Lee, Yu Jeong; Je, Nam Kyung
European journal of clinical pharmacology
2023Aug ; 79 ( 8 ) :1107-1116.
PMID : 37310478
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Lee, Yu Jeong -
Je, Nam Kyung -
ABSTRACT
Purpose: Cilostazol is a widely used antiplatelet drug for secondary stroke prevention in Asia, but its comparison with clopidogrel is not well understood. This study aims to investigate the effectiveness and safety of cilostazol compared to clopidogrel for the secondary prevention of noncardioembolic ischemic stroke.
Methods: This retrospective comparative effectiveness research analyzed 1:1 propensity scorematched data from insured individuals between 2012 and 2019, using administrative claims data in Health Insurance Review and Assessment in Korea. Patients with diagnosis codes for ischemic stroke without cardiac disease were included and divided into two groups, those receiving cilostazol and those receiving clopidogrel. The primary outcome was a recurrent ischemic stroke. Secondary outcomes included all-cause death, myocardial infarction, hemorrhagic stroke, and a composite of these outcomes. The safety outcome was major gastrointestinal bleeding.
Results: The study analyzed 4,754 patients in the propensity scorematched population and found no statistically significant difference in recurrent ischemic stroke (cilostazol group vs clopidogrel group, 2.7% vs 3.2%; 95% CI, 0.62-1.21), the composite outcome of recurrent ischemic stroke, all-cause death, myocardial infarction, and hemorrhagic stroke (5.1% vs 5.5%; 0.75-1.22), and major gastrointestinal bleeding (1.3% vs 1.5%; 0.57-1.47) between patients receiving cilostazol and those receiving clopidogrel. In subgroup analysis, cilostazol was associated with a lower incidence of recurrent ischemic stroke compared to clopidogrel in hypertensive patients (2.5% vs 3.9%; interaction P = 0.041).
Conclusions: This real-world study suggests that cilostazol is effective and safe for noncardioembolic ischemic stroke and may be associated with better effectiveness in hypertensive patients compared to clopidogrel.
keyword
Antiplatelet therapy; Cilostazol; Clopidogrel; Ischemic stroke; Secondary prevention
MESH
Humans, Clopidogrel/adverse effects, Cilostazol/adverse effects, Aspirin/adverse effects, *Ischemic Stroke/drug therapy, Retrospective Studies, *Hemorrhagic Stroke/drug therapy, Secondary Prevention, Drug Therapy, Combination, Platelet Aggregation Inhibitors/adverse effects, *Stroke/drug therapy, *Myocardial Infarction/drug therapy/epidemiology/prevention & control, Gastrointestinal Hemorrhage/chemically induced/epidemiology/prevention & control, Treatment Outcome
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