A Safer Alternative to Aspirin?

LONDON, May 4, 2008-A study in China has shown that the antiplatelet* drug cilostazol is as effective as aspirin at preventing recurrent stroke, but causes less 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.

Patients with a mean age of just over 60 years were enrolled, with 360 randomised to receive cilostazol and 359 to receive aspirin. Patients in both groups took the medication for 12–18 months, with the endpoint measured being any recurrence of stroke. Patients were examined using a variety of diagnostic techniques, including MRI, to assess this. The researchers found that 12 patients in the cilostazol group had a recurrence of stroke, compared with 20 in the aspirin group—translating to a 38% reduction in risk in the cilostazol group. 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 (1 patient) versus the aspirin group (7 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."

In an accompanying Reflection and Reaction comment, Dr Graeme J Hankey, Department of Neurology, Royal Perth Hospital, Perth, WA, Australia, says: "The implications of these results for clinicians are that they offer hope for a safer antiplatelet drug that is at least as effective as aspirin for use in patients with ischaemic stroke."

Dr Yining Huang, Department of Neurology, Peking University First Hospital, Beijing, China. T) +86-10-66551122 ext 2857

Dr Graeme J Hankey, Department of Neurology, Royal Perth Hospital, Perth, WA, Australia. T) + 61 404 894 071 / + 61 8 9224 2244

Posted: May 2008

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