DAPT with cilostazol reduces stroke recurrence without raising bleeding risk

Dual antiplatelet therapy (DAPT) using cilostazol appears to be more beneficial than single antiplatelet therapy (SAPT), with the results of a study suggesting that DAPT helps lower the incidence of ischemic stroke recurrence without increasing the risk of severe or life-threatening bleeding.

The study, CSPS.com (Cilostazol Stroke Prevention Study for Antiplatelet Combination), involved 1,884 patients with high-risk noncardioembolic stroke. These patients were randomly assigned to receive treatment with either SAPT or DAPT using cilostazol. All of them were followed up between 0.5 and 3.5 years.

The present analysis included a subgroup of 925 patients (mean age 69.5 years, 69.4 percent men) with lacunar stroke, among whom 464 (50.2 percent) were in the DAPT group receiving cilostazol and either aspirin or clopidogrel and 461 (49.8 percent) in the SAPT group receiving aspirin or clopidogrel alone.

The primary efficacy endpoint of the first recurrence of ischemic stroke occurred in 12 patients in the DAPT group and in 31 patients in the SAPT group. The respective incidence rates were 1.84 and 4.42 per 100 patient-years.

On multivariable analysis, DAPT was associated with a significantly lower risk of recurrence compared with SAPT (hazard ratio [HR], 0.43, 95 percent confidence interval [CI], 0.22–0.84).

The safety outcome of severe or life-threatening bleeding did not significantly differ by treatment, occurring in two patients in the DAPT group and in six patients in the SAPT group (0.31 vs 0.86 per 100 patient-years; HR, 0.36, 95 percent CI, 0.07–1.81).