Effectiveness of cilostazol in transient ischemic attack refractory to aspirin: A report of two cases

Transient ischemic attack (TIA) is a warning of impending ischemic stroke. It provides an important therapeutic time window in which appropriate intervention may prevent permanent neurological injury. The anti-platelet agent, aspirin, is an option for reducing the risk of stroke following TIA. However, for patients who are not responsive to aspirin, cilostazol may be an effective treatment. The current study presents two cases of TIA that were refractory to aspirin but were successfully treated with cilostazol. In case 1, an 83-year-old female patient suffered from episodes of weakness and numbness of the left extremities. Aspirin alone or aspirin in combination with clopidogrel were not effective. Anticoagulation therapy with low molecular heparin decreased the frequency of ischemic episodes with complete remission following antiplatelet therapy with cilostazol. In case 2, a 51-year-old male presentedwith episodes of paroxysmal weakness of the left extremities with dysarthria. Antiplatelet therapy with aspirin was initiated. Eight episodes of ischemic attack recurred on the seventh day following admission. After the change of the antiplatelet agent to cilostazol, no ischemic episodes recurred, with the exception of three on the first day. This study suggested that cilostazol may be efficacious in the prevention of ischemic stoke following TIA of a non-cardiac origin that was not responsive to aspirin.