included. Data Synthesis: Antiplatelet therapy plays a vital role in the multifaceted approach to secondary stroke prevention. Current American Heart Association/American Stroke Association clinical guidelines for secondary stroke prevention support the use of aspirin, Clopidogrel, and combination aspirin/extended-release dipyridamole. The antiplatelet, antithrombotic, and vasoditatory effects of cilostazol make it a potential alternative agent for atherosclerotic stroke prevention. Recent literature has demonstrated superior efficacy of cilostazol 100 mg twice daily for secondary stroke prevention compared to placebo and aspirin. Three clinical trials were reviewed (1 placebo-controlled, 2 aspirin-controlled), all of which were conducted in Japan or China. Cilostazol reduced the primary outcome of recurrence of stroke, with significantly fewer major bleeding events when compared to aspirin. Conclusions: Available literature suggests that cilostazol may be safer and more effective than aspirin in the secondary prevention of stroke in Asian patients. Further large-scale studies in more heterogeneous study populations are warranted to determine whether cilostazol is a viable therapeutic option for patients with a history of non-cardioembolic ischemic stroke.
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Affiliation(s)
- Alexander J Ansara
- Internal Medicine, Department of Pharmacy, Methodist Hospital (Indiana University Health); Associate Professor of Pharmacy Practice, Department of Pharmacy Practice, College of Pharmacy and Health Sciences, Butler University, Indianapolis, IN
| | - Dane L Shiltz
- Family Medicine, Department of Pharmacy, Methodist Hospital (Indiana University Health); Assistant Professor of Pharmacy Practice, Department of Pharmacy Practice, College of Pharmacy and Health Sciences, Butler University
| | - Jennifer B Slavens
- Internal Medicine, Department of Pharmacy, The Ohio State University Medical Center, Columbus, OH
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Nakamura T, Tsuruta S, Uchiyama S. Cilostazol combined with aspirin prevents early neurological deterioration in patients with acute ischemic stroke: A pilot study. J Neurol Sci 2012; 313:22-6. [DOI: 10.1016/j.jns.2011.09.038] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2011] [Revised: 09/24/2011] [Accepted: 09/28/2011] [Indexed: 10/16/2022]
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Small vessel cerebrovascular disease: the past, present, and future. Stroke Res Treat 2012; 2012:839151. [PMID: 22315706 PMCID: PMC3270464 DOI: 10.1155/2012/839151] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Accepted: 10/26/2011] [Indexed: 12/20/2022] Open
Abstract
Brain infarction due to small vessel cerebrovascular disease (SVCD)-also known as small vessel infarct (SVI) or "lacunar" stroke-accounts for 20% to 25% of all ischemic strokes. Historically, SVIs have been associated with a favorable short-term prognosis. However, studies over the years have demonstrated that SVCD/SVI is perhaps a more complex and less benign phenomenon than generally presumed. The currently employed diagnostic and therapeutic strategies are based upon historical and contemporary perceptions of SVCD/SVI. What is discovered in the future will unmask the true countenance of SVCD/SVI and help furnish more accurate prognostication schemes and effective treatments for this condition. This paper is an overview of SVCD/SVI with respect to the discoveries of the past, what is known now, and what will the ongoing investigations evince in the future.
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Gresele P, Momi S, Falcinelli E. Anti-platelet therapy: phosphodiesterase inhibitors. Br J Clin Pharmacol 2012; 72:634-46. [PMID: 21649691 DOI: 10.1111/j.1365-2125.2011.04034.x] [Citation(s) in RCA: 203] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Inhibition of platelet aggregation can be achieved either by the blockade of membrane receptors or by interaction with intracellular signalling pathways. Cyclic adenosine 3',5'-monophosphate (cAMP) and cyclic guanosine 3',5'-monophosphate (cGMP) are two critical intracellular second messengers provided with strong inhibitory activity on fundamental platelet functions. Phosphodiesterases (PDEs), by catalysing the hydrolysis of cAMP and cGMP, limit the intracellular levels of cyclic nucleotides, thus regulating platelet function. The inhibition of PDEs may therefore exert a strong platelet inhibitory effect. Platelets possess three PDE isoforms (PDE2, PDE3 and PDE5), with different selectivity for cAMP and cGMP. Several nonselective or isoenzyme-selective PDE inhibitors have been developed, and some of them have entered clinical use as antiplatelet agents. This review focuses on the effect of PDE2, PDE3 and PDE5 inhibitors on platelet function and on the evidence for an antithrombotic action of some of them, and in particular of dipyridamole and cilostazol.
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Affiliation(s)
- Paolo Gresele
- Department of Internal Medicine, Section of Internal and Cardiovascular Medicine, University of Perugia, Italy.
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Hase Y, Okamoto Y, Fujita Y, Kitamura A, Nakabayashi H, Ito H, Maki T, Washida K, Takahashi R, Ihara M. Cilostazol, a phosphodiesterase inhibitor, prevents no-reflow and hemorrhage in mice with focal cerebral ischemia. Exp Neurol 2012; 233:523-33. [DOI: 10.1016/j.expneurol.2011.11.038] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Revised: 11/05/2011] [Accepted: 11/25/2011] [Indexed: 11/29/2022]
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Geng DF, Deng J, Jin DM, Wu W, Wang JF. Effect of cilostazol on the progression of carotid intima-media thickness: a meta-analysis of randomized controlled trials. Atherosclerosis 2011; 220:177-83. [PMID: 22015232 DOI: 10.1016/j.atherosclerosis.2011.09.048] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 09/15/2011] [Accepted: 09/27/2011] [Indexed: 10/16/2022]
Abstract
BACKGROUND It has been well established that cilostazol has anti-proliferative effect against in-stent restenosis. However, it remains unclear whether cilostazol can prevent the progression of carotid atherosclerosis. METHODS AND RESULTS We performed a meta-analysis of all relevant randomized controlled trials (RCTs) to evaluate the effect of cilostazol on the progression of carotid intima-media thickness (IMT). Five RCTs with 698 patients [597 subjects with type 2 diabetes mellitus (T2DM)] were included in this study. Cilostazol was associated with a significant reduction in the progression of carotid IMT (WMD, -0.08mm, 95% CI -0.13, -0.04; P=0.00003). Subgroup analysis shows that cilostazol monotherapy or addition to dual antiplatelet therapy (aspirin and clopidogrel) was superior to placebo (WMD, -0.04mm, 95% CI -0.05, -0.03; P<0.00001), no antiplatelet medication (WMD, -0.12mm, 95% CI -0.21, -0.03; P=0.008), aspirin monotherapy (WMD, -0.06mm, 95% CI -0.12, 0.00; P=0.04) or dual antiplatelet therapy (WMD, -0.16mm, 95% CI -0.30, -0.02; P=0.03) in preventing the progression of carotid IMT. Cilostazol resulted in a significant decrease in total cholesterol (WMD -8.47mg/dl, 95% CI -14.18, -2.75; P=0.004) and LDL-C (WMD -8.25mg/dl, 95% CI -14.15, -2.36; P=0.006) and favorable trends in reducing triglyceride (WMD -15.83mg/dl, 95% CI -32.14, 0.48; P=0.06). CONCLUSION It suggests that cilostazol may have beneficial effects in preventing the progression of carotid atherosclerosis and improving pro-atherogenic lipid profile, especially in patients with T2DM. Whether the anti-atherosclerotic effect of cilostazol is independent of improving pro-atherogenic dyslipidemia is worth further investigation.
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Affiliation(s)
- Deng-Feng Geng
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107 West Yanjiang Road, Guangzhou 510120, China
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Abstract
Cilostazol is an antiplatelet drug often used in Asia; however, it is rarely used in the western hemisphere, particularly for stroke patients. Further studies of cilostazol in other ethnicities are required to prove or disprove whether this drug is also beneficial in non-Asian populations.
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Affiliation(s)
- Jong S Kim
- Stroke Center and Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Yamamoto Y, Ohara T, Ishii R, Tanaka E, Murai T, Morii F, Tamura A, Oohara R. A Combined Treatment for Acute Larger Lacunar-Type Infarction. J Stroke Cerebrovasc Dis 2011; 20:387-94. [DOI: 10.1016/j.jstrokecerebrovasdis.2010.02.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Revised: 02/10/2010] [Accepted: 02/13/2010] [Indexed: 10/19/2022] Open
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Rosales RL, Santos MMSDD, Mercado-Asis LB. Cilostazol: a pilot study on safety and clinical efficacy in neuropathies of diabetes mellitus type 2 (ASCEND). Angiology 2011; 62:625-35. [PMID: 21733952 DOI: 10.1177/0003319711410594] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Diabetic polyneuropathy may have vascular and metabolic components in its pathophysiologic mechanism. Cilostazol, aside from its antiplatelet and vasodilatory properties, may increase nerve blood flow and potentially improve neuropathy. OBJECTIVE To assess the efficacy and safety of cilostazol in diabetic polyneuropathy. METHODS Forty-seven diabetic patients were randomized into placebo, low-dose (100 mg/d), and high-dose (200 mg/d) cilostazol groups. Primary efficacy parameter was a change in neuropathy symptom scores and secondary efficacy parameter was a change in walking speed from baseline to week 12. Safety parameters were changes in nerve conduction studies as well as reporting of adverse events. RESULTS/CONCLUSION Despite significant improvement in the neuropathy symptom scores in the overall motor and sensory categories of the 3 arms of the study from baseline to week 12, no significant differences were found among the groups, indicating nonsuperiority of cilostazol in regard to improvement of neuropathy symptoms over the short study span. However, cilostazol, at low dose, was effective in improving walking speed from baseline to week 12, implying an improved blood flow. No significant worsening nor improvement in motor and sensory nerve conduction parameters were observed, comparing the 3 study arms from baseline to weeks 4, 12, and 16, supporting cilostazol's safety. Overall, the adverse events of the 3 study arms did not significantly differ, and neither were there serious adverse events reported, also signifying safety and tolerability in our Filipino cohort of patients with neuropathy in diabetes mellitus treated with cilostazol.
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Affiliation(s)
- Raymond L Rosales
- Department of Neurology and Psychiatry, Faculty of Medicine and Surgery, The University of Santo Tomas Hospital, Manila, Philippines.
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Abstract
Atherothrombosis remains a major global public health problem. Chronic atherosclerotic disease is often clinically silent and coexists across vascular beds, but when complicated by thrombosis can result in acute coronary syndrome, stroke, transient ischaemic attack and critical limb ischaemia. Platelets play a role in the development of chronic atherosclerotic disease and are a key mediator of clinical events in atherothrombosis. Numerous trials have examined the role of antiplatelet agents in primary and secondary prevention and several new antiplatelet drugs are under development. In secondary prevention, there is evidence of clear benefit of single and in some cases dual antiplatelet therapy in the prevention of recurrent cerebro-vascular complications. Dual antiplatelet therapy has emerged as the standard of care in acute coronary syndromes, with aspirin typically being used in combination with clopidogrel or one of the newer more potent antiplatelet agents. Conversely, in chronic stable coronary disease, no benefit has yet been convincingly demonstrated from dual antiplatelet therapy. In cerebro-vascular disease, aspirin monotherapy remains the cornerstone of prevention of recurrent events, with clopidogrel or the combination of aspirin and dipyridamole being only modestly more efficacious. In primary prevention, the evidence for the routine use of aspirin or any other antiplatelet agent is mixed and suggests this should only be considered on an individual basis in high-risk groups where the thrombotic risk outweighs the risk of major bleeding complications.
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Affiliation(s)
- Ph G Steg
- INSERM U-698, Université Paris-Diderot, Assistance Publique-Hôpitaux de Paris, Paris, France.
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137
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Lee YS, Bae HJ, Kang DW, Lee SH, Yu K, Park JM, Cho YJ, Hong KS, Kim DE, Kwon SU, Lee KB, Rha JH, Koo J, Han MG, Lee SJ, Lee JH, Jung SW, Lee BC, Kim JS. Cilostazol in Acute Ischemic Stroke Treatment (CAIST Trial): a randomized double-blind non-inferiority trial. Cerebrovasc Dis 2011; 32:65-71. [PMID: 21613787 DOI: 10.1159/000327036] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2010] [Accepted: 03/03/2011] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Aspirin is a proven antiplatelet agent in acute ischemic stroke, and there are no current guidelines for other antiplatelet treatments. We aimed to compare the efficacy and safety of cilostazol with aspirin in acute stroke. METHODS Patients with measurable neurological deficits (NIHSS score ≤15) within 48 h of onset were randomly assigned to cilostazol (200 mg/day) or aspirin (300 mg/day) for 90 days. The primary endpoint was a modified Rankin Scale (mRS) score of 0-2 at 90 days. Cardiovascular events, bleeding complications, and other functional outcomes were also assessed. Statistical analysis was carried out by intention-to-treat and per-protocol bases. This trial is registered with ClinicalTrials.gov (NCT00272454). RESULTS In total, 458 patients were enrolled (mean age of 63 years, median NIHSS of 3), and mRS at 90 days was obtained in 447 patients. The primary endpoint was achieved in 76% (173/228) of those randomized to cilostazol and in 75% (165/219) assigned to aspirin, which supported the pre-specified non-inferiority of cilostazol to aspirin (95% CI of proportion difference: -6.15 to 7.22%, p = 0.0004). These results were also supported by per-protocol analysis (p = 0.045). Cardiovascular events occurred in 6 patients (3%) treated with cilostazol, and in 9 patients (4%) treated with aspirin (p = 0.41). Adverse events were more common in cilostazol-treated patients during the trial (91 vs. 85%, p = 0.055), while the frequencies of bleeding complications (cilostazol 11%, aspirin 13%, p = 0.43) or drug discontinuation (cilostazol 10%, aspirin 7%, p = 0.32) were not different. CONCLUSION Cilostazol is feasible in acute ischemic stroke, and comparable to aspirin in its efficacy and safety.
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Affiliation(s)
- Yong-Seok Lee
- Seoul National University Boramae Medical Center, Seoul, Korea.
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138
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Antithrombotic Management for Transient Ischemic Attack and Ischemic Stroke (Other than Atrial Fibrillation). Curr Atheroscler Rep 2011; 13:314-20. [DOI: 10.1007/s11883-011-0185-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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139
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Al-Qudah ZA, Hassan AE, Qureshi AI. Cilostazol in patients with ischemic stroke. Expert Opin Pharmacother 2011; 12:1305–1315. [DOI: 10.1517/14656566.2011.576248] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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140
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Benavente OR, White CL, Pearce L, Pergola P, Roldan A, Benavente MF, Coffey C, McClure LA, Szychowski JM, Conwit R, Heberling PA, Howard G, Bazan C, Vidal-Pergola G, Talbert R, Hart RG. The Secondary Prevention of Small Subcortical Strokes (SPS3) study. Int J Stroke 2011; 6:164-75. [PMID: 21371282 PMCID: PMC4214141 DOI: 10.1111/j.1747-4949.2010.00573.x] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Small subcortical strokes, also known as lacunar strokes, comprise more than 25% of brain infarcts, and the underlying vasculopathy is the most common cause of vascular cognitive impairment. How to optimally prevent stroke recurrence and cognitive decline in S3 patients is unclear. The aim of the Secondary Prevention of Small Subcortical Strokes study (Trial registration: NCT00059306) is to define strategies for reducing stroke recurrence, cognitive decline, and major vascular events. METHODS Secondary Prevention of Small Subcortical Strokes is a randomised, multicentre clinical trial (n = 3000) being conducted in seven countries, and sponsored by the US NINDS/NIH. Patients with symptomatic small subcortical strokes in the six-months before and an eligible lesion on magnetic resonance imaging are simultaneously randomised, in a 2 × 2 factorial design, to antiplatelet therapy--325 mg aspirin daily plus 75 mg clopidogrel daily, vs. 325 mg aspirin daily plus placebo, double-blind--and to one of two levels of systolic blood pressure targets--'intensive' (<130 mmHg) vs. 'usual' (130-149 mmHg). Participants are followed for an average of four-years. Time to recurrent stroke (ischaemic or haemorrhagic) is the primary outcome and will be analysed separately for each intervention. The secondary outcomes are the rate of cognitive decline and major vascular events. The primary and most secondary outcomes are adjudicated centrally by those unaware of treatment assignment. CONCLUSIONS Secondary Prevention of Small Subcortical Strokes will address several important clinical and scientific questions by testing two interventions in patients with recent magnetic resonance imaging-defined lacunar infarcts, which are likely due to small vessel disease. The results will inform the management of millions of patients with this common vascular disorder.
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Affiliation(s)
- Oscar R. Benavente
- Department of Medicine, Brain Research Center, Division of Neurology, University of British Columbia, Vancouver, BC, Canada
| | - Carole L. White
- School of Nursing, University of Texas Health Sciences Center at San Antonio, San Antonio, TX, USA
| | | | - Pablo Pergola
- Department of Neurology, University of Texas Health Sciences Center at San Antonio, San Antonio, TX, USA
| | - Ana Roldan
- Department of Medicine, Brain Research Center, Division of Neurology, University of British Columbia, Vancouver, BC, Canada
| | - Marie-France Benavente
- Department of Medicine, Brain Research Center, Division of Neurology, University of British Columbia, Vancouver, BC, Canada
| | | | - Leslie A. McClure
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jeff M. Szychowski
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robin Conwit
- NINDS, Office of Clinical Research, Bethesda, MD, USA
| | - Patricia A. Heberling
- Department of Neurology, University of Texas Health Sciences Center at San Antonio, San Antonio, TX, USA
| | - George Howard
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Carlos Bazan
- Department of Radiology, University of Texas Health Sciences Center at San Antonio, San Antonio, TX, USA
| | - Gabriela Vidal-Pergola
- Department of Neurology, University of Texas Health Sciences Center at San Antonio, San Antonio, TX, USA
| | - Robert Talbert
- College of Pharmacy, University of Texas at Austin, Austin, TX, USA
| | - Robert G. Hart
- Department of Neurology, University of Texas Health Sciences Center at San Antonio, San Antonio, TX, USA
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141
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Hashimoto K, Ishima T. Neurite outgrowth mediated by translation elongation factor eEF1A1: a target for antiplatelet agent cilostazol. PLoS One 2011; 6:e17431. [PMID: 21390260 PMCID: PMC3046984 DOI: 10.1371/journal.pone.0017431] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Accepted: 01/29/2011] [Indexed: 01/29/2023] Open
Abstract
Cilostazol, a type-3 phosphodiesterase (PDE3) inhibitor, has become widely used as an antiplatelet drug worldwide. A recent second Cilostazol Stroke Prevention Study demonstrated that cilostazol is superior to aspirin for prevention of stroke after an ischemic stroke. However, its precise mechanisms of action remain to be determined. Here, we report that cilostazol, but not the PDE3 inhibitors cilostamide and milrinone, significantly potentiated nerve growth factor (NGF)-induced neurite outgrowth in PC12 cells. Furthermore, specific inhibitors for the endoplasmic reticulum protein inositol 1,4,5-triphosphate (IP(3)) receptors and several common signaling pathways (PLC-γ, PI3K, Akt, p38 MAPK, and c-Jun N-terminal kinase (JNK), and the Ras/Raf/ERK/MAPK) significantly blocked the potentiation of NGF-induced neurite outgrowth by cilostazol. Using a proteomics analysis, we identified that levels of eukaryotic translation elongation factor eEF1A1 protein were significantly increased by treatment with cilostazol, but not cilostamide, in PC12 cells. Moreover, the potentiating effects of cilostazol on NGF-induced neurite outgrowth were significantly antagonized by treatment with eEF1A1 RNAi, but not the negative control of eEF1A1. These findings suggest that eEF1A1 and several common cellular signaling pathways might play a role in the mechanism of cilostazol-induced neurite outgrowth. Therefore, agents that can increase the eEF1A1 protein may have therapeutic relevance in diverse conditions with altered neurite outgrowth.
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Affiliation(s)
- Kenji Hashimoto
- Division of Clinical Neuroscience, Center for Forensic Mental Health, Chiba University, Chiba, Japan.
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142
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Matsumoto S, Shimodozono M, Miyata R, Kawahira K. Effect of cilostazol administration on cerebral hemodynamics and rehabilitation outcomes in poststroke patients. Int J Neurosci 2011; 121:271-8. [PMID: 21348793 DOI: 10.3109/00207454.2010.551431] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PRIMARY OBJECTIVE Cilostazol is an antiplatelet agent that inhibits phosphodiesterase III in platelets and the vascular endothelium. We assessed the effects of cilostazol on human cerebral hemodynamics and rehabilitation outcomes. RESEARCH DESIGN Prospective, consecutive, observational trial with pretreatment and posttreatment evaluations. EXPERIMENTAL INTERVENTIONS Cilostazol (200 mg/day) administered for 8 weeks. METHODS AND PROCEDURES Cerebral blood flow at rest, cerebrovascular reserve capacity, and rehabilitation outcomes (Brunnstrom stage, Barthel index score, modified Rankin Scale score, and Mini-Mental State Examination score) were measured in 104 poststroke patients with an average age ± standard deviation of 60.8 ± 9.2 years. MAIN OUTCOMES AND RESULTS The cerebral blood flow increased by 23.8% on the affected side of the brain and by 16.9% on the nonaffected side. The cerebrovascular reserve capacity increased by 19.0% on the affected side of the brain and by 13.3% on the nonaffected side. Improvements were observed in the Brunnstrom stage, Barthel index score, modified Rankin Scale score, and Mini-Mental State Examination score. CONCLUSIONS Cilostazol appeared to have beneficial effects in poststroke patients with cerebral ischemia and might improve cerebral circulation and rehabilitation outcome.
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Affiliation(s)
- Shuji Matsumoto
- Department of Rehabilitation and Physical Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kirishima City, Kagoshima, Japan.
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143
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Margey R, Drachman DE. Carotid artery disease and stenting: insights from recent clinical trials. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2011; 13:129-45. [PMID: 21318556 DOI: 10.1007/s11936-011-0116-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OPINION STATEMENT Cerebrovascular disease remains a leading cause of morbidity, mortality, and health care expenditure in the United States. Approximately 80% of strokes are ischemic in origin, with 20% to 25% due to atherosclerotic disease of the carotid artery. It is well established that untreated, symptomatic carotid stenosis confers a 25% risk of stroke within 2 years, and that asymptomatic carotid stenosis > 60% is associated with an 11% stroke risk at 5 years. Over the past six decades, surgical revascularization with carotid endarterectomy, when performed by experienced surgeons, has been demonstrated to be effective in reducing stroke risk in patients with severe stenosis. During the same time, medical therapy has improved considerably, and endovascular therapy with carotid angioplasty and stenting has emerged as an important alternative strategy that may play a significant role in reducing the risk of stroke in patients with carotid disease. In this review, we examine the current evidence regarding optimal medical therapy, endarterectomy, and stenting for the management of patients with carotid stenosis. Armed with these data, we may tailor our approach to optimize care based on patient- and lesion-specific considerations.
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Affiliation(s)
- Ronan Margey
- Cardiology Division, Section of Vascular Medicine, Massachusetts General Hospital and Harvard Medical School, Gray-Bigelow 800, 55 Fruit Street, Boston, MA, 02114, USA
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144
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Weber R, Diener HC. Controversies and future perspectives of antiplatelet therapy in secondary stroke prevention. J Cell Mol Med 2011; 14:2371-80. [PMID: 20738445 PMCID: PMC3823155 DOI: 10.1111/j.1582-4934.2010.01162.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Antiplatelet agents are a cornerstone in the treatment of acute arterial thrombotic events and in the prevention of thrombus formation. However, existing antiplatelet agents (mainly aspirin, the combination of aspirin and dipyridamole and clopidogrel) reduce the risk of vascular events only by about one quarter compared with placebo. As a consequence, more efficacious antiplatelet therapies with a reduced bleeding risk are needed. We give an overview of several new antiplatelet agents that are currently investigated in secondary stroke prevention: adenosine 5'-diphosphonate receptor antagonists, cilostazol, sarpogrelate, terutroban and SCH 530348. There are unique features in secondary stroke prevention that have to be taken into account: ischaemic stroke is a heterogeneous disease caused by multiple aetiologies and the blood-brain barrier is disturbed after stroke which may result in a higher intracerebral bleeding risk. Several small randomized trials indicated that the combination of aspirin and clopidogrel might be superior to antiplatelet monotherapy in the acute and early post-ischaemic phase. There is an ongoing debate about antiplatelet resistance. Decreasing response to aspirin is correlated independently with an increased risk of cardiovascular events. However, there is still no evidence from randomized trials linking aspirin resistance and recurrent ischaemic events. Similarly, randomized trials have not demonstrated a clinical significantly decreased antiplatelet effect by the concomitant use of clopidogrel and proton pump inhibitors. Nevertheless, a routine use of this drug combination is not recommended.
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Affiliation(s)
- Ralph Weber
- Department of Neurology and Stroke Center, University Duisburg-Essen, Essen, Germany
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145
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Rizzo M, Corrado E, Patti AM, Rini GB, Mikhailidis DP. Cilostazol and atherogenic dyslipidemia: a clinically relevant effect? Expert Opin Pharmacother 2011; 12:647-55. [DOI: 10.1517/14656566.2011.557359] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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146
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Abstract
Stroke is one of the leading causes of disability; most are due to atherothrombotic mechanisms. About one third of ischemic strokes are preceded by other stroke or transient ischemic attacks. Stroke survivors are at high risk for vascular events (i.e., cerebrovascular and cardiovascular). Prevention of recurrent stroke and other major vascular events can be accomplished by control of risk factors. Nonetheless, the use of antiplatelet agents remains the fundamental component of secondary stroke prevention strategy in patients with noncardioembolic disease. Currently, the uses of aspirin, clopidogrel, or aspirin plus extended-release dipyridamole are valid alternatives for stroke or transient ischemic attack patients. To maximize the beneficial effects of these agents, the treatment should be initiated as early as possible and continue on a lifelong basis.
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Affiliation(s)
- Thalia S. Field
- Department of Medicine, Division of Neurology, University of British Columbia, S169-2211 Wesbrook Mall, Vancouver, BC V6T 2B5, Canada
| | - Oscar R. Benavente
- Department of Medicine, Division of Neurology, Brain Research Center, University of British Columbia, S169-2211 Wesbrook Mall, Vancouver, BC V6T 2B5, Canada
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147
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148
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Kai Y, Watanabe M, Morioka M, Hirano T, Yano S, Ohmori Y, Kawano T, Hamada JI, Kuratsu JI. Cilostazol improves symptomatic intracranial artery stenosis - Evaluation of cerebral blood flow with single photon emission computed tomography. Surg Neurol Int 2011; 2:8. [PMID: 21297930 PMCID: PMC3031048 DOI: 10.4103/2152-7806.76145] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Accepted: 11/29/2010] [Indexed: 11/11/2022] Open
Abstract
Background: To evaluate the effectiveness of cilostazol in patients with intracranial arterial stenosis, we used magnetic resonance angiography (MRA). The drug's effect on the cerebral blood flow (CBF) was examined by single photon emission computed tomography (SPECT). Methods: In this retrospective study, we evaluated the clinical outcomes of 20 patients with stenosis in the M1 segment of the middle cerebral artery (MCA) who had suffered ischemic stroke within 12 weeks or manifested asymptomatic stenosis exceeding 50%. All patients received cilostazol (100 mg twice daily). MRA and SPECT (at rest and after acetazolamide challenge) studies were performed before and 6 and 12 months after the start of cilostazol treatment. Results: In 5 patients the stenotic lesion showed improvement on MRA. Mean stenosis before cilostazol therapy was 71.7 ± 4.9%, which improved to 39.0 ± 3.2% at 6 months and to 27.2 ± 2.8% at 12 months. SPECT study showed that CBF was improved in 3 patients; in one there was improvement at rest and the other 2 manifested improvement upon acetazolamide challenge. Conclusions: Cilostazol had a remodeling effect on stenotic lesions due to arteriosclerotic changes and improved CBF in some patients.
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Affiliation(s)
- Yutaka Kai
- Department of Neurosurgery, Graduate School of Medicine, Kumamoto University, Kumamoto, Japan
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149
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Kamal AK, Naqvi I, Husain MR, Khealani BA. Cilostazol versus aspirin for secondary prevention of vascular events after stroke of arterial origin. Cochrane Database Syst Rev 2011; 2011:CD008076. [PMID: 21249700 PMCID: PMC6599824 DOI: 10.1002/14651858.cd008076.pub2] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Aspirin is widely used for secondary prevention after stroke. Cilostazol has shown promise as an alternative to aspirin in Asian people with stroke. OBJECTIVES To determine the relative effectiveness and safety of cilostazol compared directly with aspirin in the prevention of stroke and other serious vascular events in patients at high vascular risk for subsequent stroke, those with previous transient ischaemic attack (TIA) or ischaemic stroke of arterial origin. SEARCH STRATEGY We searched the Cochrane Stroke Group Trials Register (last searched September 2010), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2009, Issue 4), MEDLINE (1950 to May 2010) and EMBASE (1980 to May 2010). In an effort to identify further published, ongoing and unpublished studies we searched journals, conference proceedings and ongoing trial registers, scanned reference lists from relevant studies and contacted trialists and Otsuka Pharmaceutical Co Ltd. SELECTION CRITERIA We selected all randomised controlled trials (RCTs) comparing cilostazol with aspirin where participants were treated for at least one month and followed systematically for development of vascular events. DATA COLLECTION AND ANALYSIS Data extracted from eligible studies included: (1) a composite outcome of vascular events (stroke, myocardial infarction or vascular death) during follow up (primary outcome); (2) separate outcomes of stroke (ischaemic or haemorrhagic, fatal or non-fatal), myocardial infarction (MI) (fatal or non-fatal), vascular death and death from all causes; and (3) main outcomes of safety including any intracranial, extracranial or gastrointestinal (GI) haemorrhage and other outcomes during treatment follow up (secondary outcomes). We computed an estimate of treatment effect and performed a test for heterogeneity between trials. We analysed data on an intention-to-treat basis and assessed bias for all included studies. MAIN RESULTS We included two RCTs with 3477 Asian participants. Compared with aspirin, cilostazol was associated with a significantly lower risk of composite outcome of vascular events (6.77% versus 9.39%, risk ratio (RR) 0.72, 95% confidence interval (CI) 0.57 to 0.91), and lower risk of haemorrhagic stroke (0.53% versus 2.01%, RR 0.26, 95% CI 0.13 to 0.55). In terms of outcome of safety compared with aspirin, cilostazol was significantly associated with minor adverse effects (8.22% versus 4.95%, RR 1.66, 95% CI 1.51 to 1.83). AUTHORS' CONCLUSIONS Cilostazol is more effective than aspirin in the prevention of vascular events secondary to stroke. Cilostazol has more minor adverse effects, although there is evidence of fewer bleeds.
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Affiliation(s)
- Ayeesha K Kamal
- Aga Khan University HospitalStroke Service, International Cerebrovascular Translational Clinical Research Training Program, Section of Neurology, Department of MedicineStadium RoadPO Box 3500KarachiPakistan74800
| | - Imama Naqvi
- Aga Khan University HospitalStroke Service, International Cerebrovascular Translational Clinical Research Training Program, Section of Neurology, Department of MedicineStadium RoadPO Box 3500KarachiPakistan74800
| | - Muhammad R Husain
- Aga Khan University HospitalStroke Service, Section of Neurology, Department of MedicineStadium RoadPO Box 3500KarachiPakistan74800
| | - Bhojo A Khealani
- Aga Khan University HospitalStroke Service, Section of Neurology, Department of MedicineStadium RoadPO Box 3500KarachiPakistan74800
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150
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Ueno M, Kodali M, Tello-Montoliu A, Angiolillo DJ. Role of Platelets and Antiplatelet Therapy in Cardiovascular Disease. J Atheroscler Thromb 2011; 18:431-42. [DOI: 10.5551/jat.7633] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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