Dual Antiplatelet Therapy With Cilostazol for Secondary Prevention in Lacunar Stroke: Subanalysis of the CSPS.com Trial Article Swipe
Yasuhiro Nishiyama
,
Kazumi Kimura
,
Toshiaki Otsuka
,
Ḱazunori Toyoda
,
Shinichiro Uchiyama
,
Haruhiko Hoshino
,
Nobuyuki Sakai
,
Yasushi Okada
,
Hideki Origasa
,
Hiroaki Naritomi
,
Kiyohiro Houkin
,
Keiji Yamaguchi
,
Kazuo Minematsu
,
Masayasu Matsumoto
,
Teiji Tominaga
,
Hidekazu Tomimoto
,
Yasuo Terayama
,
Satoshi Yasuda
,
Takenori Yamaguchi
·
YOU?
·
· 2023
· Open Access
·
· DOI: https://doi.org/10.1161/strokeaha.122.039900
YOU?
·
· 2023
· Open Access
·
· DOI: https://doi.org/10.1161/strokeaha.122.039900
Background: The effectiveness of long-term dual antiplatelet therapy (DAPT) to prevent recurrent strokes in patients with lacunar stroke remains unclarified. Therefore, this study aimed to compare and to elucidate the safety and effectiveness of DAPT and single antiplatelet therapy (SAPT) in preventing recurrence in chronic lacunar stroke. Methods: CSPS.com (Cilostazol Stroke Prevention Study for Antiplatelet Combination) was a prospective, multicenter, randomized controlled trial. In this prespecified subanalysis, 925 patients (mean age, 69.5 years; 69.4% men) with lacunar stroke were selected from 1884 patients with high-risk noncardioembolic stroke, enrolled in the CSPS.com trial after 8 to 180 days following stroke. Patients were randomly assigned to receive either SAPT or DAPT using cilostazol and were followed for 0.5 to 3.5 years. The primary efficacy outcome was the first recurrence of ischemic stroke. The safety outcomes were severe or life-threatening bleeding. Results: The DAPT group receiving cilostazol and either aspirin or clopidogrel and SAPT group receiving aspirin or clopidogrel alone comprised 464 (50.2%) and 461 (49.8%) patients, respectively. Ischemic stroke occurred in 12 of 464 patients (1.84 per 100 patient-years) in the DAPT group and 31 of 461 patients (4.42 per 100 patient-years) in the SAPT group, during follow-up. After adjusting for multiple potential confounding factors, ischemic stroke risk was significantly lower in the DAPT group than in the SAPT group (hazard ratio, 0.43 [95% CI, 0.22–0.84]). The rate of severe or life-threatening hemorrhage did not differ significantly between the groups (2 patients [0.31 per 100 patient-years] versus 6 patients [0.86 per 100 patient-years] in the DAPT and SAPT groups, respectively; hazard ratio, 0.36 [95% CI, 0.07–1.81]). Conclusions: In patients with lacunar stroke, DAPT using cilostazol had significant benefits in reducing recurrent ischemic stroke incidence compared with SAPT without increasing the risk of severe or life-threatening bleeding. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01995370. URL: https://www.umin.ac.jp/ctr ; Unique identifier: UMIN000012180.
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Metadata
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.1161/strokeaha.122.039900
- https://www.ahajournals.org/doi/pdf/10.1161/STROKEAHA.122.039900
- OA Status
- bronze
- Cited By
- 24
- References
- 33
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W4319063241
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
-
https://openalex.org/W4319063241Canonical identifier for this work in OpenAlex
- DOI
-
https://doi.org/10.1161/strokeaha.122.039900Digital Object Identifier
- Title
-
Dual Antiplatelet Therapy With Cilostazol for Secondary Prevention in Lacunar Stroke: Subanalysis of the CSPS.com TrialWork title
- Type
-
articleOpenAlex work type
- Language
-
enPrimary language
- Publication year
-
2023Year of publication
- Publication date
-
2023-02-03Full publication date if available
- Authors
-
Yasuhiro Nishiyama, Kazumi Kimura, Toshiaki Otsuka, Ḱazunori Toyoda, Shinichiro Uchiyama, Haruhiko Hoshino, Nobuyuki Sakai, Yasushi Okada, Hideki Origasa, Hiroaki Naritomi, Kiyohiro Houkin, Keiji Yamaguchi, Kazuo Minematsu, Masayasu Matsumoto, Teiji Tominaga, Hidekazu Tomimoto, Yasuo Terayama, Satoshi Yasuda, Takenori YamaguchiList of authors in order
- Landing page
-
https://doi.org/10.1161/strokeaha.122.039900Publisher landing page
- PDF URL
-
https://www.ahajournals.org/doi/pdf/10.1161/STROKEAHA.122.039900Direct link to full text PDF
- Open access
-
YesWhether a free full text is available
- OA status
-
bronzeOpen access status per OpenAlex
- OA URL
-
https://www.ahajournals.org/doi/pdf/10.1161/STROKEAHA.122.039900Direct OA link when available
- Concepts
-
Medicine, Cilostazol, Lacunar stroke, Stroke (engine), Secondary prevention, Aspirin, Platelet aggregation inhibitor, Internal medicine, Ischemic stroke, Cardiology, Ischemia, Mechanical engineering, EngineeringTop concepts (fields/topics) attached by OpenAlex
- Cited by
-
24Total citation count in OpenAlex
- Citations by year (recent)
-
2025: 10, 2024: 11, 2023: 3Per-year citation counts (last 5 years)
- References (count)
-
33Number of works referenced by this work
- Related works (count)
-
10Other works algorithmically related by OpenAlex
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