Abstract 4034: Aspirin And Cilostazol Increase Cerebral Blood Flow In Acute Ischemic Stroke Patients Compared To Clopidogrel - A Single Center, Randomized, Open, Blinided-endpoint Pilot Study

Abstract

Introduction & Hypothesis : Antiplatelet drugs are widely used in the treatment and prevention of ischemic stroke. The key effect of antiplatelet drugs is inhibition of platelet aggregation, which may prolong bleeding time and increase bleeding complications. Improving cerebral blood flow (CBF) is important in recovery after ischemic stroke. Cilostazol is a phosphodiesterase III inhibitor and has a vasodilatory effect as well as antiplatelet effect. Previous report showed that cilostazol did not increase bleeding time despite comparable effect on platelet aggregation compared to aspirin or clopidogrel. Cilostazol is also known to increase CBF. We conducted a single center, prospective, randomised, open-label blinded-endpoint pilot study to assess the hypothesis that aspirin plus cilostazol may increase CBF compared to clopidogrel in patients with acute ischemic stroke. Methods : We enrolled consecutive 24 acute ischemic stroke patients who visited our clinic within 72 hours of symptom onset. Patients were randomly assigned to aspirin (100 mg/d) and cilostazol (200 mg/d) (n=11) or clopidogrel (75 mg/d, n=13) and treated for 12 weeks. Measurement of platelet aggregation (ADP, collagen, epinephrine, and ristocetin), bleeding time and CBF were done at baseline (before taking study medication) and at 12 weeks. CBF was measured by use of 99mTc HMPAO SPECT and the results were analyzed by use of statistical parametric mapping 2 (SPM 2) with aid of MATLAB 6.1 software. Results : Demographic and clinical features of the patients of each treatment group were not significantly different. Degree of platelet aggregation and bleeding time at baseline and 12 weeks were not significantly different between the treatment groups. The change of CBF between baseline and at 12 weeks were significantly different and CBF were more increased in patients treated with aspirin and cilostazol compared to clopidogrel only. Two patients taking clopidogrel had serious adverse events; one with angina pectoris and the other duodenal ulcer. Conclusion : In ischemic stroke patients, aspirin plus cilostazol increased CBF significantly more than clopidogrel only with similar effect on platelet aggregation and bleeding time.